From the Guidelines
Propranolol can cause several side effects, including sleep disturbance, cold hands and feet, diarrhea, and bronchial hyperreactivity, as well as rare but serious adverse effects like bradycardia, hypotension, and severe hypoglycemia, as reported in a 2015 study 1.
Common Side Effects
- Sleep disturbance
- Cold hands and feet
- Diarrhea
- Bronchial hyperreactivity
Rare but Serious Side Effects
- Bradycardia
- Hypotension
- Severe hypoglycemia These side effects occur because propranolol blocks beta-adrenergic receptors throughout the body, affecting not only the heart but also blood vessels, airways, and metabolic processes.
Precautions to Reduce Risk of Hypoglycemia
- Administration of medication after feeding
- Holding doses when the patient is ill with decreased oral intake, vomiting, or diarrhea
- Avoiding prolonged intervals of longer than 6 hours between feedings It is essential for patients to be aware of these potential side effects and to contact their healthcare provider if they experience any severe or concerning symptoms, rather than stopping the medication abruptly, which can cause rebound hypertension or worsening angina.
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 side effects of propranolol include:
- Cardiovascular side effects such as bradycardia, congestive heart failure, and hypotension
- Central Nervous System side effects such as lightheadedness, mental depression, and vivid dreams
- Gastrointestinal side effects such as nausea, vomiting, and diarrhea
- Allergic reactions including anaphylactic reactions and erythematous rash
- Respiratory side effects such as bronchospasm
- Hematologic side effects such as agranulocytosis and thrombocytopenic purpura
- Autoimmune side effects such as systemic lupus erythematosus (SLE)
- Skin and mucous membranes side effects such as Stevens-Johnson Syndrome and toxic epidermal necrolysis
- Genitourinary side effects such as male impotence and Peyronie’s disease 2
From the Research
Side Effects of Propranolol
The side effects of propranolol, a beta-blocker, have been studied in various research papers. Some of the known side effects include:
- CNS side effects, such as reduced severity scores and overall incidence rates 3
- Impaired glucose recovery from insulin-induced hypoglycemia in patients with insulin-dependent diabetes mellitus 4
- Vasoconstriction, delayed response to hypoglycemia in diabetic patients, and bronchoconstriction due to the block of beta 2-receptors 5
- Blockage of cardiac and neuronal voltage-gated sodium channels, which may explain some beneficial effects of the drug in treating cardiac arrhythmias and certain adverse central nervous system effects 6
Specific Populations
In certain populations, propranolol may have specific side effects or contraindications, such as:
- Patients with peripheral vascular disease, where beta-blockers should be avoided only in those with vasospastic disorders, rest pain with severe peripheral vascular disease, or nonhealing lesions 5
- Patients with diabetes mellitus, where beta-blockers are not contraindicated, but caution should be addressed when signs of autonomic disease are present or in patients with difficult glycemic control 5
- Patients with COPD or asthma, where beta-blockers are contraindicated in certain cases, such as when history of asthma is present, COPD is moderate to severe, or in patients on chronic bronchodilator treatment 5