Propranolol

Reduce migraines with Propranolol on prescription

Propranolol is a FDA-approved beta blocker that is good at lowering the frequency of migraines and reducing their severity. It takes only three weeks of use to show first effects.

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Information

Written by Dr Yasmin Aghajan, MD

Information last reviewed 08/07/19

About

What is Propranolol?

Propranolol is a FDA approved drug used to prevent migraine attacks. Classified as a beta-blocker medication, Propranolol works by reducing the frequency of migraine attacks in around 60 to 80 percent of people, although it is unclear whether it prevents migraines that are already occurring.

Propranolol is available in liquid, tablet and capsule form as well as an injectable solution; however, not all formulations are approved for the treatment of migraines. The medication is also used to treat a range of heart-related ailments including high blood pressure, irregular heartbeats and heart attacks. The brand names the medication is sold under include:

  • Inderal
  • Inderal LA
  • Inderal XL
  • InnoPran XL

How does Propranolol work?

In the prevention of migraine headaches, Propranolol works by blocking the hormone adrenaline which is responsible for the ‘fight or flight’ response in situations involving stress or danger. When adrenaline enters the bloodstream, it binds to blood vessels in the brain, essentially causing them to constrict and triggering the onset of a migraine. Propranolol and other beta-blocker drugs reverse this effect by relaxing the vessels and allowing the blood to flow freely to the brain.

How long does Propranolol take to work?

The effects of Propranolol on blood pressure and the cardiovascular system are usually felt within a few hours. However, for migraine prevention, it is recommended to take Propranolol for at least a few weeks to see if it works for you. On average, users should experience at least a 50 percent decrease in the number of migraines they experience, along with a marked reduction in the intensity and duration of the migraine attack.

How long do the effects of Propranolol last?

Propranolol taken as an oral medication is available in either an immediate-release pill or extended-release capsule. The type you take will be dependent on your individual symptoms as well as your doctor’s recommendations.

The drug from the immediate-release pill enters the bloodstream shortly after being ingested and you may need to take several doses a day depending on your response to the medication.

The extended-release capsule is usually consumed once a day. It will secrete the drug into the bloodstream at a much slower rate than the pill, the effects of which will typically last up to 24 hours.

Ingredients

Active ingredients

Propranolol is available at Medzino in tablet form of 20mg strength. The active ingredients in Propranolol (Inderal LA, Inderal XL and InnoPran XL) is propranolol hydrochloride.

Inactive ingredients

The inactive ingredients in Inderal tablets are: lactose, magnesium stearate, microcrystalline cellulose and stearic acid. In addition, the 20mg tablets contain FD&C Blue No. 1.

Please note: Inactive ingredients may vary between different manufacturers. 

Dosage

Propranolol dosage

Due to the variable rates at which Propranolol is absorbed into the blood, dosage should be individualized based on your doctor’s recommendations, as well as your response to the medication.

Initially, the recommended prescribed amount for preventing migraines is 80mg divided into even doses throughout the day. The dosage can then be gradually increased from anywhere between 160mg to 240mg until you experience relief from migraine symptoms.

How to take Propranolol

Propranolol can be taken with or without food, however, for optimum results it should be taken in a consistent way and at the same time of day. Due to possible effects of dizziness resulting from the extended-release capsule, your doctor may ask you to take it before bed.

Always refer to the patient information leaflet for full instructions.

How to stop taking Propranolol

It is important to note that if a satisfactory response is not achieved within 6 weeks of starting therapy, Propranolol should be withdrawn gradually over several weeks under the guidance of your physician.

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

If you are still within a few hours of your missed dose, take the missed dose late. However, do not take two doses within 12 hours of each other, as you may experience more dose-related side effects (such as low blood pressure, dizziness, slow heart rate).

What should I do if I took too much Propranolol?

You should seek immediate medical attention, either by calling your health provider, or going to the nearest urgent care or emergency department for evaluation. Overdose can have serious complications including death.

Side Effects

Propranolol side effects

In addition to its wide-ranging benefits, Propranolol can also cause many unwanted side-effects, although not everyone will experience them. Such undesired effects may gradually subside as your body adjusts to the medication, however, if symptoms persist or worsen, seek your doctor’s advice immediately.

The most common side-effects include (affecting less than 1 in 10 people):

  • Fatigue
  • Dizziness
  • Stomach cramps
  • Constipation
  • Cold hands or feet
  • Disturbed sleep
  • Slow heartbeat/ low blood pressure

Less common side-effects include:

  • Impotence/reduced sexual desire
  • Headaches
  • Mood changes
  • Shortness of breath/coughing
  • Tightness of chest
  • Yellow skin or whites of the eyes turning yellow

Precautions

Take caution not to break, chew, crush or open the Propranolol capsules before ingesting - this can cause potentially dangerous side effects. If the desired response is not obtained within four to six weeks after reaching the maximum dose, Propranolol should be discontinued. It is also advisable to withdraw the drug gradually over a period of several weeks rather than discontinuing abruptly as this can prompt chest pains and, in some instances, a heart attack.

