From the Guidelines
The maximum recommended dose of propranolol is 160 mg per day for immediate release (IR) and long-acting (LA) formulations, as indicated in the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1.
Key Considerations
- The dose of propranolol may vary depending on the specific indication, such as hypertension, angina, migraine prevention, anxiety, or arrhythmias.
- The usual dose range for propranolol IR is 80-160 mg per day, and for propranolol LA is 80-160 mg per day, as stated in the guideline 1.
- It is essential to start with a low dose and gradually increase it under medical supervision to minimize side effects like fatigue, dizziness, and bradycardia.
- Patients with liver or kidney impairment may require lower maximum doses, and individual factors may affect appropriate dosing.
Important Precautions
- Never abruptly stop propranolol, as this can cause rebound effects, including worsened angina or heart rhythm problems.
- Propranolol should be taken exactly as prescribed by a healthcare provider, considering individual factors that may affect dosing.
- The 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia also supports the use of propranolol, with a maximum total daily maintenance dose of 40-160 mg in divided or single dose with long-acting formulations 1.
From the FDA Drug Label
The usual maintenance dosage is 120 to 160 mg once daily. In some instances a dosage of 640 mg may be required
- The maximum recommended dose of propranolol is 640 mg per day 2.
- This dose may be required in some instances for hypertension.
- For angina pectoris, the safety of dosage exceeding 320 mg per day has not been established.
From the Research
Maximum Recommended Dose of Propranolol
The maximum recommended dose of propranolol varies depending on the condition being treated.
- For hypertension, the typical dose range is 40-240 mg per day, divided into 2-3 doses 3.
- For angina pectoris, the typical dose range is 80-320 mg per day, divided into 2-3 doses 3.
- For migraine prophylaxis, the typical dose range is 80-240 mg per day, divided into 2-3 doses 3.
- For anxiety disorders, the typical dose range is 40-160 mg per day, divided into 2-3 doses 3.
High-Dose Propranolol
In some cases, high-dose propranolol may be prescribed, such as for the treatment of challenging behaviors in individuals with autism spectrum disorders.
- A study published in the Journal of Clinical Psychopharmacology found that doses ranging from 120 to 960 mg per day were effective in reducing symptoms, with a mean dose of 462 mg per day 4.
- However, it is essential to note that high-dose propranolol should only be prescribed under close clinical monitoring due to the potential for adverse cardiovascular effects.
Comparison with Other Studies
Other studies have also investigated the use of propranolol for various indications, including hypertension, cardiac arrhythmias, and hyperthyroidism 5, 6.
- A study published in the Annals of Indian Academy of Neurology provided a historical perspective on the development and use of propranolol, highlighting its versatility and efficacy in various medical conditions 5.
- A study published in Wiadomosci Lekarskie reviewed the clinical applications of propranolol, including its use in cardiovascular diseases and neuropsychiatric disorders 6.