From the Guidelines
Propranolol is a beta-blocker medication primarily used to treat high blood pressure, irregular heart rhythms, angina (chest pain), and certain types of tremors, as well as for preventing migraines, managing symptoms of anxiety, and treating certain symptoms of hyperthyroidism. The medication works by blocking the effects of adrenaline (epinephrine) on beta receptors in the heart and blood vessels, which reduces heart rate, blood pressure, and the workload on the heart 1. For hypertension, typical dosing ranges from 40-320 mg daily, often divided into multiple doses. For anxiety, lower doses of 10-40 mg may be used as needed before anxiety-provoking situations. Common side effects include fatigue, dizziness, and cold extremities. Propranolol is contraindicated in people with certain conditions including severe asthma, certain heart conditions like heart block, and uncontrolled heart failure 1. Some key points to consider when prescribing propranolol include:
- Evaluating patients for potential adverse effects, such as sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension 1
- Monitoring patients for signs of hypoglycemia, hypotension, bradycardia, and bronchospasm 1
- Adjusting the dosage or discontinuing treatment if necessary to minimize adverse effects 1
- Considering alternative treatments, such as intralesional corticosteroid injection, for certain conditions like periocular infantile hemangiomas 1
From the FDA Drug Label
CLINICAL PHARMACOLOGY General: Propranolol is a nonselective, beta-adrenergic receptor-blocking agent possessing no other autonomic nervous system activity... In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction The mechanism of the antihypertensive effect of propranolol has not been established... Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action.
Propranolol is used for:
- Hypertension: to reduce blood pressure
- Angina pectoris: to reduce oxygen requirement of the heart
- Antiarrhythmic effects: to treat arrhythmias
- Migraine: although the mechanism is not established 2
From the Research
Uses of Propranolol
- Propranolol is used to control hypertension, pheochromocytoma, myocardial infarction, cardiac arrhythmias, angina pectoris, and hypertrophic cardiomyopathy 3
- It is also used to control symptoms of sympathetic overactivity in the management of hyperthyroidism, anxiety disorders, and tremor 3
- Other indications cover the prophylaxis of migraine and of upper gastrointestinal bleeding in patients with portal hypertension 3
Beta-Adrenergic Receptor Blockers in Hypertension
- Beta-adrenergic receptor blockers (β-blockers) are an appropriate treatment for patients having systemic hypertension (HTN) who have concomitant ischemic heart disease (IHD), heart failure, obstructive cardiomyopathy, aortic dissection or certain cardiac arrhythmias 4
- β-Blockers can be used in combination with other antiHTN drugs to achieve maximal blood pressure control 4
- β-Blockers may be useful in HTN patients having a hyperkinetic circulation (palpitations, tachycardia, HTN, and anxiety), migraine headache, and essential tremor 4