Know the basics
What is propranolol used for?
This medication is a beta blocker used to treat high blood pressure, irregular heartbeats, shaking (tremors), and other conditions. It is used after a heart attack to improve the chance of survival. It is also used to prevent migraine headaches and chest pain (angina). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Preventing chest pain can help improve your ability to exercise.
This drug works by blocking the action of certain natural chemicals in your body (such as epinephrine) that affect the heart and blood vessels. This effect reduces heart rate, blood pressure, and strain on the heart.
OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
This medication has also been used to control symptoms of anxiety or overactive thyroid (hyperthyroidism).
How should I take propranolol?
Take this medication by mouth, usually 2 to 4 times daily or as directed by your doctor. Take this medication before meals (and at bedtime if taking 4 times daily). Measure the liquid medication with a medication-measuring spoon or device. Do not use a household spoon because you may not get the correct dose.
The dosage is based on your medical condition and response to treatment.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day. It is important to continue taking this medication even if you feel well.
This medication is used to help prevent chest pain or migraines. It should not be used to treat chest pain or migraines when they occur. Use other medications (e.g., nitroglycerin tablets placed under the tongue for chest pain, sumatriptan for migraines) to relieve sudden attacks as directed by your doctor. Consult your doctor or pharmacist for details.
If you also take certain drugs to lower your cholesterol (bile acid-binding resins such as cholestyramine or colestipol), take propranolol at least 1 hour before or at least 4 hours after these medications.
For the treatment of high blood pressure, it may take 1 to 2 weeks before you get the full benefit of this drug.
Tell your doctor if your condition worsens (e.g., your routine blood pressure readings increase, your chest pain or migraines occur more often).
How do I store propranolol?
Propranolol is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store propranolol in the bathroom or the freezer. There may be different brands of propranolol that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.
You should not flush propranolol down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.
Know the precautions & warnings
What should I know before using propranolol?
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Appropriate studies have not been performed on the relationship of age to the effects of propranolol injection in the pediatric population. Safety and efficacy have not been established .
Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of propranolol injection in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving propranolol injection.
Is it safe to take propranolol during pregnancy or breast-feeding?
There isn’t enough information about the safety of using this medication during pregnancy and breast-feeding. Please always consult with your doctor to weigh the potential benefits and risks before taking this medication.
Know the side effects
What are the side effects of propranolol?
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have a serious side effect such as:
- fast, slow, or uneven heartbeats;
- feeling light-headed, fainting;
- feeling short of breath, even with mild exertion;
- swelling of your ankles or feet;
- nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
- cold feeling in your hands and feet;
- depression, confusion, hallucinations; or
- severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Less serious side effects may include:
- nausea, vomiting, diarrhea, constipation, stomach cramps;
- decreased sex drive, impotence, or difficulty having an orgasm;
- sleep problems (insomnia); or
- tired feeling.
Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.
Know the interactions
What drugs may interact with propranolol?
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Bupivacaine Liposome
- Eslicarbazepine Acetate
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Amtolmetin Guacil
- Choline Salicylate
- Flufenamic Acid
- Guar Gum
- Ibuprofen Lysine
- Insulin Aspart, Recombinant
- Insulin Glulisine
- Insulin Lispro, Recombinant
- Mefenamic Acid
- Niflumic Acid
- Salicylic Acid
- Sodium Salicylate
- St John’s Wort
- Tiaprofenic Acid
- Tolfenamic Acid
Does food or alcohol interact with propranolol?
Propranolol may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.
What health conditions may interact with propranolol?
Propranolol may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have, especially:
- Angina (severe chest pain)—May provoke chest pain if stopped too quickly .
- Asthma or
- Bradycardia (slow heartbeat) or
- Heart block or
- Heart failure—Should not use in patients with these conditions .
- Diabetes or
- Hyperthyroidism (overactive thyroid) or
- Hypoglycemia (low blood sugar)—May cover up some of the signs and symptoms of these diseases, such as a fast heartbeat .
- Kidney disease or
- Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body .
- Lung disease (e.g., bronchitis, emphysema)—May cause difficulty with breathing in patients with this condition .
- Wolff-Parkinson-White syndrome (rare heart condition)—May cause a very slow heartbeat in patients with this condition.
Understand the dosage
The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this medication.
What is the dose of propranolol for an adult?
Usual Adult Dose for Hypertension
Immediate-release: 40 mg orally 2 times a day
Sustained-release: 80 mg orally once a day
XL sustained-release: 80 mg orally once a day at bedtime
Immediate-release: 120 to 240 mg orally per day
Sustained-release: 120 to 160 mg orally per day
XL sustained-release: 80 to 120 mg orally once a day at bedtime
IR/SR: 640 mg orally per day
XR: 120 mg orally per day
Usual Adult Dose for Angina Pectoris
Immediate-release: Total daily doses of 80 to 320 mg orally 2 to 4 times a day have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG.
