Inderal 80mg Tablets
It is used to treat high blood pressure.It is used to treat chest pain or pressure. It is used to help certain heart problems.It is used to prevent migraine headaches.It is used to treat tremor (essential).It is used after a heart attack to help prevent future heart attacks and lengthen life.It is used to treat pheochromocytoma. It is used to treat certain types of abnormal heartbeats.
Drug Class
Antihypertensive, Antiarrhythmic, Antianginal, Migraine Prophylaxis
Pharmacologic Class
Non-selective Beta-Adrenergic Blocker
Pregnancy Category
Not available
FDA Approved
Nov 1967
DEA Schedule
Not Controlled
Overview
What is this medicine?
Propranolol is a type of medicine called a beta-blocker. It works by blocking certain natural chemicals in your body, like adrenaline, from affecting your heart and blood vessels. This helps to slow down your heart rate, relax your blood vessels, and lower your blood pressure. It's used to treat conditions like high blood pressure, chest pain (angina), irregular heartbeats, and to prevent migraines and reduce tremors.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Some medications should be taken with food, while others should be taken on an empty stomach. If you're unsure, consult with your pharmacist to determine the best way to take your medication.
It's crucial to continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better. Don't stop taking your medication without consulting your doctor first.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature, away from freezing temperatures. Protect your medication from heat, cold, and light, and keep the lid tightly closed.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, it's essential to take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Some medications should be taken with food, while others should be taken on an empty stomach. If you're unsure, consult with your pharmacist to determine the best way to take your medication.
It's crucial to continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better. Don't stop taking your medication without consulting your doctor first.
Storing and Disposing of Your Medication
To maintain the effectiveness and safety of your medication, store it at room temperature, away from freezing temperatures. Protect your medication from heat, cold, and light, and keep the lid tightly closed.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Do not stop taking this medication suddenly, especially if you have heart disease. Your doctor will tell you how to slowly reduce the dose.
- Take your pulse regularly as instructed by your doctor. Report if it's too slow.
- Avoid activities that require alertness until you know how the medication affects you, as it can cause dizziness or lightheadedness.
- Avoid alcohol, as it can increase the effects of propranolol.
- If you have diabetes, monitor your blood sugar closely, as propranolol can mask the signs of low blood sugar.
- Maintain a healthy diet, exercise regularly, and manage stress to support overall cardiovascular health.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Varies by indication. For hypertension: Initial 40 mg twice daily, maintenance 120-240 mg/day in 2-3 divided doses.
Dose Range:
40 - 640 mg
Condition-Specific Dosing:
Hypertension:
Initial 40 mg BID, usual 120-240 mg/day (max 640 mg/day)
Angina Pectoris:
80-320 mg/day in 2-4 divided doses
Arrhythmias:
10-30 mg 3-4 times daily
Migraine Prophylaxis:
Initial 80 mg/day in divided doses, usual 160-240 mg/day
Essential Tremor:
Initial 40 mg BID, usual 120-320 mg/day
Hypertrophic Subaortic Stenosis:
20-40 mg 3-4 times daily
Pheochromocytoma (adjunct):
60 mg/day in divided doses for 3 days pre-op, or 30 mg/day for chronic management
Pediatric Dosing
Neonatal:
Not established for routine use; specific indications (e.g., infantile hemangioma) have specialized dosing.
Infant:
Not established for routine use; specific indications (e.g., infantile hemangioma) have specialized dosing.
Child:
Hypertension: Initial 0.5-1 mg/kg/day divided BID-QID; usual max 2 mg/kg/day (not to exceed 4 mg/kg/day or 60 mg/day).
Adolescent:
Dosing similar to adult for some indications, adjusted by weight/BSA.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
Use with caution; consider lower initial doses and careful titration, as accumulation of active metabolites may occur. Monitor clinical response.
Dialysis:
Propranolol is not significantly removed by hemodialysis. No supplemental dose needed post-dialysis.
Hepatic Impairment:
Mild:
Consider lower initial doses.
Moderate:
Significant dose reduction required due to extensive hepatic metabolism. Reduce dose by 50% or more.
Severe:
Contraindicated or use with extreme caution and substantial dose reduction (e.g., 75% reduction). Monitor closely for adverse effects.
Pharmacology
Mechanism of Action
Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks beta-1 (myocardial) and beta-2 (bronchial and vascular smooth muscle) adrenergic receptors. This blockade leads to decreased heart rate, decreased myocardial contractility, reduced cardiac output, and reduced blood pressure. It also inhibits renin release from the kidneys. Its anti-migraine effect is thought to be due to blockade of beta-receptors in cerebral vasculature and/or central mechanisms. Its anti-tremor effect is likely due to blockade of peripheral beta-2 receptors.
