What are the doses of Propranolol (beta blocker)?

From the Guidelines

Propranolol dosing should be initiated at 20-80 mg twice daily for angina, as recommended by the most recent guidelines 1. The dosing of propranolol varies based on the condition being treated.

• For angina, the usual dose is 20 to 80 mg twice daily, as stated in the guidelines 1.
• For other conditions such as hypertension, anxiety, migraine prevention, and essential tremor, the dosing may differ, but the guidelines provided do not specifically address these conditions. It is essential to note that propranolol should be taken consistently, and patients should never stop abruptly as this can cause rebound hypertension or angina.
• Common side effects include fatigue, dizziness, and cold extremities.
• Propranolol is contraindicated in patients with certain conditions, including asthma, severe bradycardia, and heart block, so a thorough medical history is essential before prescribing 1. The choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity 1.
• The target resting heart rate is 50 to 60 beats per minute unless a limiting side effect is reached.
• Selection of the oral agent should include the clinician’s familiarity with the agent.
• Maintenance doses are given in the guidelines, and the medication should be adjusted based on the patient's response and tolerance 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION General: Propranolol hydrochloride extended-release capsules provide propranolol hydrochloride in a sustained-release capsule for administration once daily. Hypertension: The usual initial dosage is 80 mg propranolol hydrochloride extended-release capsules once daily, whether used alone or added to a diuretic. The dosage may be increased to 120 mg once daily or higher until adequate blood pressure control is achieved. The usual maintenance dosage is 120 to 160 mg once daily. In some instances a dosage of 640 mg may be required Angina Pectoris: Starting with 80 mg propranolol hydrochloride extended-release capsules once daily, dosage should be gradually increased at three- to seven-day intervals until optimal response is obtained Although individual patients may respond at any dosage level, the average optimal dosage appears to be 160 mg once daily. Migraine: The initial oral dose is 80 mg propranolol hydrochloride extended-release capsules once daily. The usual effective dose range is 160 to 240 mg once daily. Hypertrophic Subaortic Stenosis: The usual dosage is 80 to 160 mg propranolol hydrochloride extended-release capsules once daily.

The recommended doses of propranolol are:

• Hypertension: 80-640 mg once daily, with a usual maintenance dosage of 120-160 mg once daily 2
• Angina Pectoris: 80-320 mg once daily, with an average optimal dosage of 160 mg once daily 2
• Migraine: 80-240 mg once daily, with a usual effective dose range of 160-240 mg once daily 2
• Hypertrophic Subaortic Stenosis: 80-160 mg once daily 2

From the Research

Propranolol Doses

• The provided studies do not directly mention the doses of propranolol, but they discuss the use of beta-adrenergic receptor blockers (β-blockers) in hypertension treatment 3.
• β-Blockers, including propranolol, can be used in combination with other anti-hypertension drugs to achieve maximal blood pressure control 3.
• The studies focus on the use of low-dose combination therapy for initial treatment of hypertension, which may include β-blockers, but do not specify the doses of propranolol 4, 5.
• The selection of a β-blocker, such as propranolol, depends on various pharmacologic properties, including degree of intrinsic sympathomimetic activity, membrane stabilizing activity, β1 selectivity, and α1-adrenergic blocking effects 3.

Hypertension Treatment

• Low-dose combination therapy is a promising option for initial treatment of hypertension, appearing to be safe and effective 4.
• The evidence for initiating antihypertensive drug treatment and achieving specific systolic blood pressure levels is scanty, but current recommendations can be accepted as prudent statements 5.
• β-Blockers are an appropriate treatment for patients with systemic hypertension who have concomitant ischemic heart disease, heart failure, or certain cardiac arrhythmias 3.