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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

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Original poster

To not go to A&E?

38 replies

schwaneverstressed · 17/12/2021 21:47

NH 24 have fair put the frighteners on me.

I take propranolol 3 x a day (40mg) for anxiety and associated palpitations . Running out this weekend, I’m convinced I had 3 left for Saturday but there’s only two in the pack, which suggests I accidentally took a fourth one tonight . The pack says doses of up to 320mg a day can be prescribed safely to some people . I weigh 140kg (yes, I’m aware that’s way too much) . I suspect what I’ve taken falls within safe limits .

Rang NHS 24 to check and the nurse said I’m at high risk of coma, seizures, sudden collapse, and said make my way to A&E asap for monitoring .

The thing is I’m a full time carer to my mum, and I cannot leave her alone at all, she needs 24 hour care just now and we don’t have carers coming in as waiting on a package being set up . A&E is 30 miles away, would cost £60 in a taxi there and £60 back - I can’t afford that ..!!

They said I wouldn’t be able to take Mum with me either due to covid .

So nurse has said to sit awake as long as I can, at least 4-6 more hours, check pulse rate regularly and phone 999 if I become unwell, and said several times she was concerned I might collapse - wouldn’t even put it for a GP to call back as said ‘you might be seriously ill by then’ .

I don’t know what to do . Mum is rural, she doesn’t know her neighbours . No family nearby . AIB stupid not to go to A&E? My pulse is regular, 85-88 and apart from being a bit dizzy on standing I feel mostly OK .

Would you sit it out? Online says propranolol is severely toxic in overdose but then the pack says I’ve taken a normal therapeutic dose (admittedly for someone with angina and not anxiety…)

OP posts:
Bagamoyo1 · 17/12/2021 21:50

I wouldn’t go to A&E in that situation .

Tee20x · 17/12/2021 21:51

I don't have any experience with this medication but from what you've said it sounds ok? Yes you've technically overdosed but from what you've said it doesn't sound as if it's by that much & like you said still within therapeutic dosage (admittedly just not for the reason it was prescribed to you).

Personally I'd sit and wait it out - but up to you all the same.

georgarina · 17/12/2021 21:54

Don't ever want to tell someone to do something dangerous so by all means go if they tell you

But I had a severe public speaking phobia in high school and was prescribed 40mg propranolol, GP basically told me they were harmless so I was taking them like sweets before presentations and I was fine.

As I said though maybe I was just lucky...I wouldn't be concerned taking one extra 40mg but of course it's a risk...

ShirleyPhallus · 17/12/2021 21:54

I also wouldn’t go to A&E for this. Did you tell the nurse your weight? Presumably you can safely take a larger dose because of that anyway?

Original poster
schwaneverstressed · 17/12/2021 21:59

@ShirleyPhallus

I also wouldn’t go to A&E for this. Did you tell the nurse your weight? Presumably you can safely take a larger dose because of that anyway?
I did yes, she said doesn’t matter as they go for a maximum weight for most tablets - said she had to check it on database (toxbase) and said couldn’t find enough evidence to suggest it would be safe .

BNF says even for benign tremor you can take up to 4 a day safely . I do take an anti depressant and have had 1mg diazepam today (anxiety is severe right now) however the diazepam was at 1pm, and the anti depressant I’ve always been told won’t interact with the beta blocker .

OP posts:
SleepyRich · 17/12/2021 22:05

A discussion with GP or similar sounds quite sensible regards any potential risks of this accidental overdose.

You've probably already found it but the BNF guide used by Doctors in prescribing can be found here:

bnf.nice.org.uk/drug/propranolol-hydrochloride.html

Only you know how you feel, and it's your risk to take. As you say the adult dosage of this medication is sometimes prescribed at 40mgx4,(or quite a bit more) a day. It's a medication you're used to taking, you report feeling well with a normal pulse. Peak concentration occurs 1-2hours after indigestion with a half life of 3-6hours.

If it was me I wouldn't worry, but then I'm just a random guy on the Internet so not a reliable source for medical information.

lillylemons · 17/12/2021 22:08

When I called 111 I was told to go a&e because I took 1 to many paracetamol the lady on the phone was telling me I could become really ill. I refused to go has it was just one paracetamol and I'd taken way more in the past and live to tell the tail.
Not sure I trust their advice now after them telling me to go in for 1 paracetamol.

VictoryLap · 17/12/2021 22:11

@lillylemons

When I called 111 I was told to go a&e because I took 1 to many paracetamol the lady on the phone was telling me I could become really ill. I refused to go has it was just one paracetamol and I'd taken way more in the past and live to tell the tail. Not sure I trust their advice now after them telling me to go in for 1 paracetamol.
Why did you call them on this occasion if you'd taken more than this before? Paracetamol is extremely dangerous to overdose on.
GreenLunchBox · 17/12/2021 22:12

Was she really a nurse?!Confused

That's nowhere near a toxic dose. Why did you phone 111... you should have just spoken to a pharmacist

VictoryLap · 17/12/2021 22:12

OP sometimes a pharmacist is your best bet for these types of questions - do you have a late night one nearby?

NovemberNovemberDarkNights · 17/12/2021 22:14

Oh you poor thing, it's scary isn't it.

But firstly are you absolutely sure about how many you had to start with?

Could you have dropped one or knocked it under something?

If people are prescribed 320mg and you think you may have taken 4x40=160mg

I think I'm missing the problem?!

