What are the most common side effects of Propranolol?

All you need to know about Propranolol’s safety and side effects

What is Propranolol?

Propranolol is one of the 1st generation beta-blockers and has been in use since the 1960s. Initially intended for treating high blood pressure, the drug eventually came to be used for many other purposes, including heart issues, performance anxiety, tremors, and the symptoms of hyperthyroidism. This wide range of medical applications makes Propranolol one of the most frequently prescribed medications in the United States.

The medication’s active ingredient is Propranolol hydrochloride.  Inactive ingredients include magnesium stearate, cellulose, and lactose. Different treatment purposes need different doses and time periods. Propranolol thus is sold as capsules, tablets, drops, and intravenous solutions. The doses range from 10 mg per dose all the way to 160 mg.

Propranolol is a fast-acting medication. Depending on its treatment purposes, it takes as little as 30 minutes to take effect. For some treatments, such as when using Propranolol to manage blood pressure, it will take longer — up to a week of scheduled dosing  — before the full effect is reached.

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What are typical Propranolol side effects?

The medication generally is well-tolerated and serious complications are rare. Being in wide use for many decades, Propranolol side effects have a long, well-documented track record. Below is a list of the most common side effects.

Keep in mind that most of these side effects are likely to occur with long-term Propranolol treatment, such as when treating hypertension or chronic migraine disorder. If you only occasionally take Propranolol, as when treating performance anxiety, you are less likely to experience side effects.

Moreover, for long-term users, many side effects will resolve after the first couple of weeks, as your body gets used to the medication. 

Common but generally mild side effects that can occur in about 1-5% of Propranolol users include:

  • Fatigue
  • Dizziness
  • Nausea
  • Cold and/or numb fingers and toes 
  • Sleeping difficulties and nightmares
  • Lower libido

As mentioned, these side effects most often appear during the first few weeks of using Propranolol. If you don’t notice any improvements in side effects by the third week of using Propranolol or if side effects worsen, stop the medication and talk to your doctor. Your MD may adjust your Propranolol dose or prescribe an alternative medication.  

As with most medications, Propranolol also can have serious side effects. Fortunately, these are rare, meaning they appear in less than 1% of patients.  Should you experience any of the more serious side effects described below, it’s recommended that you seek medical help right away.

  • Irregular or very slow heartbeat
  • Breathing difficulties and chest pain
  • Swollen legs and ankles
  • Vision problems
  • Yellowing of your skin and eyes
  • Confusion
  • Anxiety
  • Severe skin allergies

For a complete list of common and rare Propranolol side effects, speak to your doctor or refer to the manufacturer’s leaflet.

 

What are contraindications for Propranolol?

Unless your doctor says otherwise, Propranolol should NOT be taken if you have:

  • Allergies to the drug’s ingredients
  • Asthma
  • An abnormally slow heartbeat 
  • Heart conditions (sick sinus syndrome, AV nodal block) 
  • Impaired liver function

While not strict contraindications, any of the following conditions also need to be discussed with a doctor before starting Propranolol:

  • Pregnancy and breastfeeding
  • Diabetes
  • Bronchitis or other breathing difficulties
  • Kidney or liver issues
  • Depression
  • Thyroid issues 
  • Coronary heart disease
  • Circulatory problems

 

Does Propranolol interact with other drugs?

Before beginning Propranolol treatment your doctor will ask you whether you are taking any other medications and advise you on whether these interact with Propranolol. Common known interactions with other medications include:

  • Other high blood pressure medications
  • NSAIDs (aspirin, naproxen, ibuprofen, diclofenac)
  • Blood thinners
  • Antidepressants
  • Drugs treating the prostate disorder
  • Drugs for heart rhythm disorders
  • Certain muscle relaxants 
  • Parkinson's disease drugs
  • Diabetes medication
  • Allergy drugs 

Lastly, you will also need to bear in mind that alcohol can enhance the effect of Propranolol on blood pressure. Combining the two can unintentionally lower blood pressure to levels that result in symptoms such as dizziness or lightheadedness. Minimizing alcohol consumption is recommended while taking Propranolol.

 

References

  1. Steenen, Serge A, et al. “Propranolol for the Treatment of Anxiety Disorders: Systematic Review and Meta-Analysis.” Journal of Psychopharmacology, vol. 30, no. 2, 4 Aug. 2020, pp. 128–139, www.ncbi.nlm.nih.gov/pmc/articles/PMC4724794/, 10.1177/0269881115612236. Accessed 29 July 2020.
  2. Srinivasan, AV. “Propranolol: A 50-Year Historical Perspective.” Annals of Indian Academy of Neurology, vol. 22, no. 1, 4 Aug. 2020, p. 21, 10.4103/aian.aian_201_18.

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