• Basic Info
• Top Questions
• Clinical Info
• Interactions

What is propranolol?
Propranolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). Propranolol is used to treat tremors, angina (chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack, and to reduce the severity and frequency of migraine headaches. Propranolol may also be used for other purposes not listed in this medication guide.

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What is the price of this medication and similar alternatives?

This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.

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What are the possible side effects of propranolol?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• fast, slow, or uneven heartbeats;

• feeling light-headed, fainting;

• feeling short of breath, even with mild exertion;

• swelling of your ankles or feet;

• fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;

• nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• depression, confusion, hallucinations; or

• cold feeling in your hands and feet.

Less serious side effects may include:

• nausea, vomiting, diarrhea, constipation, stomach cramps;

• decreased sex drive, impotence, or difficulty having an orgasm;

• sleep problems (insomnia); or

• tired feeling.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

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How should I take propranolol?
Take propranolol exactly as it was prescribed for you. Do not take the medication in larger amounts or for longer than recommended by your doctor. Follow the directions on your prescription label. Take this medication with a full glass of water. Take propranolol at the same time every day. Do not crush, chew, break, or open an extended-release capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

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What is the most important information I should know about propranolol?
You should not use this medication if you are allergic to propranolol, or if you have asthma or certain heart conditions, especially second or third degree heart block. Do not stop taking propranolol without first talking to your doctor. Stopping suddenly may make your condition worse. If you need to have any type of surgery, you may need to temporarily stop using propranolol. Be sure the surgeon knows ahead of time that you are using propranolol. Avoid drinking alcohol. It may increase your blood levels of propranolol.

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What happens if I miss a dose?
For regular (short-acting) propranolol: Take the missed dose as soon as you remember. If your next dose is less than 4 hours away, skip the missed dose and take the medicine at the next regularly scheduled time. For extended-release propranolol (Inderal LA, InnoPran XL and others): Take the missed dose as soon as you remember. If your next dose is less than 8 hours away, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

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What other drugs will affect propranolol?
Tell your doctor about all other medications you use, especially: clonidine (Catapres); digitalis (digoxin, Lanoxin); dobutamine (Dobutrex); haloperidol (Haldol); isoproterenol (Isuprel); a blood thinner such as warfarin (Coumadin); an antidepressant such as amitriptyline (Elavil, Etrafon), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Janimine, Tofranil), and others; an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate);

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Can I take this if I am pregnant or trying to get pregnant or if I am breastfeeding?

Propranolol has been assigned to pregnancy category C by the FDA. Some animal studies using high doses have revealed evidence of embryotoxicity. There are no controlled data in human pregnancy. Propranolol has been given during pregnancy to treat both maternal and fetal conditions without evidence of teratogenicity. However, fetal and neonatal adverse effects are reported and should be monitored. Propranolol should only be given during pregnancy when benefit outweighs risk.

Propranolol has been used safely to treat a variety of conditions during pregnancy, including hypertension and pheochromocytoma in the mother, and tachyarrhythmias in both the mother and fetus. There are a number of abnormalities associated with the use of propranolol during pregnancy, but many of these may be attributable to underlying diseases. These abnormalities include some signs and symptoms of beta-blockade, such as bradycardia, hypoglycemia, and respiratory depression. Other abnormalities that may be due to propranolol include intrauterine growth retardation, small placentas, polycythemia, thrombocytopenia, and hypocalcemia. Structural anomalies associated with propranolol are rare, and have been reported when propranolol was used with a possible teratogen, such as an angiotensin converting enzyme inhibitor, or in the case of significant underlying maternal diseases. In short, propranolol does not appear to be teratogenic, but maternal and fetal propranolol toxicity may occur. For this reason, it is recommended that neonates of mothers who are receiving propranolol be observed for at least 48 hours for signs and symptoms of toxicity, such as bradycardia, hypotension, and hypoglycemia. Data from the Michigan Medicaid Birth Defects study failed to reveal an association between the use of propranolol and congenital abnormalities (written communication, Franz Rosa, MD, Food and Drug Administration, 1994). This was a retrospective study of 229,101 completed pregnancies between 1985 and 1992, of which 274 were exposed to propranolol at some time during the first trimester and 470 were exposed to the drug at any time during pregnancy. Eleven total and 3 cardiovascular defects were observed (12 and 3 were expected, respectively). There were two cases of hypospadias. The incidence of birth defects did not achieve statistical significance. These data do not support an association between propranolol and birth defects. Incidentally, the pharmacokinetics of propranolol do not appear to be altered during pregnancy.

Propranolol is excreted into human milk. Adverse effects in the nursing infant are not reported, and are unlikely. The manufacturer recommends caution be used when administering propranolol to nursing women.

Propranolol milk to maternal plasma ratios as high as 1.5 are reported. While no adverse effects in the nursing infant are reported, experts advise monitoring the infant for signs and symptoms of beta-blockade and to schedule feedings at least three hours after maternal propranolol administration.

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Who should NOT use this medication?

• Sinus bradycardia.
• Heart block greater than first degree.
• Cardiogenic shock.
• CHF (unless secondary to a tachyarrhythmia treatable with propranolol). (See Cardiac Failure under Cautions.)
• Raynaud’s syndrome.
• Malignant hypertension.
• Bronchial asthma. (See Bronchospastic Disease under Cautions.)
• Concomitant thioridazine therapy. (See Specific Drugs under Interactions.)
• Pre-excited atrial fibrillation or flutter.

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What happens if I overdose?
Seek emergency medical attention if you think you have used too much of this medicine. Overdose symptoms may include slow or uneven heartbeats, dizziness, weakness, or fainting.

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What should I discuss with my healthcare provider before taking propranolol?
You should not use this medication if you are allergic to propranolol, or if you have asthma or certain heart conditions, especially second or third degree heart block. If you have certain conditions, you may need a dose adjustment or special tests to safely use this medication. Before taking propranolol, tell your doctor if you have: bronchitis, emphysema, or other breathing disorders; diabetes; low blood pressure; a heart problem such as heart block, sick sinus syndrome, slow heart rate, or congestive heart failure;

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Can I stop taking the medication if I feel better?
Even though you may feel better you should not stop taking your high blood pressure medication without first checking with your healthcare provider.

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I am on so many medications; do I have to take them all?
This is called polypharmacy—many different medications being used at the same time by one person. Sometimes, being on multiple medications is acceptable and appropriate but at other times it may be problematic. If you are receiving your medications from multiple physicians you need to ensure that they all know what medications you are taking. The best way to do this is to make a list of all the medications you are currently using, including all nutritional supplements, homeopathic remedies, vitamins and over-the-counter drugs (if possible, also include all the diseases you have been diagnosed with). Give a copy to every doctor who takes care of you so they have it on file, this way they can avoid duplicating medications and perhaps even try to consolidate some. After every doctor's visit remember to update the list accordingly. Also, as much as you possibly can, try to use the same pharmacy to fill all your prescriptions, this way any potential drug interactions can be caught and averted.

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Where can I get more information?
More Information

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