Unless it's the earlier drugs...?

SleepyRich · 17/12/2021 22:17

Propranolol can be a very dangerous drug to overdose on a can easily be fatal - this would only be seen in deliberate overdoses (i.e. 50+ 40mg tablets, this is for fatal however you can get some nasty side effects with less). In order for a Doctor to consider whether you were safe they'd need to consider all your medications as some other medications can cause a similar effect on the heart (prolonging the time it takes for the heart cells to recharge after contraction, the QT interval), as well as whether you have any heart disease. In addition to this there would be concerns whether you're not giving the full story, perhaps concealing a deliberate overdose. They don't know you, have limited access to your medical info, they might reasonably want to see you/garner a full set of obs...

I do think the nurse you spoke with could have referred you on to a GP for their opinion though when you told them that you disagreed with the A&E plan!

Calmdown14 · 17/12/2021 22:17

They have to advise based on potential risk. They can't tell you it will be fine however small the chance is that it won't.
I would probably think like you are..is there anyone you can ask to phone you in an hour or so just to check you are fine? And so someone knows if not

rocky1914 · 17/12/2021 22:18

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AntiHop · 17/12/2021 22:22

There should be a late night pharmacy somewhere that you can call.

Original poster
schwaneverstressed · 17/12/2021 22:23

@SleepyRich

Propranolol can be a very dangerous drug to overdose on a can easily be fatal - this would only be seen in deliberate overdoses (i.e. 50+ 40mg tablets, this is for fatal however you can get some nasty side effects with less). In order for a Doctor to consider whether you were safe they'd need to consider all your medications as some other medications can cause a similar effect on the heart (prolonging the time it takes for the heart cells to recharge after contraction, the QT interval), as well as whether you have any heart disease. In addition to this there would be concerns whether you're not giving the full story, perhaps concealing a deliberate overdose. They don't know you, have limited access to your medical info, they might reasonably want to see you/garner a full set of obs...

I do think the nurse you spoke with could have referred you on to a GP for their opinion though when you told them that you disagreed with the A&E plan!

Aye I wondered if they weren’t trusting the accidental part as my mental health has been more that a bit skewiff lately, but this is definitely just a mistake .

I thought that too, no reason they couldn’t have got a GP to ring .

RE QT interval (unfortunately this is all stuff I’ve googled before, as get health anxiety badly), only minor risk of that is the mirtazapine which was normal dose and not thought to be all that toxic anyway .

No history of heart disease at all other than benign ectopics .

I am wondering that, if I dropped it or just miscounted in the first place . My HR is still up at 86ish (which is slightly higher than my normal, normally my HR is 75 with propranolol) . I’d have thought if I’d taken two my HR would be a bit lower than usual !!

OP posts:
Hermanfromguesswho · 17/12/2021 22:24

I take 160mg every day and know an awful lot of other people who do too. It’s a standard dose for migraine prevention

SleepyRich · 17/12/2021 22:28

Do you take them at once or intervals through the day? When was last dose or when do you think OD occurred?

Yellowcar2 · 17/12/2021 22:31

I don't understand why you would bother calling if you are just going to ignore what they say. If you don't think it's that serious why call in the first place?
No one here should really be giving advice on this, who knows hiw you are going to react. You could be absolutely fine you might get seriously ill.

MyComputerGetsSadWithoutMe · 17/12/2021 22:33

I've accidentally taken 5 of the 40mg propranolol before OP, just keep an eye on yourself Thanks

Original poster
schwaneverstressed · 17/12/2021 22:34

@SleepyRich

Do you take them at once or intervals through the day? When was last dose or when do you think OD occurred?
Intervals so one at about 11am this morning, another about 3-4pm coming back from being in town and then another at 8pm . To be honest I’ve no idea if/when the fourth one was taken, could have been any time, if indeed I took an extra one at all .
OP posts:
whynotwhatknot · 17/12/2021 22:34

if you dont want to physically go anywhere why did you ring-they cant give you anything over the phone other that to advice to be checked

RavingAnnie · 17/12/2021 22:34

I err on the side of caution with health related things and I think the nurse is being massively overdramatise. As others have said the amount you have take us within the realms of normal dose and your heart rate is fine. I'd disregard and just continue as normal.

i take slow release beta blockers. It's 80mg once or twice a day and I was on 160mg a day for months.

They are much better than the ones you have to take multiple times a day btw. Firstly because it's easy to forget to take so many tablets everyday and secondly because they have a nice even effect throughout the day rather having peaks and troughs of symptoms throughout the day as the instant release meds wear off and take effect again.

Confuzzlediddled · 17/12/2021 22:35

My DH takes 4 X 40mg a day for migraine prevention, I'm loathe to try and give medical advice but i think they're being a bit overzealous

Slabadabbadooby · 17/12/2021 22:37

I wouldn't go to a&e for (potentially) taking one extra tablet, especially after you've read that dose is prescribed for people with other conditions. I'd only go if I started to experience some kind of adverse effect. If very worried, I'd stay up for a few hours watching TV until I reached the point I felt assured that anything bad would have happened by now, then go to bed.

My feeling is that if you've taken a dose you know others are prescribed, you have a history of taking this medication at a lower dose and haven't had any issues with it, and you are slightly overweight, then I think you don't need to worry op.

The 111 service seems to operate on a very worst case scenario sort of basis, and I can understand why they might have to but it probably does our a&e no good.