Maximum Dose for Propranolol LA (Long-Acting)
The maximum recommended daily dose for propranolol LA (Long-Acting) is 640 mg for hypertension, 320 mg for angina pectoris, and 240 mg for migraine prophylaxis. 1
Dosing Guidelines by Indication
Hypertension
- Initial dose: 80 mg once daily (alone or with a diuretic)
- Usual maintenance dose: 120-160 mg once daily
- Maximum dose: 640 mg once daily 1
- Time needed for full response: Variable, from a few days to several weeks
Angina Pectoris
- Starting dose: 80 mg once daily
- Titration: Increase at 3-7 day intervals until optimal response
- Average optimal dose: 160 mg once daily
- Maximum dose: 320 mg once daily 1
- Safety and efficacy of doses exceeding 320 mg daily have not been established
Migraine Prophylaxis
- Initial dose: 80 mg once daily
- Effective dose range: 160-240 mg once daily
- Maximum dose: 240 mg once daily 1
- Duration of trial: 4-6 weeks at maximal dose before determining efficacy
Hypertrophic Subaortic Stenosis
- Usual dosage: 80-160 mg once daily 1
Important Clinical Considerations
Pharmacokinetics
- Propranolol LA is not a simple mg-for-mg substitute for immediate-release tablets 1
- LA formulation has different kinetics and produces lower blood levels
- Retitration may be necessary, especially to maintain effectiveness at the end of the 24-hour dosing interval
- Systemic bioavailability is 30-50% less than conventional formulation 2
Monitoring Parameters
- Blood pressure and heart rate should be monitored, especially during dose titration
- Assess for signs of bronchospasm, bradycardia, or worsening heart failure 3
Contraindications and Precautions
- AV block greater than first degree or SA node dysfunction (in absence of pacemaker)
- Reactive airway disease
- Decompensated systolic heart failure
- Hypotension
- Use caution with drugs that have SA and/or AV nodal-blocking properties 3
Discontinuation
- If treatment is to be discontinued, reduce dosage gradually over a period of a few weeks to avoid withdrawal effects 1
Special Populations
While most of the evidence focuses on adult dosing, it's worth noting that for pediatric patients with infantile hemangioma, the maximum dose for non-responders is 3 mg/kg/day 3, but this is outside the scope of the original question about adult LA dosing.
Remember that individual patient response to propranolol can vary significantly, and some patients may achieve optimal therapeutic benefit at lower doses. Careful titration based on clinical response is essential for optimizing treatment outcomes while minimizing adverse effects.