Pharmacokinetics
Absorption:
Bioavailability:
25-50% (due to extensive first-pass metabolism)
Tmax:
1-1.5 hours (immediate release)
FoodEffect:
Food increases bioavailability and reduces peak plasma concentrations variability.
Distribution:
Vd:
3-4 L/kg
ProteinBinding:
90-95%
CnssPenetration:
Yes
Elimination:
HalfLife:
3-6 hours
Clearance:
Not readily available (highly variable due to first-pass)
ExcretionRoute:
Renal (primarily as metabolites)
Unchanged:
<1% (in urine)
Pharmacodynamics
OnsetOfAction:
Within 30 minutes (oral)
PeakEffect:
1-1.5 hours (oral)
DurationOfAction:
6-12 hours (immediate release)
Safety & Warnings
BLACK BOX WARNING
WARNING: ABRUPT CESSATION OF THERAPY. Do not discontinue Propranolol Tablets abruptly in patients with angina pectoris. Severe exacerbation of angina, myocardial infarction, and ventricular arrhythmias have occurred following abrupt discontinuation of beta-blocker therapy. When discontinuing chronically administered Propranolol Tablets, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, Propranolol Tablets administration should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue Propranolol Tablets therapy abruptly even in patients treated only for hypertension.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness or lightheadedness
+ Headache or feeling sleepy
+ Weakness, shaking, or a rapid heartbeat
+ Confusion, hunger, or sweating
Signs of lupus, such as:
+ A rash on the cheeks or other body parts
+ Easy sunburning
+ Muscle or joint pain
+ Chest pain or shortness of breath
+ Swelling in the arms or legs
Severe dizziness or fainting
New or worsening chest pain
Slow or irregular heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Confusion or hallucinations (seeing or hearing things that are not there)
Memory problems or loss
Depression or other mood changes
Abnormal sensations, such as burning, numbness, or tingling
Feeling cold in the arms or legs
Changes in skin color (pale, blue, gray, purple, or red)
Changes in eyesight
Unexplained bruising or bleeding
Fever, chills, or sore throat
Erectile dysfunction
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, such as red, swollen, blistered, or peeling skin; skin irritation (with or without fever); red or irritated eyes; or sores in the mouth, throat, nose, or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness, drowsiness, tiredness, or weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Sleep disturbances
Vivid or unusual dreams
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness or lightheadedness
+ Headache or feeling sleepy
+ Weakness, shaking, or a rapid heartbeat
+ Confusion, hunger, or sweating
Signs of lupus, such as:
+ A rash on the cheeks or other body parts
+ Easy sunburning
+ Muscle or joint pain
+ Chest pain or shortness of breath
+ Swelling in the arms or legs
Severe dizziness or fainting
New or worsening chest pain
Slow or irregular heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Confusion or hallucinations (seeing or hearing things that are not there)
Memory problems or loss
Depression or other mood changes
Abnormal sensations, such as burning, numbness, or tingling
Feeling cold in the arms or legs
Changes in skin color (pale, blue, gray, purple, or red)
Changes in eyesight
Unexplained bruising or bleeding
Fever, chills, or sore throat
Erectile dysfunction
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, such as red, swollen, blistered, or peeling skin; skin irritation (with or without fever); red or irritated eyes; or sores in the mouth, throat, nose, or eyes
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Dizziness, drowsiness, tiredness, or weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Sleep disturbances
Vivid or unusual dreams
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Very slow heart rate (e.g., less than 50 beats per minute)
- Shortness of breath, wheezing, or difficulty breathing
- Swelling in your ankles or feet, or sudden weight gain (signs of heart failure)
- Unusual tiredness or weakness
- Coldness, numbness, or pain in your hands or feet
- Depression or mood changes
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor blood circulation to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
* Respiratory issues, including:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing treatments and health issues. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor blood circulation to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
* Respiratory issues, including:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing treatments and health issues. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
Important Warnings and Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying down position, and be cautious when climbing stairs.
Monitoring and Lab Tests
Follow your doctor's instructions for monitoring your blood pressure and heart rate. Be aware that this medication may affect certain laboratory tests, so inform all your healthcare providers and lab personnel that you are taking this medication.
Interactions with Other Substances
Discuss with your doctor before consuming alcohol. If you smoke, consult with your doctor, as this medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia, particularly in individuals with diabetes, children, and those who are fasting or experiencing surgery, abnormal eating habits, or vomiting.
Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels.
Stopping the Medication
Do not abruptly stop taking this medication, as this may lead to worsened chest pain or even a heart attack, especially in individuals with certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the medication. Immediately contact your doctor if you experience new or worsening chest pain or other heart problems.
Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as a rapid heartbeat. If you have an overactive thyroid and suddenly stop taking this medication, your condition may worsen and become life-threatening. Consult with your doctor.
Interactions with Other Medications
If you have high blood pressure and are taking this medication, consult with your doctor before using over-the-counter products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Allergic Reactions
If you have a history of severe allergic reactions, discuss with your doctor, as you may be at risk of a more severe reaction if you are exposed to the allergen. If you use epinephrine to treat severe allergic reactions, inform your doctor, as epinephrine may be less effective while taking this medication.
Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You and your doctor will need to discuss the benefits and risks of this medication to you and your baby.
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying down position, and be cautious when climbing stairs.
Monitoring and Lab Tests
Follow your doctor's instructions for monitoring your blood pressure and heart rate. Be aware that this medication may affect certain laboratory tests, so inform all your healthcare providers and lab personnel that you are taking this medication.
Interactions with Other Substances
Discuss with your doctor before consuming alcohol. If you smoke, consult with your doctor, as this medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia, particularly in individuals with diabetes, children, and those who are fasting or experiencing surgery, abnormal eating habits, or vomiting.
Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels.
Stopping the Medication
Do not abruptly stop taking this medication, as this may lead to worsened chest pain or even a heart attack, especially in individuals with certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the medication. Immediately contact your doctor if you experience new or worsening chest pain or other heart problems.
Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as a rapid heartbeat. If you have an overactive thyroid and suddenly stop taking this medication, your condition may worsen and become life-threatening. Consult with your doctor.
Interactions with Other Medications
If you have high blood pressure and are taking this medication, consult with your doctor before using over-the-counter products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Allergic Reactions
If you have a history of severe allergic reactions, discuss with your doctor, as you may be at risk of a more severe reaction if you are exposed to the allergen. If you use epinephrine to treat severe allergic reactions, inform your doctor, as epinephrine may be less effective while taking this medication.
Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You and your doctor will need to discuss the benefits and risks of this medication to you and your baby.
Overdose Information
Overdose Symptoms:
- Severe bradycardia (very slow heart rate)
- Hypotension (very low blood pressure)
- Cardiogenic shock
- Heart failure
- Bronchospasm (difficulty breathing)
- Hypoglycemia (low blood sugar)
- Seizures
- Coma
What to Do:
Seek immediate medical attention or call 911. For poison control, call 1-800-222-1222. Treatment may involve atropine for bradycardia, glucagon, IV fluids, vasopressors, and bronchodilators.
Drug Interactions
Contraindicated Interactions
- Non-dihydropyridine Calcium Channel Blockers (e.g., Verapamil, Diltiazem) - risk of severe bradycardia, heart block, heart failure.
- MAO Inhibitors - risk of severe hypertension.
Major Interactions
- Other Beta-Blockers (additive effects)
- Clonidine (risk of rebound hypertension upon clonidine withdrawal)
- Digoxin (additive bradycardia)
- Insulin and Oral Hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
- NSAIDs (may reduce antihypertensive effect)
- Alpha-1 Blockers (e.g., Prazosin, Terazosin - risk of profound hypotension)
- Fingolimod (risk of severe bradycardia)
- Antipsychotics (e.g., Thioridazine - increased propranolol levels, increased QT prolongation risk)
- CYP2D6 inhibitors (e.g., Fluoxetine, Paroxetine, Quinidine - increased propranolol levels)
- CYP1A2 inhibitors (e.g., Cimetidine, Fluvoxamine - increased propranolol levels)
- CYP1A2 inducers (e.g., Rifampin - decreased propranolol levels)
Moderate Interactions
- Amiodarone (additive bradycardia)
- Lidocaine (increased lidocaine levels)
- Theophylline (reduced clearance of theophylline)
- Epinephrine (paradoxical hypertension and bradycardia)
- Alcohol (increased propranolol levels)
- Ergot alkaloids (increased vasoconstriction)
- Muscle relaxants (prolonged neuromuscular blockade)
Minor Interactions
- Antacids (may decrease absorption if aluminum/magnesium containing)
- Cholestyramine (may decrease absorption)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide titration for antihypertensive effect.
Timing: Prior to initiation
Heart Rate (HR)
Rationale: To establish baseline and monitor for bradycardia.
Timing: Prior to initiation
Electrocardiogram (ECG)
Rationale: To assess cardiac rhythm and conduction, especially in patients with pre-existing cardiac conditions.
Timing: Prior to initiation, if clinically indicated
Renal Function (BUN, Creatinine)
Rationale: To assess baseline kidney function, as metabolites are renally excreted.
