A Blackpool coroner has urged NICE to review its guidance on the beta blocker propranolol as he published a report on the inquest into a 17-year-old girl’s death in October last year. 

Senior coroner Anthony Wilson wrote that teenager Imogen Heap had died after consuming a “very high quantity” of propranolol as well as smaller amounts of paracetamol and prescribed fluoxetine at around 4pm on October 31, 2023. 

Imogen had taken the overdose “with a view to ending her life” but then asked for help, with an ambulance arriving close to 8pm due to pressures on the service. 

While in hospital, Imogen suffered severe effects from the overdose including seizures, and despite intubation and advance life support died on the afternoon of November 2, 2023 after going into cardiac arrest. 

The coroner wrote: “Within a period of around 2.5 hours of beginning to ingest [the propranolol], she decided to telephone for help, but by that time the extent of the overdose was going to prove fatal.” 

The drug can “rapidly cause significant chemical damage to the heart” when consumed in large quantities, he said. 

The inquest heard that propranolol is widely prescribed and “often to relatively young people reporting symptoms of anxiety” and that “there can be an under-appreciation of how toxic an elevated level of propranolol medication can be”. 

Mr Wilson urged NICE to heed the warning of a report issued in February 2020 which warned of the “under-recognised” toxicity of propranolol when used in an overdose and recommended that NICE review its guidance on the use of the medicine to treat anxiety and migraine. 

While the online NICE guidance makes reference to the concerns raised in the 2020 report, Mr Wilson said that in the wake of Imogen's death he was "confident" there should be renewed attention on the issue. 

“That report noted that it had been felt that for some time there had been a steady rise in the number of propranolol prescriptions issued to NHS patients and about the number of deaths reported being linked to propranolol overdose,” he said. 

The report was also circulated to the Royal College of General Practitioners, NHS England and the Association of Ambulance Chief Executives, as well as Imogen’s family. 

NICE is required to respond to the coroner’s report by next January 3.