Propranolol

💊 What is Propranolol used for?

• •High blood pressure (hypertension), alone or with other blood pressure medicines, especially a thiazide diuretic
• •Chest pain from coronary artery disease (angina pectoris), to reduce how often it happens and improve exercise tolerance
• •Fast heart rate in atrial fibrillation, to control how fast the lower heart chambers beat
• •Reducing cardiovascular death in people who have survived the acute phase of a heart attack and are clinically stable
• •Preventing common migraine headaches (the label says it is not meant to treat a migraine that has already started)
• •Familial or hereditary essential tremor, where it reduces the size of the shaking but not how fast it shakes
• •Improving symptoms in certain patients with hypertrophic subaortic stenosis
• •Helping control blood pressure and reducing symptoms of catecholamine-secreting tumors (pheochromocytoma), used together with alpha-blockade

How it works

The label describes propranolol as a beta-adrenergic receptor blocker. It blocks beta receptors, which are involved in heart rate, the force of heart contractions, and the widening of airways and blood vessels. The label notes that it is not indicated for tremor caused by Parkinsonism.

How it is usually taken

• •The label says the dose should be individualized based on how the patient responds, so the amount and timing are set by the prescriber. Propranolol is taken by mouth in divided doses through the day. For some uses the label describes taking it before meals and at bedtime. The label says blood pressure response can take anywhere from a few days to several weeks. If treatment is to be stopped, the label says the dose should be reduced gradually over several weeks. Follow the instructions from your prescriber or pharmacist.

Comes as

• •Tablets: 10 mg (orange, round), 20 mg (blue, round), 40 mg (green, round), 60 mg (pink, round), and 80 mg (yellow, round)
• •Each tablet also contains lactose anhydrous, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate

⚠️ Propranolol side effects

🛑 Who should not take Propranolol, and who should be careful

The label says not to take it if

• 🚨You have cardiogenic shock
• 🚨You have a slow heart rate (sinus bradycardia) or a heart block greater than first degree
• 🚨You have bronchial asthma
• 🚨You have a known allergy or hypersensitivity to propranolol hydrochloride

Tell your doctor before taking it if

• •Tell your prescriber about all your medical conditions, especially bronchial asthma, bronchospastic lung disease such as chronic bronchitis or emphysema, heart failure, a slow heart rate, heart block, Wolff-Parkinson-White syndrome, diabetes (including use of insulin), kidney problems, or a thyroid condition.
• •The label says a tumor called pheochromocytoma can be treated with propranolol, but blocking only part of epinephrine's effect can leave its constricting effect unopposed, so this condition needs careful medical oversight.
• •Tell your surgeon or anesthesia team that you take propranolol. The label says it should not be routinely stopped before major surgery, but the heart's reduced ability to respond may raise anesthesia risks.
• •Do not stop propranolol suddenly. The label says the dose should be gradually reduced over at least a few weeks if it is being stopped.
• •Tell your prescriber if you have a history of allergic reactions, since the label warns about hypersensitivity and skin reactions.
• •Tell your prescriber about all other medicines you take, including heart, blood pressure, and clonidine medicines, because the label describes many interactions.

🔀 Propranolol with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Other heart rhythm medicines such as propafenone, quinidine, and amiodarone, which can add to the beta-blocking effect or raise propranolol levels
• •Lidocaine, because propranolol reduces how fast it is cleared and lidocaine toxicity has been reported
• •Digitalis glycosides (such as digoxin), which can increase the risk of a slow heart rate when used together
• •Calcium channel blockers such as verapamil and diltiazem, which have been linked to slow heart rate, low blood pressure, heart block, and heart failure when used with beta-blockers
• •ACE inhibitors, which can cause low blood pressure when combined with beta-blockers, especially during a heart attack
• •Clonidine, whose blood-pressure-lowering effect may be reduced by beta-blockers; the label says propranolol should be used cautiously in patients withdrawing from clonidine
• •Alpha-blockers such as prazosin, terazosin, and doxazosin, which can cause low blood pressure when taken with beta-blockers
• •Insulin and other diabetes medicines, because propranolol can hide some warning signs of low blood sugar
• •Medicines that affect the CYP2D6, 1A2, or 2C19 pathways, which the label says may change how propranolol works or its side effects

Alcohol and food

The label does not say.

🤰 Propranolol in pregnancy and breastfeeding

Pregnancy

The label says there are no adequate and well-controlled studies in pregnant women. It reports intrauterine growth retardation, small placentas, and congenital abnormalities in babies whose mothers took propranolol during pregnancy. Newborns exposed at delivery have shown slow heart rate, low blood sugar, and breathing depression. The label says propranolol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Breastfeeding

The label says propranolol is excreted in human milk and that caution should be used when it is given to a nursing woman.

🗓️ Storage, missed doses and taking too much

Storage

The label does not say.

If a dose is missed

The label does not say.

If too much is taken

The label says propranolol is not significantly dialyzable. For an overdose or exaggerated response, it describes emptying the stomach if the ingestion was recent, while taking care to prevent aspiration into the lungs. It notes that low blood pressure and slow heart rate can occur and should be treated, and mentions glucagon as a possible treatment. Anyone who may have taken too much should get emergency medical help right away.

🗒️ Questions to ask about Propranolol

• Why am I being prescribed propranolol instead of another blood pressure or heart medicine?
• How long will it take before I notice the effect on my blood pressure, chest pain, or tremor?
• What should I do if I want to stop taking propranolol, given the label's warning about angina and heart attack?
• Could propranolol hide the signs of low blood sugar, and how should I monitor for them?
• Is it safe for me to drive or do activities that need alertness, given the dizziness and tiredness listed in the label?
• Which of my other medicines could interact with propranolol?
• If I have asthma or COPD, is propranolol still an option for me?

❓ Propranolol: frequently asked questions