Propranolol | Side Effects, Dosage, Uses & More
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Propranolol, Oral Tablet

Important Information

  • Warning for stopping treatment: Don’t stop taking this medicine without talking to your doctor first. Stopping propranolol suddenly can cause changes in your heart rhythm and blood pressure, worse chest pain, or a heart attack. Your doctor will slowly lower your dose over several week to help prevent these effects.
  • Drowsiness warning: This drug can cause drowsiness. Don’t drive, operate machinery, or perform any activities that require alertness until you know how this medicine affects you.
  • Diabetes warning: Propranolol can cause low blood sugar (hypoglycemia). It may also mask the signs of low blood sugar, such as higher than normal heart rate, sweating, and shakiness. This medicine should be used with caution if you have diabetes, especially if you take insulin or other diabetes drugs that can cause low blood sugar. This drug may also cause low blood sugar in infants, children, and adults who don’t have diabetes. This is more likely after periods of long exercise or if you have kidney problems.
  • Asthma warning: If you have asthma or similar breathing problems, don’t take propranolol. It can make your asthma worse.

Drug Features

Propranolol is a prescription drug. It’s available in these forms: oral tablet, oral extended-release capsule, and oral solution.

Propranolol is available in its generic form. Generic drugs usually cost less. In some cases they may not be available in every strength or form as the brand. Talk to your healthcare provider to see if the generic will work for you.

This drug may be used with other medicines that control blood pressure or decrease symptoms of tumor in the adrenal gland.

Why It's Used

Propranolol reduces the workload on the heart and helps it to beat more regularly. It’s used to treat high blood pressure, control heart rhythm, relieve chest pain (caused by angina), prevent migraines, reduce shaking or tremor, and help with medical conditions involving your thyroid and adrenal glands. Propranolol may also be helpful if you’ve had a heart attack.

How It Works

Propranolol belongs to a class of drugs called beta blockers. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

Propranolol is a non-selective beta receptor blocking agent. This means it works similarly on the heart, lungs, and other areas of the body.

The way that this drug works to lower blood pressure is not clearly understood. It reduces the workload of the heart and blocks the release of a substance called renin from the kidneys.

The beta blocking properties help to control heart rhythm, delay the start of chest pain, prevent migraines, and reduce tremors. It isn’t fully understood how this drug works to treat these problems.

Propranolol Side Effects

More Common Side Effects

The most common side effects of propranolol are:

  • slower heart rate
  • change in sex drive or performance
  • diarrhea
  • dry eyes
  • hair loss
  • nausea
  • weakness or tiredness

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • allergic reactions. Symptoms may include:
    • skin rash
    • itching
    • hives
    • swelling of your face, lips, or tongue
  • breathing problems
  • changes in blood sugar
  • cold hands or feet
  • difficulty sleeping or nightmares
  • dry, peeling skin
  • hallucinations
  • muscle cramps or weakness
  • slow heart rate
  • swelling of your legs or ankles
  • sudden weight gain
  • vomiting

Propranolol May Interact with Other Medications

Propranolol can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol Interaction

Alcohol can increase levels of propranolol in your body. This can cause more side effects. You shouldn’t drink alcohol while taking this drug.

Medications That Might Interact with This Drug

Medicines to treat heart rhythm problems

Examples are:

  • amiodarone
  • bretylium
  • quinidine
  • disopyramide
  • encainide
  • moricizine
  • flecainide
  • propafenone
  • procainamide
  • digoxin

Use caution if you’re taking these medications together. Taking drugs that treat heart rhythm problems with propranolol may cause more side effects. These include lower heart rate, lower blood pressure, or heart blockage.

Blood pressure medicine

  • clonidine

If you’re switching from clonidine to propranolol, your dose of clonidine should slowly be reduced and propranolol should slowly be increased over several days. This is done to avoid side effects, such as lower blood pressure.

