Return to Common Drugs Index
propranolol hydrochloride
Apo-Propranolol†, Deralin‡, Inderal, Inderal LA, Novopranol†, pms Propranolol†

Pregnancy Risk Category C

How supplied
Tablets:
10 mg, 20 mg, 40 mg, 60 mg, 80 mg, 90 mg
Capsules (extended-release):
60 mg, 80 mg, 120 mg, 160 mg
Oral solution:
4 mg/ml, 8 mg/ml, 80 mg/ml (concentrate)
Injection:
1 mg/ml

Action
A nonselective beta blocker that reduces cardiac oxygen demand by blocking catecholamine-induced increases in heart rate, blood pressure, and force of myocardial contraction. Depresses renin secretion and prevents vasodilation of cerebral arteries.

Indications & dosage
Angina pectoris
--
Adults:
total daily doses of 80 to 320 mg P.O. when given b.i.d., t.i.d., or q.i.d. Or, one 80-mg extended-release capsule daily. Dosage increased at 3- to 7-day intervals.
Mortality reduction after MI
--
Adults:
180 to 240 mg P.O. daily in divided doses beginning 5 to 21 days after MI has occurred. Usually administered t.i.d. or q.i.d.
Supraventricular, ventricular, and atrial arrhythmias; tachyarrhythmias caused by excessive catecholamine action during anesthesia, hyperthyroidism, or pheochromocytoma
--
Adults:
0.5 to 3 mg by slow I.V. push, not to exceed 1 mg/minute. After 3 mg have been given, another dose may be given in 2 minutes; subsequent doses, no sooner than q 4 hours. May be diluted and infused slowly. Usual maintenance dose is 10 to 30 mg P.O. t.i.d. or q.i.d.
Hypertension
--
Adults:
initially, 80 mg P.O. daily in two to four divided doses or extended-release form once daily. Increased at 3- to 7-day intervals to maximum daily dose of 640 mg. Usual maintenance dose is 160 to 480 mg daily.
Prevention of frequent, severe, uncontrollable, or disabling migraine or vascular headache--

Adults:
initially, 80 mg P.O. daily in divided doses or one extended-release capsule daily. Usual maintenance dose is 160 to 240 mg daily, t.i.d. or q.i.d.
Essential tremor
--
Adults:
40 mg (tablets, oral solution) P.O. b.i.d. Usual maintenance dose is 120 to 320 mg daily in three divided doses.
Hypertrophic subaortic stenosis--

Adults:
20 to 40 mg P.O. t.i.d. or q.i.d.; or 80 to 160 mg extended-release capsules once daily.
Adjunct therapy in pheochromocytoma
--
Adults:
60 mg P.O. daily in divided doses with an alpha blocker 3 days before surgery.

Adverse reactions
CNS:
fatigue, lethargy, vivid dreams, hallucinations, mental depression, light-headedness, insomnia.
CV:
bradycardia, hypotension, heart failure, intermittent claudication, intensification of AV block.
GI:
abdominal cramping, constipation, diarrhea, nausea, vomiting.
GU:
elevated BUN levels.
Hematologic: agranulocytosis.
Hepatic:
elevated serum transaminase, alkaline phosphatase, and LDH levels.
Respiratory:
bronchospasm.
Skin:
rash.
Other:
fever.

Interactions
Drug-drug.
Aminophylline: antagonized beta-blocking effects of propranolol. Use together cautiously.
Cardiac glycosides, diltiazem, verapamil:
hypotension, bradycardia, and increased depressant effect on myocardium. Use together cautiously.
Cimetidine:
inhibited metabolism of propranolol. Monitor for increased beta-blocking effect.
Epinephrine:
severe vasoconstriction. Monitor blood pressure and observe patient carefully.
Glucagon, isoproterenol:
antagonized propranolol effect. May be used therapeutically and in emergencies.
Haloperidol:
cardiac arrest has occurred with concomitant therapy. Avoid use together.
Insulin, oral antidiabetics:
can alter requirements for these drugs in previously stabilized diabetics. Monitor for hypoglycemia.
Phenothiazines, reserpine:
additive effect. Use cautiously.
Drug-herb.
Betel palm: decreased temperature-elevating effects and enhanced CNS effects. Avoid concomitant use.
Drug-lifestyle.
Cocaine use: increased angina-inducing potential of cocaine. Monitor patient carefully.

Effects on diagnostic tests
None reported.

Contraindications
Contraindicated in patients with bronchial asthma, sinus bradycardia and heart block greater than first-degree, cardiogenic shock, and heart failure (unless failure is secondary to a tachyarrhythmia that can be treated with propranolol).

Nursing considerations

I.V. administration

Patient teaching

*Liquid contains alcohol. **May contain tartrazine.  †Canada  ‡Australia  §U.K.  OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING

Return to Common Drugs Index