Propranolol For High Blood Pressure

What is Propranolol?

Propranolol is a medication from the 1st generation beta-blocker class and it’s commonly used to treat heart conditions, such as hypertension (high blood pressure), heart rhythm problems, or circulatory disorders. The drug also is used in the treatment and prevention of heart attack as well as in treating anxiety, angina related chest pain, thyrotoxicosis, and tremors. Propranolol has been around for nearly six decades and is the 63rd most prescribed medication in the US.  

How does Propranolol work?

Like other beta-blockers, Propranolol slows your heart rate and thus makes it easier to circulate blood in your body’s blood vessels, which will lower your blood pressure. 

How long does Propranolol take to work?

Both standard Propranolol tablets and extended-release capsules will yield first blood pressure lowering effects after about 30 minutes of taking the medication. However, it’s only after one week of continuous treatment that Propranolol will reach its full effect. 

How long does Propranolol last?

The effect of standard-release Propranolol peaks within 1 to 1½ hours of taking a capsule and will last for about 5-6 hours. When using extended-release capsules, it will take six hours before Propranolol blood levels reach their highest point and the overall effect of one capsule lasts for about 24 hours.   

Active ingredients

The active ingredient is propranolol hydrochloride.

Inactive ingredients

Inactive ingredients include lactose, magnesium stearate, microcrystalline cellulose, and stearic acid.

Please note, the inactive ingredients may vary across different brands of Propranolol. 

Which ingredients can cause an allergic reaction?

Propranolol causes a severe allergic reaction in people on rare occasions. If you have previously taken propranolol, and experienced symptoms of a severe allergic reaction, please do not take them again and let your doctor know. Facial swelling, a rash, dizziness, and trouble breathing are signs of a severe allergic reaction to propranolol. Get emergency medical help as soon as you notice any of these symptoms.

Propranolol dosage

The dose of Propranolol suitable to you will depend on your condition and severity of symptoms. The usual starting dose for adults with hypertension is 80 mg taken twice per day. If the desired blood pressure-lowering effect is not reached within a month, your GP may decide to raise your dosage up to 160 mg twice per day. For conditions other than hypertension, different dosages apply, so make sure to follow your doctor's instructions.

How to take Propranolol

Always take Propranolol as instructed by a doctor or pharmacist. Standard release tablets are taken once a day, swallowed whole with a glass of water. You can take them with or without food, as Propranolol doesn’t irritate the stomach. Extended-release capsules at first are best taken in the evening before bedtime since they can make you feel dizzy. Once your body is accustomed to the medication or if you don’t feel dizzy from the start of treatment, you can take the capsule in the morning. Generally, for the best effect, you should take Propranolol regularly at the same time each day. 

How to stop taking Propranolol

If you are thinking of stopping Propranolol treatment, first consult with your doctor. It’s recommended to gradually wean off Propranolol, as a sudden stop can cause unpleasant and even dangerous cardiovascular side effects. It will take about 2-4 weeks to gradually phase out your Propranolol treatment.  

What should I do if I miss a dose of Propranolol?

Missing a dose isn’t a cause for concern. Just take your next dose at the scheduled time. Never take a double dose to make up for a missed one. 

What should I do if I took too much Propranolol?

Overdosing on Propranolol can slow your heart rate and cause breathing difficulties, dizziness and tremors. Each person has a different overdosing threshold, so it cannot be generalized at what dosage you are likely to experience overdosing effects. So, if you think you have accidentally overdosed on Propranolol, seek medical help right away. 

Propranolol side effects

Like all medications, Propranolol may cause side effects in some patients, in particular during the initial treatment stage, when your body is still getting used to Propranolol. Many of those side effects disappear after several weeks of treatment.

Common mild side effects occurring in more than 1 out of 100 patients include:

• Dizziness
• Fatigue
• Fingers or toes feel cold (they don’t get enough blood supply) 
• Sleeping difficulties (insomnia) and nightmares
• Nausea
• Reduced libido

These side effects are most often observed during the first two weeks of treatment and normally only last a few days. If they last longer or make you feel uncomfortable, talk to your doctor.

Serious side effects are rare but can happen. If you experience any of the following side effects, you’ll need to seek immediate medical help.

• Breathing difficulties accompanied by coughing during physical exertion
• Swollen ankles or legs
• Slow, irregular heartbeat
• Vision problems
• Chest pain
• Wheezing
• Yellowing of your skin and whites of the eyes (jaundice)
• Confusion or anxiety
• Severe allergic skin reactions

For a comprehensive list of Propranolol side effects, see the manufacturer’s leaflet inside the packet.

Contraindications

Do NOT take Propranolol if you:

• Are allergic to any ingredient of this medication
• Have asthma
• Have an abnormally slow heartbeat 
• Have serious heart conditions (sick sinus syndrome, AV block) 
• Suffer from Impaired liver function

Before taking Propranolol, tell your doctor if you are/have:

• Pregnant or breastfeeding
• Bronchitis, emphysema, or other breathing conditions
• Diabetes
• Depression
• Kidney or liver issues
• Thyroid disorders;
• Pheochromocytoma 
• Coronary heart disease
• Circulatory problems (Raynaud syndrome).
• Primary hyperaldosteronism

Drug interactions

Before starting a Propranolol treatment, tell your GP about all medication you currently use or plan on using at the same time as the Propranolol treatment. Known interactions with other drugs include:

• Other hypertension medications
• NSAIDs  such as Aspirin, Ibuprofen, Naproxen, and Diclofenac
• Blood thinners such as Warfarin
• Medications for heart rhythm disorders
• Antidepressants
• Drugs treating prostate disorder such as Doxazosin or Tamsulosin
• Nitrates
• Certain muscle relaxants 
• Parkinson's disease medicines such as Levodopa
• Diabetes medications
• Allergy drugs such as Ephedrine

Propranolol and alcohol

Consuming alcohol can increase Propranolol’s blood pressure-reducing effect, resulting in dizziness. Therefore, alcohol consumption is best avoided or minimized during Propranolol treatment, especially in the first few weeks of treatment.

Propranolol vs other high blood pressure medications

There are many different types of hypertension medications, including various beta-blockers, ACE inhibitors, calcium channel blockers, diuretics, and angiotensin II receptor blockers (ARB).  Depending on your blood pressure levels, accompanying symptoms, other medical conditions, or medications you may be taking and your age, your doctor will evaluate and decide which hypertension medication will offer you the best balance of benefits and risks. Sometimes it will be a combination of drugs. Typically, Propranolol is considered a particularly suitable choice for treating hypertension if the patient has abnormal heart rhythms.

Lifestyle changes to reduce your blood pressure

Taking Propranolol regularly for treating high blood pressure doesn’t require lifestyle changes. However, there are several lifestyle improvements you can make to help Propranolol reduce blood pressure and boost your overall well-being. Cut back on fatty foods and limit your salt intake to 6g per day or lower. Eat plenty of fruits and vegetables, and always go for whole grains and lean meats. Exercising regularly will keep the heart and blood vessels in good condition and also contributes to relieving stress. Mental stress is a major cause of hypertension, so try avoiding it. Limit alcohol consumption as much as possible and, if you are currently smoking, it’s time you quit.