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We read Dr Burnakis' comments concerning our case report with interest. His point about propranolol not decreasing peripheral resistance is well taken. We are aware of the reported effects of propranolol and haloperidol that Dr Burnakis mentions in his letter. What is unique about our patient, we feel, is that she was treated with propranolol and haloperidol singly at different times without adverse effects, and only had the severe reactions we reported when she was given propranolol and haloperidol concurrently or in close temporal succession.Perhaps Dr Burnakis is correct in stating that our proposed mechanism is erroneous. We suspect that the patient in our case report has a genetic susceptibility to this drug combination and is unique in this respect. We do not suggest that this drug combination not be used, but we do advise caution.
Alexander HE, McCarty K, Giffen MB. Haloperidol and Propranolol in Combination-Reply. JAMA. 1985;253(11):1557–1558. doi:10.1001/jama.1985.03350350051009