From the Guidelines
Propranolol is indicated for various conditions, including stable, narrow-complex tachycardias, and its dosing guidelines are 0.5 to 1 mg over 1 minute, repeated up to a total dose of 0.1 mg/kg if required, as per the most recent guidelines 1.
Indications and Dosing Guidelines
The indications for propranolol include:
- Stable, narrow-complex tachycardias
- Control of ventricular rate in patients with atrial fibrillation or atrial flutter
- Certain forms of polymorphic VT (associated with acute ischemia, familial LQTS, catecholaminergic) The dosing guidelines for propranolol are:
- 0.5 to 1 mg over 1 minute, repeated up to a total dose of 0.1 mg/kg if required
Important Considerations
When using propranolol, it is essential to consider the following:
- Avoid using propranolol in patients with asthma, obstructive airway disease, decompensated heart failure, and pre-excited atrial fibrillation or flutter
- Propranolol can cause hypotension, bradycardia, and precipitation of heart failure
- The medication works by blocking both beta-1 receptors (affecting heart rate and contractility) and beta-2 receptors (affecting bronchial and vascular smooth muscle)
Additional Information
According to the American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy 1, propranolol has been used in the medical management of HCM, with doses ranging from 40-160 mg twice daily, and up to 480 mg per day in some cases. However, the most recent guidelines from the American Heart Association 1 should be followed for the management of tachycardias.
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. 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 Migraine: The initial oral dose is 80 mg propranolol hydrochloride extended-release capsules once daily. Hypertrophic Subaortic Stenosis: The usual dosage is 80 to 160 mg propranolol hydrochloride extended-release capsules once daily. INDICATIONS AND USAGE Hypertension: Propranolol hydrochloride extended-release capsules are indicated in the management of hypertension. Angina Pectoris Due to Coronary Atherosclerosis: Propranolol hydrochloride extended-release capsules are indicated to decrease angina frequency and increase exercise tolerance in patients with angina pectoris. Migraine: Propranolol hydrochloride extended-release capsules are indicated for the prophylaxis of common migraine headache Hypertrophic Subaortic Stenosis: Propranolol hydrochloride extended-release capsules improve NYHA functional class in symptomatic patients with hypertrophic subaortic stenosis.
The indications for propranolol are:
- Hypertension
- Angina Pectoris
- Migraine
- Hypertrophic Subaortic Stenosis The dosing guidelines for propranolol are:
- Hypertension: 80-640 mg once daily
- Angina Pectoris: 80-320 mg once daily
- Migraine: 80-240 mg once daily
- Hypertrophic Subaortic Stenosis: 80-160 mg once daily 2 2
From the Research
Indications for 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
- Propranolol may be useful in hypertension patients having a hyperkinetic circulation (palpitations, tachycardia, hypertension, and anxiety), migraine headache, and essential tremor 4
Dosing Guidelines for Propranolol
- The dosing guidelines for propranolol vary depending on the indication and patient population 3
- For migraine prophylaxis, propranolol is typically started at a low dose and titrated up to an effective dose, with a common dose range of 20-60 mg every 6 hours 5, 6
- In critically ill patients receiving mechanical ventilation, propranolol has been used at a dose of 20-60 mg every 6 hours, titrated to effect 6
Pharmacological Properties of Propranolol
- Propranolol is a noncardioselective β-blocker with membrane-stabilizing properties, but it does not have intrinsic sympathomimetic activity 3
- β-Blockers, including propranolol, are highly heterogeneous with respect to various pharmacologic properties, such as degree of intrinsic sympathomimetic activity, membrane stabilizing activity, β1 selectivity, α1-adrenergic blocking effects, tissue solubility, routes of systemic elimination, potencies and duration of action 4