From the Guidelines
The starting dose of propranolol is 20 to 80 mg twice daily for angina, as recommended in the guidelines. According to the study published in the Journal of the American College of Cardiology 1, the choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity. The guidelines suggest that beta blockers, including propranolol, should be initiated orally, in the absence of contraindications, within the first 24 hours. Some key points to consider when initiating propranolol therapy include:
- The usual dose for angina is 20 to 80 mg twice daily
- The medication should be taken consistently, preferably with food to enhance absorption and reduce gastrointestinal side effects
- Patients should be monitored for potential side effects, including bradycardia, hypotension, fatigue, and bronchospasm
- Dosage adjustments should be made gradually, usually at 3-7 day intervals, to allow the body to adapt to the medication's effects. It's also important to note that propranolol is a non-selective beta blocker, meaning it blocks both beta-1 and beta-2 adrenergic receptors, which can have various effects on the body, including reducing heart rate and blood pressure. As stated in the guidelines 1, the target resting heart rate is 50 to 60 beats per minute unless a limiting side effect is reached.
From the FDA Drug Label
The usual initial dosage is 80 mg propranolol hydrochloride extended-release capsules once daily, whether used alone or added to a diuretic. 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 The initial oral dose is 80 mg propranolol hydrochloride extended-release capsules once daily. The usual dosage is 80 to 160 mg propranolol hydrochloride extended-release capsules once daily.
The starting dose of propranolol is 80 mg once daily, regardless of the condition being treated, such as hypertension, angina pectoris, migraine, or hypertrophic subaortic stenosis 2.
From the Research
Starting Dose of Propranolol
The starting dose of propranolol can vary depending on the condition being treated.
- For migraine prophylaxis, a low dose close to or up to 1 mg/kg body weight daily can be effective 3.
- For angina pectoris, the dose of propranolol which produces the optimal therapeutic effect can vary widely among patients, but maximal therapeutic benefit has been observed at a dose of 144 mg/day 4.
- For hypertension, once-daily long acting propranolol can be as effective as divided doses of conventional propranolol 5.
- For patients with cirrhosis and portal hypertension, it is suggested that propranolol therapy should be initiated in hospital with a low starting dose of 20 mg of the conventional formulation tds or 80 mg of the slow release preparation daily 6.
- For suppression of chronic ventricular arrhythmias, the dosage of propranolol was increased sequentially until arrhythmia suppression was achieved, side effects appeared, or a maximum dosage of 960 mg/day was reached, with 24 patients having 70--100% arrhythmia suppression at plasma levels ranging from 12--1100 ng/ml 7.