Blood pressure medicines (beta blockers)

Examples are:

  • acebutolol (Sectral)
  • atenolol (Tenormin)
  • bisoprolol (Zebeta)
  • carteolol (Cartrol)
  • esmolol (Brevibloc)
  • metoprolol (Lopressor, Toprol XL)
  • nadolol (Corgard)
  • nebivolol (Bystolic)
  • sotalol

Don’t use propranolol with another beta blocker. It can lower your heart rate too much.

Blood pressure medicines (ACE inhibitors)

Examples are:

  • lisinopril
  • enalapril 

Use caution if you’re taking ACE inhibitors with propranolol. Taking these drugs together can cause lower than normal blood pressure.

Blood pressure medicines (calcium channel blockers)

  • diltiazem

Use caution if you’re taking this medicine with propranolol. Using these drugs together can cause severely low heart rate, heart failure, and heart blockage.

Blood pressure medicines (alpha blockers)

Examples are:

  • prazosin
  • terazosin
  • doxazosin

Use caution if you’re taking these medicines with propranolol. They may cause lower than normal blood pressure, fainting, or lower than normal blood pressure after standing up too fast.

Medicines that block sensation (anesthetics)

Examples are:

  • lidocaine
  • bupivacaine
  • mepivicaine

Use caution if you’re taking these medications with propranolol. Propranolol might affect how these medications are cleared from your body and may cause toxicity. Your doctor may check your blood levels of these drugs if you take them with propranolol.

Medicine to treat malaria

  • mefloquine 

Use caution if you’re taking mefloquine with propranolol. Using these medicines together can cause heart rhythm problems and stop your heart from working properly. 

Medicines used to increase heart rate and blood pressure

Examples are: 

  • epinephrine
  • dobutamine
  • isoproterenol

Don’t use these medicines with propranolol. These drugs cancel out the action of one another. This means that neither of them will work.

Crizotinib

Avoid using this medicine with propranolol because it can lower your heart rate. 

Phenothiazines

Caution should be used if you’re taking these drugs with propranolol. Phenothiazines may reduce how long it takes propranolol to leave your body. This may cause more side effects.

Asthma drugs

Examples are: 

  • theophylline
  • aminophylline

You shouldn’t take these medicines with propranolol. Propranolol can reduce how long it takes these drugs to clear from your body. This can increase your risk for side effects.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Examples are:

  • diclofenac (Cataflam)
  • etodolac
  • fenoprofen (Nalfon)
  • flurbiprofen
  • ibuprofen (Motrin)
  • indomethacin (Indocin)
  • ketoprofen
  • ketorolac (Sprix, Toradol)
  • meclofenamate
  • mefenamic acid (Ponstel)
  • meloxicam (Mobic)
  • nabumetone
  • naproxen (Naprosyn)
  • oxaprozin (Daypro)
  • piroxicam (Feldene)
  • sulindac (Clinoral)
  • tolmetin

These medicines may decrease the blood pressure lowering effects of propranolol. Your blood pressure should be monitored and your propranolol dose may need to be changed if you take these drugs.

Blood thinner

  • warfarin

Propranolol can increase the amount of warfarin in your body. This may cause an increase in your bleeding time. Your warfarin dose may need to be changed if you take propranolol.

Medicine to treat stomach ulcers

  • cimetidine

Cimetidine can increase the levels of propranolol in your blood. This can cause more side effects.

Antacids with aluminum hydroxide

These drugs may decrease the effectiveness of propranolol. Your doctor will need to monitor you and may need to change your dose of propranolol.