Sustained-release: Initial dose: 80 mg orally once a day. Dosage should be gradually increased at 3 to 7 day intervals. The average optimal dosage appears to be 160 mg once a day.
Maximum dose: 320 mg per day
Usual Adult Dose for Arrhythmias
Immediate-release: 10 to 30 mg orally 3 to 4 times a day, before meals and at bedtime
IV: 1 to 3 mg at a rate not exceeding 1 mg/min. Sufficient time should be allowed for the drug to reach the site of action even when a slow circulation is present. A second dose may be given after 2 minutes. Thereafter, additional drug should not be given in less than 4 hours.
Usual Adult Dose for Myocardial Infarction
Initial dose: 40 mg orally 3 times a day for 1 month, then increase to 60 to 80 mg orally 3 times a day as tolerated.
Maintenance dose: 180 mg to 240 mg orally per day in divided doses (2 to 4 times daily)
Maximum dose: 240 mg orally per day
Usual Adult Dose for Migraine Prophylaxis
Initial dose: 80 mg orally per day in divided doses
Maintenance dose: 160 to 240 mg orally per day in divided doses
Initial dose: 80 mg orally once a day
Maintenance dose: 160 to 240 mg once a day
Usual Adult Dose for Benign Essential Tremor
Initial dose: 40 mg orally 2 times a day
Maintenance dose: 120 to 320 mg orally per day
Usual Adult Dose for Aortic Stenosis
Immediate-release: 20 to 40 mg orally 3 to 4 times a day, before meals and at bedtime
Sustained-release: 80 to 160 mg orally once a day
Use: Hypertrophic Subaortic Stenosis
Usual Adult Dose for Pheochromocytoma
Preoperatively: 60 mg orally daily in divided doses for 3 days prior to surgery as adjunctive therapy to alpha-adrenergic blockade
Management of Inoperable Tumor: 30 mg orally daily in divided doses as adjunctive therapy to alpha-adrenergic blockade
Usual Adult Dose for Atrial Fibrillation
Immediate-release: 10 mg to 30 mg orally 3 or 4 times a day before meals and at bedtime
What is the dose of propranolol for a child?
Usual Pediatric Dose for Arrhythmias
Oral: Children: Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 8 hours; titrate dosage upward every 3 to 5 days; usual dose: 2 to 4 mg/kg/day; higher doses may be needed; do not exceed 16 mg/kg/day
IV: Children: 0.01 to 0.1 mg/kg slow IV over 10 minutes; maximum dose: 1 mg (infants); 3 mg (children)
Usual Pediatric Dose for Hypertension
Immediate release formulations:
Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 12 hours; increase gradually every 5 to 7 days
Usual dose: 1 to 5 mg/kg/day
Maximum dose: 8 mg/kg/day
Children and Adolescents 1 to 17 years:
Immediate release formulations:
Initial: 1 to 2 mg/kg/day divided in 2 to 3 doses/day; titrate dose to effect
Maximum dose: 4 mg/kg/day up to 640 mg/day; sustained release formulation may be dosed once daily (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents).
Usual Pediatric Dose for Thyrotoxicosis
Neonates: Oral: 2 mg/kg/day in divided doses every 6 to 12 hours; occasionally higher doses may be required
Adolescents: Oral: 10 to 40 mg/dose every 6 hours
Usual Pediatric Dose for Hemangioma
Propranolol oral solution 4.28 mg/mL:
Initiate treatment at ages 5 weeks to 5 months:
Initial dose: 0.15 mL/kg (0.6 mg/kg) orally 2 times a day (at least 9 hours apart)
-After 1 week: Increase the daily dose to 0.3 mL/kg (1.1 mg/kg) orally 2 times a day (at least 9 hours apart)
-After 2 weeks: Increase the dose to 0.4 mL/kg (1.7 mg/kg) orally 2 times a day (at least 9 hours apart) maintain for 6 months
How is propranolol available?
Propranolol is available in the following dosage forms and strengths:
Capsule: 60 mg; 80 mg; 120 mg; 160 mg
What should I do in case of an emergency or overdose?
In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.
What should I do if I miss a dose?
If you miss a dose of propranolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: May 30, 2016 | Last Modified: November 28, 2019
Propranolol. http://www.healthline.com/health/propranolol/oral-tablet. Accessed July 14, 2016.
Propranolol. https://www.drugs.com/propranolol.html. Accessed July 14, 2016.
Propranolol. http://www.mayoclinic.org/drugs-supplements/propranolol-oral-route/proper-use/drg-20071164. Accessed July 14, 2016.