From the Guidelines
The maximum dose of propranolol for treating tachycardia is 160 mg per day in divided or single dose with long-acting formulations, as recommended by the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
Key Considerations
- The dose of propranolol can be adjusted based on patient response and tolerance, with elderly patients and those with liver or kidney impairment generally requiring lower doses.
- Propranolol works by blocking beta-adrenergic receptors in the heart, reducing the influence of the sympathetic nervous system and thereby decreasing heart rate and cardiac contractility.
- Common side effects include fatigue, dizziness, and bradycardia, and propranolol is contraindicated in patients with certain conditions including severe bradycardia, heart block, cardiogenic shock, and uncontrolled heart failure.
Important Details
- The 2015 ACC/AHA/HRS guideline provides the most recent and highest quality evidence for the management of supraventricular tachycardia, including the use of propranolol 1.
- Other studies, such as the 2006 ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation, may provide additional information on the use of propranolol, but are not as relevant to the specific question of maximum dose for tachycardia 1.
- A 2018 study on the use of oral propranolol in the treatment of proliferating infantile haemangiomas provides guidance on dosing for this specific condition, but is not directly applicable to the treatment of tachycardia in adults 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Maximum Dose of Propranolol for Treating Tachycardia
The maximum dose of propranolol for treating tachycardia (elevated heart rate) can vary depending on the individual and the specific condition being treated. However, based on the available evidence, here are some key points to consider:
- The average optimum dosage of propranolol for treating angina pectoris is 500-800 mg a day 2.
- In a study on the suppression of chronic ventricular arrhythmias with propranolol, the maximum dosage used was 960 mg/day 3.
- A comparative trial of high-dose and medium-dose propranolol in the relief of exercise-induced myocardial ischemia used a high-dose of 480 mg/day 4.
- The beta-Blocker Heart Attack Trial (BHAT) used a prescribed maintenance dose of propranolol hydrochloride of either 180 or 240 mg/day 5.
- A study on the use of propranolol in severely burned children found that a dose of 4 mg/kg per day was effective in decreasing heart rate and cardiac work 6.
Key Considerations
- The dose of propranolol required to treat tachycardia can vary depending on the individual and the specific condition being treated.
- Higher doses of propranolol may be required to achieve optimal effects, but may also increase the risk of side effects.
- The dose of propranolol should be adjusted based on the individual's response to treatment and the presence of any side effects.
Dose-Response Relationship
- The dose-response relationship of propranolol can vary depending on the specific condition being treated.
- A biphasic dose-response curve was seen in some patients with ventricular arrhythmias, where the frequency of arrhythmias decreased at lower doses but increased at higher doses 3.
- The effective plasma drug concentrations of propranolol can be achieved within 30 minutes, and the half-life is approximately 4 hours 6.