Propranolol, Oral Tablet

Medically reviewed by University of Illinois-Chicago, Drug Information Group on March 1, 2017Written by University of Illinois-Chicago, Drug Information Group

Important warnings

  • Warning for stopping treatment: Don’t stop taking this medication without talking to your doctor first. Stopping propranolol suddenly can cause changes in your heart rhythm and blood pressure, worsened chest pain, or a heart attack. Your doctor will slowly lower your dosage over several weeks to help prevent these effects.
  • Drowsiness warning: This drug can cause drowsiness. Don’t drive, use machinery, or perform any activities that require alertness until you know how this drug affects you.
  • Diabetes warning: Propranolol can cause low blood sugar (hypoglycemia). It may also mask the signs of low blood sugar, such as a heart rate that’s higher than normal, sweating, and shakiness. This drug 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.

What is propranolol?

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

Propranolol oral tablet is only available in a generic form. Generic drugs usually cost less than brand-name versions.

Propranolol oral tablet may be used in combination with other drugs.

Why it's used

Propranolol reduces your heart’s workload and helps it beat more regularly. It’s used to:

How it works

Propranolol belongs to a class of drugs called beta blockers. A class of drugs is a group of medications that work in a similar way. These drugs 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

Propranolol oral tablet may cause drowsiness. Don’t drive, use machinery, or perform any activities that require mental alertness until you know how this drug affects you.

Propranolol can also cause other side effects.

More common side effects

The more common side effects of propranolol can include:

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

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

  • Allergic reactions. Symptoms can include:
  • Breathing problems
  • Changes in blood sugar
  • Cold hands or feet
  • Nightmares or trouble sleeping
  • Dry, peeling skin
  • Hallucinations
  • Muscle cramps or weakness
  • Slow heart rate
  • Swelling of your legs or ankles
  • Sudden weight gain
  • vomiting

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Propranolol may interact with other medications

Propranolol oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with propranolol are listed below.

Arrhythmia drugs

Taking propranolol with other drugs that treat heart rhythm problems may cause more side effects. These include lower heart rate, lower blood pressure, or heart blockage. Your doctor should use caution if prescribing these medications together.

Examples of these drugs include:

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

Blood pressure drug

If you’re switching from clonidine to propranolol, your doctor should slowly reduce your dosage of clonidine and slowly increase your dosage of propranolol over several days. This is done to avoid side effects, such as lowered blood pressure.

Blood pressure drugs

Don’t use propranolol with another beta blocker. It can lower your heart rate too much. Examples of beta blockers include:

  • acebutolol
  • atenolol
  • bisoprolol
  • carteolol
  • esmolol
  • metoprolol
  • nadolol
  • nebivolol
  • sotalol

Your doctor should use caution if they’re prescribing angiotensin-converting enzyme (ACE) inhibitors with propranolol. Taking these drugs together can cause blood pressure that’s lower than normal. Examples of ACE inhibitors include:

  • lisinopril
  • enalapril

Your doctor should use caution if they’re prescribing calcium channel blockers with propranolol. Using these drugs together can cause severely low heart rate, heart failure, and heart blockage. Examples of calcium channel blockers include:

  • diltiazem

Your doctor should use caution if they’re prescribing alpha blockers with propranolol. Using these drugs together can cause blood pressure that’s lower than normal, fainting, or low blood pressure after standing up too fast. Examples of these drugs include:

  • prazosin
  • terazosin
  • doxazosin

Anesthetics (drugs that block sensation)

Use caution if you’re taking these medications with propranolol. Propranolol might affect how these medications are cleared from your body, which can be harmful. Your doctor may check your blood levels of these drugs if you take them with propranolol.

Examples of these drugs include:

  • lidocaine
  • bupivacaine
  • mepivacaine

Drugs used to increase heart rate and blood pressure

Don’t use these medications with propranolol. These drugs cancel one another out. This means that neither of them will work. Examples of these drugs include:

  • epinephrine
  • dobutamine
  • isoproterenol

Phenothiazines

Your doctor should be cautious if they’re prescribing these drugs with propranolol. Phenothiazines may reduce how long it takes propranolol to leave your body. This may cause more side effects.