Contraindications

Propranolol is not suitable for those with respiratory conditions such as asthma, bronchitis or emphysema. It should also be avoided by those who experience slow heartbeats, low blood pressure or any other heart conditions.

If you are scheduled for surgery where you will receive general anesthesia, you must inform your doctor and inquire how to manage your Propranolol dosing around the surgery.

Although Propranolol is not known to be harmful during pregnancy or while breastfeeding, it is not guaranteed. Therefore, it is always best to speak with your doctor about the potential benefits and risks associated with taking Propranolol and alternative medications that are better-suited for you.

While Propranolol enters the breast milk in small amounts, it is not enough to cause any harm to your baby. Having said this, it is important to inform your doctor if your baby was premature or suffers from any health problems.

Seek immediate medical attention if you experience any of the following symptoms as they could be indicative of an allergic reaction to Propranolol:

  • Itching or peeling skin
  • Difficulty breathing
  • Swelling of the face, lips, throat or tongue
  • Unusual bleeding

Drug Interactions

As certain medications may interfere with Propranolol, always tell your doctor about any you are currently taking, both prescribed and over-the-counter, including herbal or vitamin supplements.

Inform your doctor if you are taking medication for:

  • High blood pressure
  • Low blood pressure including for enlarged prostate glands or Parkinson’s disease
  • Irregular heartbeats
  • Asthma or chronic obstructive pulmonary disease
  • Diabetes, particularly insulin
  • Non-steroidal anti-inflammatory medicines (NSAIDs), such as Ibuprofen, Diclofenac or Naproxen

Treatment Options

Why choose Propranolol?

Over half of people experience improvement in their migraine frequency and severity after taking beta-blocking drugs such as Propranolol, making it a viable treatment option.

Regularly taking Propranolol can effectively lower the chances of you suffering a migraine in the first place. Furthermore, in instances where a migraine does occur, it will likely be shorter and less severe.

Where can I buy Propranolol?

Propranolol is a doctor-prescribed drug and therefore cannot be purchased over the counter in the United States. Medzino is able to offer first and repeat prescriptions for those who are interested in using Propranolol tablets as an effective treatment for migraines. Through our online consultation service, our doctor’s will assess your symptoms and subsequently advise you on the most suitable treatment and dosage.

Alternative treatment options

Migraine symptoms manifest differently in each individual as does the response to different treatment methods, based on medical history. In order to determine the best treatment for you, you may need to explore a range of medications. Your doctor will base this on the rate and severity of your migraines as well as any other health problems you may suffer from. Always speak with your doctor prior to considering any medication.

CGRP Inhibitors

Calcitonin gene-related peptide (CGRP) is a molecule responsible for initiating migraine pain. CGRP inhibitors are administered via an injection once a month and are clinically-proven to block the effects of CGRP. The most common side effects of the treatment include mild pain and redness at the site of the injection.

Verapamil

Verapamil may be a worthwhile alternative for preventing migraines and cluster headaches as – unlike the beta-blocking group of drugs – it is also safe to use by asthma sufferers. However, side effects can include low blood pressure and constipation.

Antidepressants

Tricyclic antidepressants or TCAs is one type of antidepressant that manipulates the chemicals in the brain that can set off a migraine attack. It is important to note that TCAs can cause severe problems in those who are pregnant or suffer from heart disease. This treatment can also make depression and suicide more likely in children and young adults.

Botulinum Toxin (Botox)

In addition to treating wrinkles, Botox can also effectively prevent migraines by obstructing the pain network in the brain from activating. The treatment is only recommended for those who experience headaches for more than 15 days per month, with several treatments required to achieve the desired effect.

Q&A

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.

  1. C. Doherty, ‘Propranolol for Migraine Prevention’, Very Well Health, DotDash, 2019, https://www.verywellhealth.com/propranolol-for-migraine-treatment-4172827, (accessed 18th April 2019).
  2. J. Johnson, ‘Everything You Need To Know About Propranolol’, Medical News Today, Healthline Media, 2018, https://www.medicalnewstoday.com/articles/316061.php, (accessed 21st April 2019).
  3. Migraine, ‘Propranolol’, Migraine, Health Media, 2019, https://migraine.com/migraine-treatment/propranolol-inderal/, (accessed 20th April 2019).
  4. M. Stewart, ‘Propranolol – A Beta-Blocker’, Patient, Author, 2017, https://patient.info/medicine/propranolol-a-beta-blocker, (accessed 17th April 2019).
  5. NHS, ‘Propranolol’, NHS, Crown, 2018, https://www.nhs.uk/medicines/propranolol/, (accessed 20th April 2019).
  6. Silberstein SD et al. 'Evidence-based guideline update: Pharmacologic treatment for episodic migraine prevention in adults'. Neurology. 2012 Apr 24; 78(17): 1337–1345. [PubMed: 22529202]
  7. Aijie He et al. 'Unveiling the relative efficacy, safety and tolerability of prophylactic medications for migraine: pairwise and network-meta analysis'. J Headache Pain. 2017; 18(1): 26. [PubMed: 28220376]

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