From the Guidelines
Propranolol commonly causes side effects including sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension. These side effects are due to its beta-blocking properties that reduce heart rate and blood pressure 1. Some patients may experience gastrointestinal symptoms, and sexual dysfunction is also possible. More serious but less common side effects include shortness of breath and depression.
Common Side Effects
- Sleep disturbances, including vivid dreams or insomnia
- Bronchial irritation, including hyperreactivity, bronchospasm, bronchiolitis, and cold-induced wheezing
- Clinically symptomatic bradycardia and hypotension
- Gastrointestinal effects like nausea, vomiting, and diarrhea
- Sexual dysfunction, including decreased libido or erectile difficulties
Less Common Side Effects
- Shortness of breath
- Wheezing
- Depression
- Confusion Propranolol works by blocking beta-adrenergic receptors, reducing the effects of adrenaline on the heart and blood vessels, which explains many of these side effects 1. Patients should not abruptly stop taking propranolol as this can cause rebound hypertension or worsening angina. If experiencing concerning side effects, especially breathing difficulties, significant mood changes, or very slow heart rate (below 50 beats per minute), patients should contact their healthcare provider immediately rather than discontinuing the medication on their own.
From the FDA Drug Label
ADVERSE REACTIONS The following adverse events were observed and have been reported in patients using propranolol. Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type Central Nervous System: Lightheadedness; mental depression manifested by insomnia, lassitude, weakness, fatigue; catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics For immediate release formulations, fatigue, lethargy, and vivid dreams appear dose related. Gastrointestinal: Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, ischemic colitis Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions; pharyngitis and agranulocytosis; erythematous rash; fever combined with aching and sore throat; laryngospasm; respiratory distress. Respiratory: Bronchospasm. Hematologic: Agranulocytosis, nonthrombocytopenic purpura, and thrombocytopenic purpura. Autoimmune: Systemic lupus erythematosus (SLE) Skin and mucous membranes: Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema multiforme, urticaria, alopecia, SLE-like reactions, and psoriasisiform rashes. Oculomucocutaneous syndrome involving the skin, serous membranes, and conjunctivae reported for a beta-blocker (practolol) have not been associated with propranolol. Genitourinary: Male impotence; Peyronie’s disease. The common side effects of propranolol include:
- Cardiovascular: Bradycardia, congestive heart failure, hypotension
- Central Nervous System: Lightheadedness, mental depression, fatigue
- Gastrointestinal: Nausea, vomiting, diarrhea
- Allergic: Hypersensitivity reactions, anaphylactic/anaphylactoid reactions
- Respiratory: Bronchospasm
- Hematologic: Agranulocytosis, thrombocytopenic purpura
- Autoimmune: Systemic lupus erythematosus (SLE)
- Skin and mucous membranes: Stevens-Johnson Syndrome, toxic epidermal necrolysis, urticaria
- Genitourinary: Male impotence, Peyronie’s disease 2
From the Research
Propranolol Side Effects
- The incidence of adverse effects of propranolol is reported in a group of more than 400 patients treated with propranolol between 1964 and 1974, with severe side effects necessitating withdrawal of the drug found in less than 10% of patients 3.
- Dose-limiting side effects were found in less than 15% of patients, and tolerable side effects are studied in detail, with pharmacologically based side effects recorded and ways of minimizing their frequency discussed 3.
- Propranolol is a non-selective beta-blocker, and its side effects may be related to its beta-blocking activity, which can affect the cardiovascular system and other bodily functions 4.
- The side effects of propranolol can be minimized by adjusting the dose and monitoring the patient's response to the medication, and by using alternative beta-blockers with more selective beta-blocking activity if necessary 4.
Comparison with Other Beta-Blockers
- Propranolol has been compared with other beta-blockers, such as atenolol, bisoprolol, metoprolol, and carvedilol, in terms of its efficacy and side effects 5, 6.
- The evidence suggests that propranolol has similar efficacy to other beta-blockers in reducing cardiovascular morbidity and mortality, but its side effects may be more pronounced due to its non-selective beta-blocking activity 5, 6.
- Carvedilol, a vasodilating beta-blocker, has been shown to have more potent beneficial effects on cardiovascular mortality and morbidity compared to propranolol and other beta-blockers 6.
Patient Populations
- Propranolol can be used in patients with congestive heart failure and concomitant obstructive airway disease, but its use should be cautious and monitored due to the potential risk of bronchospasm 7.
- The evidence suggests that propranolol can be safe and effective in patients with hypertension, but its use should be individualized and monitored due to the potential risk of side effects 5.