Asthma drugs

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

  • theophylline
  • aminophylline

Nonsteroidal anti-inflammatory drugs (NSAIDs)

These drugs may decrease the blood pressure-lowering effects of propranolol. If you take these drugs together, your doctor should monitor your blood pressure. They may need to change your propranolol dosage.

Examples of NSAIDs include:

  • diclofenac
  • etodolac
  • fenoprofen
  • ibuprofen
  • indomethacin
  • ketoprofen
  • ketorolac
  • meloxicam
  • nabumetone
  • naproxen
  • oxaprozin
  • piroxicam

Blood thinner

When taken with warfarin, propranolol can increase the amount of warfarin in your body. This may cause an increase in how long you bleed from any wound. Your warfarin dosage may need to be changed if you take these drugs together.

Drug to treat stomach ulcers

Taking cimetidine with propranolol can increase the levels of propranolol in your blood. This can cause more side effects.

Antacids with aluminum hydroxide

Taking these drugs with propranolol may make propranolol less effective. Your doctor will need to monitor you and may need to change your dosage of propranolol.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we can not guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.

Propranolol warnings

This drug comes with several warnings.

Allergy warning

Propranolol can cause a severe allergic reaction. Symptoms may include:

  • rash
  • hives
  • wheezing
  • trouble breathing
  • swelling of the mouth, face, lips, tongue, or throat

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

If you’ve had severe allergic reactions to other agents causing anaphylaxis, your allergies may be more reactive when you take propranolol. The usual doses of your allergy medication, epinephrine, may not work as well while you take this drug. Propranolol may block some of epinephrine’s effect.

Alcohol Interaction warning

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

Warnings for people with certain health conditions

For people with cardiogenic shock: Don’t use propranolol. Propranolol reduces the force of your heartbeat, which could make this condition much worse.

For people with slower than normal heart rate: You shouldn’t use propranolol. This drug can slow down your heart rate even more, which could be dangerous.

For people with higher than first-degree heart block: You shouldn’t use propranolol. Propranolol reduces the force of your heartbeat, which could make your heart block worse.

For people with asthma: You shouldn’t use propranolol. This drug can make your asthma worse.

For people with severe chest pain: Suddenly stopping propranolol can worsen your chest pain.

For people with heart failure: You shouldn’t take this drug. Propranolol reduces the force of your heartbeat, which 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.

For people with Wolff-Parkinson-White syndrome: This medical condition can cause a heart rate that’s slower than normal. Treatment of this condition with propranolol may reduce blood pressure too much. Treatment with a pacemaker may be needed.

For people with diabetes: Propranolol can cause hypoglycemia (low blood sugar). It may also mask the signs of low blood sugar, such as a heart rate that’s faster than normal, sweating, and shakiness. This drug should be used with caution if you have diabetes, especially if you take insulin or other diabetes drugs that can cause low blood sugar.

For people with hyperactive thyroid: Propranolol can mask the symptoms of hyperthyroidism (hyperactive thyroid), such as a heart rate that’s faster than normal. If you suddenly stop taking propranolol and have hyperthyroidism, your symptoms can get worse, or you may get a serious condition called thyroid storm.

For 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.

For people who plan to have major surgery: Tell your doctor that you’re taking propranolol. This drug can change how your heart reacts to general anesthesia and surgery.

For people with glaucoma: Propranolol may decrease the pressure in your eyes. This may make it hard to tell if your medications for glaucoma are working. When you stop taking propranolol, the pressure in your eyes may increase.

For 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 medication epinephrine may not work as well. Propranolol may block some of the effects of epinephrine.

For people with uncontrolled bleeding or shock: If you have hemorrhage or shock, a serious problem where your organs don’t get enough blood, drugs to treat these conditions may not work as well if you’re taking propranolol. This is especially true if you’re taking propranolol to treat pheochromocytoma, a tumor in the adrenal gland.

Warnings for other groups

For 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.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: Propranolol is passed through breast milk. The drug may be used while you’re breastfeeding, but your child should be monitored. In your child, propranolol may cause a slower heart rate and low blood sugar. It can also cause decreased oxygen in the blood that can cause cyanosis. This condition turns your child’s skin, lips, or nails blue.

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: It hasn’t been determined that propranolol is safe and effective for use in children younger than 18 years old. There have been reports of heart failure and airway spasms in children who have taken this drug.

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 drugs 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.

