table of contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Propranolol is available in a wide range of doses and forms. When it comes to pills taken by mouth, there are also lots of different options. Some pills are long-acting, some are short acting.
And if that weren’t confusing enough, the dosage your healthcare provider picks depends on your underlying condition, what other medications you might be taking, and how your body responds to treatment. To find out what dosage you’re supposed to take, consult with your healthcare provider.
Propranolol is a beta blocker, a class of medications that work by reducing how hard your heart pumps. It’s been proven effective in treating a wide range of conditions, including high blood pressure, chest pain, and even stage fright.
Because propranolol has such a diverse array of uses, what dosage a person requires also varies greatly. Dosages can range anywhere from 10 to 320 mg per day, depending on the condition you’re using it for (Srinivasan, 2019). Let’s take a closer look at how to safely use this medication, as well as what health problems propranolol is prescribed for.
How to take propranolol
As we mentioned, how much propranolol you take and how often you take it is usually a function of your underlying health condition.
For example, someone with hypertension (high blood pressure) may have to take several doses of propranolol per day, as opposed to a person who uses the medication to alleviate symptoms of performance anxiety, and may only take it occasionally.
That’s why it’s important to speak with a healthcare provider who can tailor your medication regimen to your specific needs (FDA, 2010). If you have other underlying health issues or are taking multiple medications, it may also impact how much propranolol you take.
Propranolol, also available under the brand name Inderal, can be taken by mouth as a pill or a liquid solution for people who have trouble swallowing pills. In a hospital setting, it’s also available as an injection. It is available in doses of 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg, and also in an extended-release tablet in amounts of 120 mg and 160 mg (FDA, 2010).
A healthcare professional can recommend which type of propranolol is best for you; immediate-release tablets are taken anywhere from two to four times per day, while the extended-release form is typically taken just once daily. The average cost for a 30-day supply of this medication ranges from $9–$33 (GoodRx, n.d.).
What is propranolol?
Propranolol is a beta blocker, a type of medication that helps reduce stress on the heart. Beta blockers work by “blocking” the impact of adrenaline on beta receptors in the body.
Beta blockers: how they’re used to treat heart conditions
Typically, adrenaline increases how hard your heart beats—and by blocking receptors, these medications reduce how hard your heart beats (Farzam, 2020). By relieving extra pressure on the heart, drugs like propranolol have been an important tool to help regulate heart rate, keep blood pressure down, alleviate chest pain, and more (Srinivasan, 2020).
Here are the main conditions propranolol is FDA-approved to treat, as well as its off-label uses (FDA, 2010):
- High blood pressure: Also known as hypertension, is something nearly half the US population lives with today (CDC-a, 2020). Left untreated, hypertension can cause significant damage to blood vessels and the different organs in your body, including your heart. Propranolol isn’t typically the first line of treatment for hypertension, but when it is used, it’s often coupled with other blood pressure medications like diuretics (water pills), calcium channel blockers, and drugs known as ACE inhibitors.
- Angina pectoris: When it was first developed more than 50 years ago, propranolol was used for the treatment of certain types of heart-related chest pain, or angina (UpToDate, 2020). Of course the drug’s uses have expanded greatly since then, but it still effectively alleviates pressure or tightness in the chest caused by reduced blood flow to the heart (a risk factor for heart attacks).
- Atrial fibrillation: Atrial fibrillation (afib) is a fast, irregular heartbeat that prevents the heart from properly filling up with blood. Propranolol assists treating this condition by decreasing heart rate, which improves the heart’s ability to properly pump blood throughout the body.
- Heart attacks: Beta blockers like propranolol are also used to prevent myocardial infarction, more commonly known as a heart attack. This medication is also given to patients to improve their survival rate after a heart attack.
- Migraine: Propranolol is a popular drug option for preventing migraine attacks, although it hasn’t been found to be an effective treatment for a migraine attack once one starts.
- Essential tremor: Different from tremors related to Parkinson’s disease, essential tremor is often hereditary and causes involuntary shaking in parts of the body. Propranolol can help reduce the amplitude of these tremors (NIH, 2020).
- Social anxiety: Beta blockers are also prescribed off-label (which means for conditions other than ones indicated by the FDA) for things like performance anxiety and stage fright. Taking propranolol before a stressful social event lowers your heart rate, helping to reduce symptoms of anxiety like sweating and shaking (Srinivasan, 2019).
Social anxiety test: do you have social anxiety disorder?
Side effects of propranolol
Before taking this drug, there are some important warnings to take note of. The FDA has stamped propranolol with a black box warning, meaning it can cause serious or life-threatening side effects (FDA, 2010). Do not discontinue this medication without consulting a healthcare provider as it could lead to a heart attack.
Some of the most common adverse reactions people experience while taking propranolol include the following (FDA, 2010):
- Difficulty breathing
- Dry eyes
- Difficulty sleeping
- Digestive issues
- Tingling hands
- Weight gain
Like many medications, beta blockers can also carry more serious risks. Because propranolol slows down your heart rate, there’s a risk it can slow your heart down too much—a condition known as bradycardia.
