Hypertension/Angina: 40 mg orally twice daily; may titrate to 120–240 mg/day
Arrhythmias: 10–30 mg orally 3–4 times daily (immediate release) or 80–160 mg/day (extended release)
Migraine prophylaxis: 80–240 mg/day orally, divided doses or extended release
Essential tremor: 40 mg orally 2–3 times daily
Note: Adjust dose in hepatic impairment; monitor heart rate and blood pressure. Avoid abrupt discontinuation.
Route of Administration
Oral (tablet, extended-release capsule), IV (for acute settings)
Mechanism of Action
Propranolol non-selectively blocks beta-1 and beta-2 adrenergic receptors, reducing heart rate, myocardial contractility, cardiac output, and renin secretion. Beta-2 blockade can also cause bronchoconstriction.
Common Adverse Effects
Fatigue
Dizziness
Bradycardia
Hypotension
Cold extremities
Sleep disturbances
Serious Adverse Effects
Severe bradycardia or AV block
Exacerbation of heart failure
Bronchospasm (especially in asthmatic patients)
Hypoglycemia masking in diabetic patients
Contraindications
Asthma or severe chronic obstructive pulmonary disease
Severe bradycardia
Second- or third-degree AV block
Cardiogenic shock
Hypersensitivity to propranolol
Precautions
Monitor heart rate and blood pressure
Use caution in patients with diabetes, peripheral vascular disease, or thyroid disorders
Do not stop abruptly to avoid rebound hypertension or angina
Drug Interactions
Other antihypertensives – additive hypotensive effect
Antiarrhythmics – increased risk of bradycardia or AV block
Insulin or oral hypoglycemics – may mask hypoglycemia
CYP2D6 inhibitors – may increase propranolol plasma levels
Pregnancy & Lactation
Use with caution during pregnancy and breastfeeding; monitor fetal and neonatal heart rate and blood pressure.
Patient Counseling
Take at the same time each day
Do not stop therapy abruptly
Monitor heart rate and blood pressure regularly
Report dizziness, fainting, or breathing difficulties