How to take propranolol

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

Drug form and strengths

Generic: Propranolol

  • Form: oral tablet
  • Strengths: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

Dosage for atrial fibrillation

Adult dosage (ages 18 years and older)

The typical dosage is 10–30 mg taken 3–4 times per day, before meals and at bedtime.

Child dosage (ages 0–17 years)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for hypertension (high blood pressure)

Adult dosage (ages 18 years and older)

  • Typical starting dosage: 40 mg taken twice per day.
  • Dosage increases: Your doctor may slowly increase your dosage.
  • Typical maintenance dosage: 120–240 mg per day given in 2–3 divided doses. Doses up to 640 mg per day have been given in some cases.
  • Notes:
    • 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 dosage or tell you to take the drug three times per day.

Child dosage (ages 0–17 years)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for angina (chest pain)

Adult dosage (ages 18 years and older)

  • Typical dosage: 80–320 mg. You’ll take this total amount in divided doses 2–4 times per day.

Child dosage (ages 0–17 years)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for heart attack

Adult dosage (ages 18 years and older)

  • Typical starting dosage: 40 mg taken three times per day.
  • Dosage increases: After 1 month, your doctor may increase your dosage to 60–80 mg taken three times per day.
  • Typical maintenance dosage: 180–240 mg. This is divided into smaller, equal doses and taken two or three times per day.

Child dosage (ages 0–17 years)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for hypertrophic subaortic stenosis

Adult dosage (ages 18 years and older)

  • Typical dosage: 20–40 mg taken 3–4 times per day, before meals and at bedtime.

Child dosage (ages 0–17 years)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for migraine

Adult dosage (ages 18 years and older)

  • Typical starting dosage: 80 mg per day. You’ll take this amount in smaller, equal doses several times during the day.
  • Typical maintenance dosage: 160–240 mg per day.
  • Note:
    • If the maximum effective dosage isn’t helping your migraines after 4–6 weeks of therapy, your doctor may have you stop taking the medication. Your dosage 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)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for essential tremor

Adult dosage (ages 18 years and older)

  • Typical starting dosage: 40 mg taken twice per day.
  • Dosage increases: You may need to take a total dosage 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)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Dosage for pheochromocytoma (tumor in the adrenal gland)

Adult dosage (ages 18 years and older)

  • Typical maintenance dosage: 60 mg per day taken in divided doses starting 3 days before your surgery.
  • Notes:
    • You’ll take this drug with other medications. Propranolol isn’t used alone to treat pheochromocytoma.
    • If the surgery can’t be done for the tumor, the usual dosage of this drug is 30 mg per day taken in divided doses with other drugs.

Child dosage (ages 0–17 years)

It hasn’t been established that propranolol is safe and effective for use in children younger than 18 years.

Special dosage considerations

  • For people with kidney problems: Your doctor should use caution when prescribing this drug for you.
  • For people with liver problems: Your doctor should use caution when prescribing this drug for you.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we can not guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Take as directed

Propranolol oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you don’t take it at all: Your condition will get worse and you may be at risk of serious heart problems, such as heart attack or stroke.

If you skip or miss doses: The condition you’re treating may get worse.

If you take too much: If you think you’ve taken too much of this drug, call your doctor or local poison control center. If your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you miss a dose, take it as soon as you remember. If it’s close to the time of your next dose, only take one dose at that time.

Don’t double the dose to try to make up for the missed dose. This can cause dangerous effects.

How to tell if the drug is working: Your symptoms should improve. For instance, your blood pressure and heart rate should be lower. Or you should have less chest pain, tremors or shaking, or fewer migraine headaches.

Important considerations for taking propranolol

Keep these considerations in mind if your doctor prescribes propranolol for you.

General

  • Take this drug before meals and at bedtime.
  • You can cut or crush the tablet.

Storage

  • Store tablets between 59°F to 86°F (15°C to 30°C).
  • Protect this drug from light.
  • Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

  • Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
  • Don’t worry about airport x-ray machines. They can’t harm your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

While you’re taking propranolol, you’ll need to monitor your:

  • blood pressure
  • heart rate
  • blood sugar (if you have diabetes)

Clinical monitoring

While you’re taking this drug, your doctor will periodically do blood tests to check your:

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Some insurance companies may require a prior authorization for the brand name version of this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription. The generic version of this drug doesn’t need a prior authorization.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained here in is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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