It can also cause low blood pressure, severe allergic reactions, and worsen certain conditions like heart failure and lung disease (FDA, 2010). This drug can also mask symptoms of other conditions, including hyperthyroidism and low blood sugar.
If you have diabetes, you may not notice signs of low blood sugar while taking propranolol, which can be life-threatening if gone untreated (Tsujimoto, 2017). Make sure to inform a healthcare professional of any additional health conditions you have before starting this drug.
Who should avoid taking propranolol
As we noted, propranolol is not safe for everyone. If you are pregnant or nursing, you may want to avoid this drug as its safety has not yet been determined for women who are pregnant or nursing (FDA, 2010). Let your healthcare provider know if you have diabetes, heart failure, hypotension, lung problems, liver disease, or kidney failure before taking this medication.
Propranolol: everything you need to know
Propranolol drug interactions
Beta blockers can be prescribed on their own or in addition to other medications. While propranolol is safe to take at the same time as many medications that shouldn’t be taken with propranolol. This doesn’t include the whole list, but here are some of the main drug interactions to be aware of (FDA, 2010):
- Drugs affecting the cytochrome P-450 system: Drugs that impact the P-450 system, which breaks down beta blockers in the liver, can also affect the concentration of propranolol in your system.
- Antiarrhythmics: These drugs help manage irregular heart rhythms, or arrhythmias. Combining antiarrhythmics and propranolol increases the chance for side effects.
- Calcium channel blockers: Calcium channel blockers are medications also used to lower blood pressure. Taking propranolol at the same time as these may increase the risk for side effects.
- Migraine medication: Propranolol can enhance the levels of migraine medications, like zolmitriptan or rizatriptan, in the body.
- Blood pressure drugs: Combining medications that lower your blood pressure can cause dangerously low blood pressure. Examples of other blood pressure medications include: enalapril, doxazosin, prazosin, lisinopril, and terazosin.
- Diazepam: Diazepam is a drug used to treat anxiety. Taking diazepam alongside propranolol can boost the risk for side effects.
- High cholesterol medication: Medications used to manage high cholesterol can impact the levels of beta blockers in the body.
- Monoamine oxidase inhibitors (MAOIs): Prescribed for depression, MAOIs include drugs like phenelzine, isocarboxazid, selegiline, and tranylcypromine. Combining propranolol and MAOIs could increase the risk for adverse reactions.
- Warfarin: Propranolol can interact with the blood thinner warfarin, heightening its concentration levels in the body.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Taking NSAIDs at the same time as beta blockers could reduce their effectiveness.
- Alcohol: Be cautious drinking alcohol on this drug as it can increase the risk for side effects.
Disclose any other health problems and medications or supplements you are taking before using propranolol. Along with a medication plan, a healthcare provider may also recommend certain lifestyle changes, such as quitting smoking, cutting down on alcohol, and getting enough physical activity, to keep you healthy and help prevent other health problems from developing (CDC-b, 2020).
- Centers for Disease Control and Prevention (CDC-a). (2020). Facts about Hypertension. Retrieved on Oct. 18, 2020 from https://www.cdc.gov/bloodpressure/facts.htm
- Centers for Disease Control and Prevention (CDC-b). (2020). How You Can Prevent Chronic Diseases. Retrieved on Oct. 22, 2020 from https://www.cdc.gov/chronicdisease/about/prevent/index.htm
- DailyMed. (2019). Propranolol hydrochloride capsule. Retrieved Oct. 20, 2020 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8efc9fc6-6db0-43c9-892b-7423a9ba679f
- Farzam, K. & Jan, A. (2020). Beta Blockers. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532906/
- GoodRx.com. (n.d.). Propranolol. Retrieved Oct. 22, 2020 from https://www.goodrx.com/propranolol
- National Institute of Neurological Disorders and Stroke (NIH). (2020). Tremor fact sheet. Retrieved from https://www.ninds.nih.gov/tremor-fact-sheet
- Srinivasan, A. V. (2019). Propranolol: A 50-Year Perspective. Annals of Indian Academy of Neurology, 22(1), 21-26. Retrieved from https://dx.doi.org/10.4103%2Faian.AIAN_201_18
- Tsujimoto, T., Sugiyama, T., Shapiro, M. F., Noda, M., & Kajio, H. (2017). Risk of Cardiovascular Events in Patients With Diabetes Mellitus on B-Blockers. Hypertension, 70, 103-110. Retrieved from https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.117.09259
- UpToDate. (2020). Patient education: Medications for angina (Beyond the Basics). Retrieved Oct. 25, 2020 from https://www.uptodate.com/contents/medications-for-angina-beyond-the-basics
- U. S. Food and Drug Administration (FDA). (2010). Inderal (propranolol hydrochloride) tablets. Retrieved on Oct. 20, 2020 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.