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Reviewed by Dr Roy Kedem, MD
Information last reviewed 07/09/20
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.
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.
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.
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.
The active ingredient is propranolol hydrochloride.
Inactive ingredients include lactose, magnesium stearate, microcrystalline cellulose, and stearic acid.
Please note, the inactive ingredients may vary across different brands of Propranolol.
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.
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.
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.
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.
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.
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.
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:
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.
For a comprehensive list of Propranolol side effects, see the manufacturer’s leaflet inside the packet.
Do NOT take Propranolol if you:
Before taking Propranolol, tell your doctor if you are/have:
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:
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.
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.
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.
Especially during the first couple of weeks of taking Propranolol or if you took a larger dose, you might feel a bit dizzy. In the event that this happens, it’s recommended to not drive a car or other vehicle.
Yes. Treating social and performance anxiety is one of Propranolol’s medical uses. How quickly Propranolol works for anxiety differs from person to person, but its effect usually starts within one hour of taking the drug. Likewise, how long Propranolol lasts for anxiety varies with each dosage and person. Generally, though, the effect will last for 5-6 hours. Your doctor can help you find the right dosage.
Yes. Propranolol can be prescribed for long-term migraine prevention. Propranolol for migraines is available through Medzino here.
If you have asthma, the use of Propranolol is advised against and most likely won’t be prescribed by doctors, since the medication could make your asthma worse.
Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.
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