Class: β-Adrenergic Blocker, Nonselective
Dosage Forms. Tablet: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg; Capsule (Extended Release): 60 mg, 80 mg, 120 mg, 160 mg; Solution: 20 mg/5 mL, 40 mg/5 mL
Common FDA Label Indication, Dosing, and Titration.
1. Angina pectoris, chronic: Immediate release, 80-320 mg po daily in 2-4 doses; Extended release, 80-160 mg po daily
2. Cardiac dysrhythmia: Adults, 10-30 mg po tid-qid; Children, 2-6 mg/kg po in 3-4 doses, max 60 mg/d
3. Hypertension: Adults, immediate release, 40 mg po bid, may titrate to 240 mg po daily in 2-3 doses; Adults, extended release, 80 mg po daily, may titrate to 160 mg po daily; Children, immediate release, 0.5-1 mg/kg po daily in 3-4 doses, may titrate to 16 mg/kg/d
4. Migraine, prophylaxis: Immediate release, 80 mg po daily in divided doses; may titrate to 240 mg po daily; Extended release, 80 mg po daily; may titrate to 240 mg po daily
1. Anxiety: 10 mg po 1 h prior to event
MOA. Propranolol is a nonselective β-adrenergic blocker that produces AV nodal conduction in supraventricular tachycardias and blockade of catecholamine-induced dysrhythmias. The antihypertensive mechanism is unknown, but contributing factors are a CNS mechanism, renin blockade, and decreases in myocardial contractility and cardiac output.
Drug Characteristics: Propranolol
Medication Safety Issues: Propranolol
Drug Interactions: Propranolol
Adverse Reactions: Propranolol
Efficacy Monitoring Parameters. Decreased BP, chest pain, number of angina attacks, nitroglycerin use, signs/symptoms of CHF, reduction in tremors, frequency of migraines.
Toxicity Monitoring Parameters. Signs/symptoms of CHF, decreased heart rate, bronchospasm, increased FPG, exacerbations of angina pectoris, or acute coronary insufficiency. Monitor vital signs, SCr, BUN.
Key Patient Counseling Points. Take on an empty stomach and avoid alcohol. Avoid abrupt discontinuation; exacerbations of angina may occur. Report signs/symptoms of hypotension, CHF, or exacerbation of angina with initial dosing and dose changes. This medicine may cause dizziness. Diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.
Clinical Pearls. When discontinuance of propranolol is planned, dosage should be gradually reduced over at least a few weeks. Avoid smoking, as smoking induces CYP1A2 and increases metabolism (reducing effectiveness) of propranolol, plus it’s bad for you.