Timing: Prior to initiation
Liver Function Tests (LFTs)
Rationale: To assess baseline hepatic function, as propranolol is extensively metabolized by the liver.
Timing: Prior to initiation
Blood Glucose (in diabetics)
Rationale: Propranolol can mask symptoms of hypoglycemia.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly, especially during dose titration and periodically thereafter (e.g., weekly to monthly)
Target: Individualized based on indication (e.g., <130/80 mmHg for hypertension)
Action Threshold: Hypotension (e.g., SBP <90 mmHg or symptomatic), inadequate BP control
Heart Rate (HR)
Frequency: Regularly, especially during dose titration and periodically thereafter (e.g., weekly to monthly)
Target: Typically >50-60 bpm (unless target for specific arrhythmia)
Action Threshold: Bradycardia (<50 bpm or symptomatic), heart block
Symptoms of Heart Failure
Frequency: At each visit
Target: N/A
Action Threshold: Worsening dyspnea, edema, weight gain
Blood Glucose (in diabetics)
Frequency: More frequent monitoring, especially during dose changes
Target: Individualized
Action Threshold: Hypoglycemia (propranolol can mask symptoms)
Respiratory Status (in patients with asthma/COPD)
Frequency: At each visit
Target: N/A
Action Threshold: Worsening bronchospasm, dyspnea
Symptom Monitoring
- Bradycardia (slow pulse)
- Hypotension (dizziness, lightheadedness, fainting)
- Fatigue, weakness
- Shortness of breath, wheezing (especially in patients with reactive airway disease)
- Cold hands and feet
- Depression, sleep disturbances
- Symptoms of heart failure (swelling, weight gain, increased shortness of breath)
- Masked symptoms of hypoglycemia (in diabetics)
Special Patient Groups
Pregnancy
Propranolol is generally not recommended during pregnancy unless the potential benefit outweighs the potential risk to the fetus. It has been associated with fetal growth restriction, bradycardia, and hypoglycemia. Use with caution, and monitor the neonate for signs of beta-blockade.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided if alternatives exist.
Second Trimester:
Risk of fetal growth restriction, bradycardia, and hypoglycemia.
Third Trimester:
Increased risk of neonatal bradycardia, hypoglycemia, and respiratory depression. Monitor neonate for several days post-delivery.
Lactation
Propranolol is excreted into breast milk. While generally considered compatible with breastfeeding (L3), monitor the infant for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding, hypoglycemia), especially in premature or jaundiced infants.
Infant Risk:
Low to moderate risk. Monitor for bradycardia, hypoglycemia, and respiratory depression.
Pediatric Use
Dosing must be carefully individualized based on weight and indication. Not all adult indications are approved for pediatric use. Close monitoring for adverse effects, especially bradycardia and hypotension, is crucial. Specific formulations (e.g., Hemangeol for infantile hemangioma) have specific pediatric dosing guidelines.
Geriatric Use
Elderly patients may be more sensitive to the effects of beta-blockers, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Monitor renal and hepatic function, as these may be impaired in the elderly, affecting drug clearance.
Clinical Information
Clinical Pearls
- Propranolol is highly lipophilic, allowing it to cross the blood-brain barrier, which contributes to its efficacy in conditions like migraine prophylaxis, essential tremor, and performance anxiety.
- It is a non-selective beta-blocker, meaning it blocks both beta-1 and beta-2 receptors. This can lead to bronchoconstriction (beta-2 blockade), making it generally contraindicated in patients with asthma or severe COPD.
- Abrupt discontinuation can lead to rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with ischemic heart disease. Always taper the dose gradually.
- Can mask symptoms of hypoglycemia in diabetic patients, except for sweating. Educate patients to monitor blood glucose closely.
- Used off-label for performance anxiety due to its ability to reduce physical symptoms like tremor, palpitations, and sweating.
Alternative Therapies
- For Hypertension: Other beta-blockers (e.g., Metoprolol, Atenolol), ACE inhibitors, ARBs, Calcium Channel Blockers, Diuretics.
- For Angina: Calcium Channel Blockers, Nitrates, Ranolazine.
- For Arrhythmias: Other antiarrhythmics (e.g., Metoprolol, Diltiazem, Amiodarone).
- For Migraine Prophylaxis: Topiramate, Valproic Acid, CGRP inhibitors, Amitriptyline.
- For Essential Tremor: Primidone, Gabapentin.
- For Anxiety: SSRIs, SNRIs, Benzodiazepines (short-term), Buspirone.
Cost & Coverage
Average Cost:
$10 - $50 per 30 tablets (generic 80mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic) or Tier 2 (Brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.