BMA Concise Guide to Medicine & Drugs

Propranolol

Brand names Angilol, Bedranol SR, Beta-Prograne, Half Inderal, Inderal, Inderal LA, Slo-Pro, Syprol, and others

Used in the following combined preparations None

QUICK REFERENCE

Drug group Beta blocker and anti-anxiety drug

Overdose danger rating High

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Propranolol, a non-cardioselective beta blocker, is mainly used to treat angina and abnormal heart rhythms and is helpful in controlling the symptoms of an overactive thyroid gland. It also helps to reduce the palpitations, sweating, and tremor of severe anxiety and to prevent migraine. The drug is also used to treat hypertension (high blood pressure) but this use is declining as more selective beta blockers are now available. Propranolol is not given to people with respiratory diseases (especially asthma) because it can cause breathing difficulties. It should be used with caution by people with diabetes because it affects the body’s response to low blood sugar.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, SR capsules, liquid, injection.

Frequency and timing of doses 2–4 x daily. Once daily (SR capsules).

Adult dosage range Abnormal heart rhythms 30–160mg daily. Angina 80–240mg daily. Hypertension 160–320mg daily. Migraine prevention; anxiety 40–160mg daily.

Onset of effect 1–2 hours (tablets); after 4 hours (SR capsules). In hypertension and migraine, it may be several weeks before full benefits are felt.

Duration of action 6–12 hours (tablets); up to 24 hours (SR capsules).

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 2 hours (tablets) or 12 hours (SR capsules), take a single dose now and skip the next.

Stopping the drug Do not stop the drug without consulting your doctor. Abrupt cessation may lead to worsening of the underlying condition.

OVERDOSE ACTION

Seek immediate medical advice. Take emergency action if breathing difficulties, collapse, or loss of consciousness occur.

POSSIBLE ADVERSE EFFECTS

Propranolol’s adverse effects are common to most beta blockers and tend to diminish with long-term use. All adverse effects should be reported to your doctor. The most common adverse effects are lethargy, fatigue, and cold hands and feet. Less commonly, there may be nausea, vomiting, vivid dreams or nightmares, and visual disturbances. With any of these less common symptoms (except nausea and vomiting), you should stop taking the drug. If you experience palpitations or fainting (which may indicate that the drug has slowed the heart excessively), breathlessness, or wheezing, you should stop taking the drug and contact your doctor immediately.

INTERACTIONS

Calcium channel blockers may cause low blood pressure, a slow heartbeat, and heart failure if used with propranolol.

Non-steroidal anti-inflammatory drugs (NSAIDs) (e.g. indometacin) may reduce the antihypertensive effect of propranolol.

Theophylline/aminophylline Propranolol may increase blood levels of these drugs.

Antihypertensive drugs Propranolol may enhance the blood-pressure-lowering effect.

Cimetidine may increase the effects of propranolol.

Cardiac glycosides may increase the heart-slowing effect of propranolol.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have long-term liver or kidney problems.

· You have a breathing disorder such as asthma, bronchitis, or emphysema.

· You have heart problems.

· You have diabetes.

· You have psoriasis.

· You have poor circulation in the legs.

· You are taking other medicines.

Pregnancy May affect the baby. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk, but at normal doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 Increased risk of adverse effects. Reduced starting dose will therefore be necessary.

Driving and hazardous work Avoid such activities until you have learned how the drug affects you because it can cause dizziness.

Alcohol Avoid excessive intake. Alcohol may increase the blood-pressure-lowering effect of propranolol.

Surgery and general anaesthetics Occasionally, propranolol may need to be stopped before you have a general anaesthetic but only do this after discussion with your doctor or dentist.

PROLONGED USE

No problems expected.