Propranolol Warnings

  • People with cardiogenic shock: If you have this condition, don’t use propranolol. Because propranolol reduces the force of your heartbeat, it could make this condition much worse.
  • People with slower than normal heart rate: If you have this condition, you shouldn’t use propranolol. This drug can slow down your heart rate even more, which could be dangerous.
  • People with higher than first degree heart block: If you have this condition, you shouldn’t use propranolol. Propranolol reduces the force of your heartbeat, which could make your heart block worse.
  • People with asthma: If you have this condition, you shouldn’t use propranolol. This drug can make your asthma worse.
  • People with severe chest pain: Suddenly stopping propranolol can worsen your chest pain.
  • People with heart failure: You shouldn’t take this drug if you have heart failure. Because propranolol reduces the force of your heart beat, it could make your heart failure worse. Propranolol may be helpful if you have a history of heart failure, are taking heart failure medications, and are being closely monitored by your doctor.
  • People with Wolff-Parkinson-White Syndrome: This medical condition can cause lower than normal heart rate. Treatment of this medical condition with propranolol may reduce blood pressure too much. Treatment with a pacemaker may be needed.
  • People with diabetes: Propranolol can cause low blood sugar (hypoglycemia). It may also mask the signs of low blood sugar, such as higher than normal heart rate, sweating, and shakiness. This medicine should be used with caution if you have diabetes, especially if you take insulin or other diabetes drugs that can cause low blood sugar.
  • People with hyperactive thyroid: Propranolol can mask the symptoms of a hyperactive thyroid (hyperthyroidism), such as higher than normal heart rate. If you suddenly stop taking propranolol and have hyperthyroidism, your symptoms can get worse, or you may get a condition called thyroid storm.
  • People with chronic bronchitis or emphysema: In general, if you have problems breathing, you shouldn’t take propranolol. It can make your lung condition worse.
  • People who plan to have major surgery: If you’re going to have surgery, tell your doctor that you’re taking propranolol. This drug can change how your heart reacts to general anesthesia and surgery.
  • People with glaucoma: Propranolol tablets and liquid may decrease the pressure in your eyes. This may make it difficult to tell if your medicines for glaucoma are working. When you stop taking propranolol, the pressure in your eyes may increase.
  • People with allergies: If you have had severe allergic reactions that cause anaphylaxis, your allergies may get worse when you take propranolol. Your usual doses of the allergy medicine epinephrine may not work as well. Propranolol may block some of the effect of epinephrine.
  • People with uncontrolled bleeding or shock: If you have hemorrhage or shock, a serious problem where your organs don’t get enough blood, medicines may not work as well to treat these conditions if you’re taking propranolol. This is especially true if you’re taking propranolol to treat pheochromocytoma, a tumor in your adrenal gland.
  • Pregnant women: Propranolol is a category C pregnancy drug. That means two things:
    1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
    2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.
    Tell your doctor if you’re pregnant or plan to become pregnant. Propranolol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
  • Women who are breast-feeding: Propranolol is passed through breast milk. The drug may be used while you’re breastfeeding, but your baby should be monitored. In your baby, propranolol may cause lower heart rate, low blood sugar, and decreased oxygen in the blood that can cause blue color in your baby’s skin, lips, or nails (cyanosis).
  • For Seniors: Seniors might have decreased liver, kidney, and heart function and other medical conditions. Your doctor will take these factors and the medications that you’re taking into account when starting you on propranolol.
  • For Children: The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined. There have been reports of heart failure and airway spasms in children who have taken this drug.
  • Contact with drug: Don’t share this medicine with others, even if they have the same medical problems. It may cause serious side effects.
  • When to call the doctor: Tell your doctor if you have a cough, cold, allergies, or pain. Your doctor or pharmacist will help you find medicines that can be safely used with propranolol. Tell your doctor or surgeon if you’re going to have surgery. They will monitor your heart and blood pressure and watch for drug interactions with propranolol.
  • Allergies: Propranolol can cause a severe allergic reaction. Symptoms may include:
    • rash
    • hives
    • wheezing
    • difficulty breathing
    • swelling of the mouth, face, lips, tongue, or throat
    Don’t take propranolol if you’ve ever had an allergic reaction to it. Taking it again could be fatal. If you’ve had severe allergic reactions causing anaphylaxis, your allergies may be more reactive when you take propranolol. The usual doses of your allergy medicine, epinephrine, may not work as well while you take this drug. Propranolol may block some of epinephrine’s effect.

How to Take Propranolol (Dosage)

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What Are You Taking This Medication For?

