Neither β2‐adrenoreceptor agonists nor β2‐adrenoreceptor antagonists are associated with altering the risk of Parkinson disease (PD), according to results of a population-based case-control study.

In order to determine the risk of PD associated with various β2‐adrenoreceptor drugs, the study authors assessed United States Medicare beneficiary data from 2009. They examined diagnosis codes, procedure codes, and prescription data to obtain a total of 48,295 incident PD cases and 52,324 control cases.

“We examined the risk of PD in relation to use of selected β antagonists (propranolol, carvedilol, metoprolol), the β2 agonist salbutamol, and other medications used for the same clinical indications (primidone, inhaled corticosteroids),” the authors explained. Demographics, smoking, and overall medical care use were adjusted for. “We then examined the effect of also adjusting for clinical indication and applying medication exposure lagging.”

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Results indicated that neither β2 agonists nor β2 antagonists were associated with an increase in PD risk. Although propranolol originally appeared to increase the risk of PD (OR: 3.62; 95% CI: 3.31, 3.96), the association was not statistically significant when adjusted for clinical indication (tremor, abnormal involuntary movement) and lagged medication exposure (OR: 0.97; 95% CI: 0.80, 1.18). Additionally, primidone was found to be similarly sensitive when adjusted for its clinical indication (tremor) and medication exposure lagging.

“β antagonists not indicated for tremor appeared to reduce PD risk (carvedilol OR=0.77, 95% CI 0.73–0.81; metoprolol OR=0.94, 95% CI 0.91–0.97) and were insensitive to adjustment for indications and lagging,” the authors reported. Finally, no association was found between PD risk and use of salbutamol or inhaled corticosteroids.      

According to this case-control study, β2 agonists and β2 antagonists do not increase the risk of PD. “Given the many complexities inherent in an analysis of β2 (ant)agonist medications and PD, we cannot completely rule out the possibility that there could be some effect of these medications, but it is clear that if any effect exists it is much smaller than previously reported,” concluded the authors.


Nielsen SS, Gross A, Camacho-Soto A, Willis AW, Racette BA. β2‐adrenoreceptor medications and risk of Parkinson disease. Annals of Neurology. 2018.