From the FDA Drug Label
If treatment is to be discontinued, reduce dosage gradually over a period of a few weeks (see "WARNINGS") It may be advisable to withdraw the drug gradually over a period of several weeks depending on the patient’s age, comorbidity, and dose of propranolol hydrochloride extended-release capsules
The recommended protocol for tapering propranolol is to reduce the dosage gradually over a period of a few weeks or several weeks, taking into account the patient's age, comorbidity, and dose of propranolol hydrochloride extended-release capsules 1.
- The exact tapering schedule is not specified, but it should be done gradually to minimize withdrawal symptoms.
- It is essential to consider the patient's individual factors, such as age and comorbidity, when determining the tapering protocol.
- The dose of propranolol hydrochloride extended-release capsules should also be taken into account when tapering the medication.
From the Research
The recommended protocol for tapering propranolol involves reducing the dose to a prolonged small dose of 30 mg daily for 2 weeks before complete withdrawal, as this approach has been shown to largely prevent cardiac hypersensitivity and other adverse events 2. This approach is supported by a study published in The American Journal of Cardiology, which found that reducing the dose to a small amount before complete withdrawal was more effective in preventing withdrawal symptoms than a serial dose reduction over 6 to 9 days 2. Some key points to consider when tapering propranolol include:
- Gradually reducing the dose over a period of time to minimize withdrawal symptoms
- Monitoring for withdrawal symptoms such as increased heart rate, elevated blood pressure, anxiety, tremors, and potential rebound angina in patients with coronary artery disease
- Being aware that abrupt discontinuation can lead to severe rebound hypertension, tachycardia, and even precipitate angina or myocardial infarction in susceptible individuals
- Understanding that chronic beta-blocker use leads to upregulation of beta-adrenergic receptors, and sudden withdrawal can result in excessive sympathetic nervous system activity as these receptors are no longer blocked but remain hypersensitive to circulating catecholamines It's also important to note that the choice of beta-blocker and the tapering protocol may vary depending on the individual patient's needs and medical history, and that other studies have shown that beta-blockers can be an effective treatment for hypertension and other conditions 3, 4, 5, 6. However, the most recent and highest quality study on tapering propranolol recommends the prolonged small dose approach 2. In terms of specific tapering schedules, the following is an example:
- If a patient is taking 80mg twice daily, reduce to 60mg twice daily for 3-7 days, then to 40mg twice daily for 3-7 days, and so on until a dose of 30mg daily is reached
- Once the patient is taking 30mg daily, continue this dose for 2 weeks before complete withdrawal It's also important to monitor the patient closely during the tapering process and adjust the schedule as needed to minimize withdrawal symptoms.