Fast heart rate (atrial fibrillation)

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)
The recommended dose is 10–30 mg taken 3–4 times per day, before meals and at bedtime.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

High blood pressure (hypertension)

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)

  • The starting dose is 40 mg taken twice per day.
  • It’s given alone or with other medicines that treat low blood pressure.
  • Your dose may be slowly increased.
  • The usual maintenance dose is 120–240 mg per day given in 2–3 divided doses. Doses up to 640 mg per day have been given in some cases.
  • It may take a few days to several weeks for this drug to fully work.
  • If you’re taking a low dose twice per day and your blood pressure isn’t controlled, your doctor may increase your dose or tell you to take the drug three times a day.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Chest pain

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)

  • The total dose per day is 80–320 mg. You’ll take this total amount in divided doses 2–4 times per day.
  • If you’re going to stop propranolol, your doctor will tell you how to do it slowly over several days to weeks to avoid side effects.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Heart attack

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)

  • The starting dose is 40 mg taken 3 times per day.
  • After 1 month, your dose may be increased to 60–80 mg taken 3 times per day.
  • The recommended total dose per day is 180–240 mg. This is divided into smaller, equal doses and taken three times per day.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Hypertrophic subaortic stenosis

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)
The usual dose is 20–40 mg taken 3–4 times per day, before meals and at bedtime.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Migraine

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)

  • The starting total dose per day is 80 mg. You’ll take this amount in smaller, equal doses several times during the day.
  • The usual total dose per day is 160–240 mg.
  • If the maximum effective dose isn’t helping your migraines after 4–6 weeks of therapy, your doctor may decide to take you off the medication. Your dose or how often you take the drug may be slowly reduced over several weeks to avoid side effects from stopping too quickly.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Essential tremor

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)

  • The starting dose is 40 mg taken twice per day.
  • You may need to take a total dose of 120 mg per day.
  • In some cases, it may be necessary to take 240–320 mg per day.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Tumor in the adrenal gland (pheochromocytoma)

Form: Oral tablet
Strengths: 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg

Adult Dosage (ages 18 years and older)

  • The usual dose is 60 mg per day taken in divided doses starting 3 days before your surgery.
  • You’ll take this drug with other medicines. Propranolol isn’t used alone to treat pheochromocytoma.
  • If the surgery can’t be done for the tumor, the usual dose is 30 mg per day taken in divided doses with other medicines.

Child Dosage (ages 0-17 years)
The safety and effectiveness of propranolol in people younger than 18 years old haven’t been determined.

Special Considerations

  • Kidney problems: If you have kidney problems, use caution when taking this drug.
  • Liver problems: If you have liver problems, use caution when taking this drug.

Important Considerations for Taking Propranolol

  • Take this drug before meals
  • Take propranolol before meals and at bedtime
  • You can cut or crush the tablet
  • Store tablets between 59°F to 86°F (15°C to 30°C) and protect them from light. Protect this drug from very cold and very hot temperatures. Keep this drug out of the reach of children. Store this drug away from moist environments, such as bathrooms and other damp locations.
  • This prescription is refillable
  • When traveling with your medication:
    • Always carry your medication with you or in your carry-on bag.
    • Don’t worry about airport X-ray machines. They can’t hurt this medication.
    • You may need to show your pharmacy’s preprinted label to clearly identify the medication.
    • Keep the original prescription label with you when traveling.
  • While you’re taking propranolol you’ll need to monitor your:
    • blood pressure
    • heart rate
    • blood sugar, if you have diabetes
  • While you’re taking this drug, your doctor will periodically do blood tests to check your:
    • electrolyte levels
    • heart function
    • liver function
    • kidney function
  • The generic is usually stocked at pharmacies. The brand name products might not be stocked, so call ahead.
  • Insurance: The generic doesn’t need a prior authorization. The brand name product might need a prior authorization.

Are There Any Alternatives?

There are several medications in this class as well as other medicines that can be used to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.

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