Lethal suicide attempt with a mixed-drug intoxication of metoprolol and propafenone − a first pediatric case report

Metoprolol, a commonly prescribed selective β1 adrenergic receptor blocker, is widely used to treat patients with various cardiovascular diseases. Blockade of the β1 receptor in the heart reduces the heart rate and myocardial contractility. It also blocks β-adrenergic receptors in the kidney and reduces plasma renin activity. Orally administered metoprolol is almost completely absorbed, although first-pass metabolism reduces its systemic availability by about 50%. Its lipophilicity and a low degree of binding to plasma proteins (about 12%) facilitate extensive distribution in and penetration into the central nervous system.

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