Shou wrote: "Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and the velocity and extent of myocardial contraction. Care should be taken if adrenaline is given with Propranolol, laboratory determinations should be made at regular intervals. Propranolol is a competitive antagonist which specifically competes with beta-adrenergic receptor stimulating agents for available beta-receptor sites. Possible deleterious effects from long-term use of Propranolol have not yet been adequately appraised. Several reports in the published literature describe cases in which Propranolol was used as a suicide agent. Treatment must always be initiated and individual titration of dosage carried out using the conventional tablets."
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