From the Guidelines
Propranolol is indicated for several cardiovascular and non-cardiovascular conditions, including hypertension, angina pectoris, arrhythmias, secondary prevention after myocardial infarction, migraine prophylaxis, essential tremor, and management of symptoms related to anxiety.
Indications for Propranolol
- Hypertension
- Angina pectoris
- Arrhythmias (particularly supraventricular tachycardias)
- Secondary prevention after myocardial infarction
- Migraine prophylaxis
- Essential tremor
- Management of symptoms related to anxiety, particularly physical manifestations like palpitations and tremor
- Portal hypertension to reduce the risk of variceal bleeding
- Hypertrophic cardiomyopathy to control symptoms by reducing left ventricular outflow obstruction
Dosage and Administration
The medication works by blocking beta-adrenergic receptors, reducing heart rate, cardiac output, and blood pressure. Typical dosing ranges from 10-40 mg twice daily for anxiety symptoms to 80-320 mg daily for hypertension, with dosage adjustments based on patient response and condition being treated 1.
Contraindications
Propranolol is contraindicated in patients with:
- Asthma
- COPD
- Bradycardia
- Heart block
- Cardiogenic shock
- Uncontrolled heart failure due to its ability to block bronchodilation and reduce cardiac output 1.
Key Considerations
When initiating propranolol, it is essential to consider the patient's overall clinical condition, including the presence of any contraindications or potential interactions with other medications. The choice of beta blocker for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity 1.
From the FDA Drug Label
Hypertension: Propranolol hydrochloride extended-release capsules are indicated in the management of hypertension. It may be used alone or used in combination with other antihypertensive agents, particularly a thiazide diuretic. 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: management of hypertension
- Angina Pectoris: decrease angina frequency and increase exercise tolerance
- Migraine: prophylaxis of common migraine headache
- Hypertrophic Subaortic Stenosis: improve NYHA functional class in symptomatic patients 2
From the Research
Propranolol Indications
Propranolol is a beta-blocker with a wide range of indications, including:
- Angina pectoris 3, 4, 5
- Myocardial infarction 3, 4, 6
- Hypertension 3, 4, 6
- Cardiac dysrhythmias 3, 4
- Hypertrophic subaortic stenosis 3
- Migraine headache 3, 4, 7
- Hyperthyroidism 3, 4
- Pheochromocytoma 3, 4
- Anxiety 4
- Essential tremors 4, 6
- Portal hypertension 4
Additional Considerations
When using propranolol, it is essential to consider the following:
- The dosage of propranolol may need to be adjusted based on the individual patient's response to the medication 7, 5
- Propranolol can be used in conjunction with other medications, such as antidepressants, without attenuating their therapeutic effects 6
- Patients taking propranolol should be monitored for potential side effects, such as intolerable side effects that may intensify as the dose is increased 7