Propranolol Dosing for Various Indications
For most indications, propranolol dosing ranges from 80-240 mg daily, with specific dosages determined by the condition being treated and patient response. 1, 2
Hypertension
- Initial dose: 80 mg once daily (extended-release) or 40 mg twice daily (immediate-release)
- Maintenance dose: 120-160 mg once daily (extended-release)
- Maximum dose: Up to 640 mg daily in some cases
- Titration: Increase gradually until adequate blood pressure control is achieved
- Efficacy threshold: Most antihypertensive effect is achieved at 80-160 mg daily 3
Angina Pectoris
- Initial dose: 80 mg once daily (extended-release)
- Maintenance dose: 160 mg once daily (extended-release)
- Maximum dose: 320 mg daily
- Titration: Increase at 3-7 day intervals until optimal response
- Caution: Reduce dosage gradually when discontinuing to avoid rebound angina 2
Migraine Prophylaxis
- Initial dose: 80 mg once daily (extended-release)
- Effective dose range: 160-240 mg once daily
- Duration: If no response after 4-6 weeks at maximum dose, discontinue therapy
- Efficacy note: More effective for pure migraine than mixed migraine/tension headaches 4, 2
Hypertrophic Subaortic Stenosis
- Usual dosage: 80-160 mg once daily (extended-release) 2
Infantile Hemangioma
- Starting dose: 1 mg/kg/day
- Maintenance dose: 2 mg/kg/day for uncomplicated patients
- Maximum dose: 3 mg/kg/day for non-responders
- Administration: Divided in 2-3 daily doses
- Duration: Treatment typically continued until 12-17 months of age
- Special populations: Lower starting dose (0.5 mg/kg/day) for patients with suspected PHACES syndrome 1
Post-Myocardial Infarction
- Usual dose: 180-240 mg daily (divided doses) 1
Important Considerations
Administration
- Administer with or after food to reduce hypoglycemia risk
- Hold doses during times of diminished oral intake or vomiting 1
- Extended-release capsules are not mg-for-mg equivalent to immediate-release tablets 2
Monitoring
- Cardiovascular and respiratory examination required before starting
- Heart rate and blood pressure monitoring during dose titration
- For infantile hemangioma: routine follow-up every 2-3 months during stable treatment 1
Precautions
- Avoid abrupt discontinuation (especially in angina and hypertension)
- Contraindicated in second/third-degree heart block
- Use with caution in patients with reactive airway disease
- Beta blockers are not recommended as first-line agents for hypertension unless patient has ischemic heart disease or heart failure 1
Combination Therapy
- In hypertension, may be combined with thiazide diuretics for enhanced effect
- Avoid routine use with non-dihydropyridine calcium channel blockers (diltiazem, verapamil) due to increased risk of bradycardia and heart block 1
When prescribing propranolol, always consider the specific indication, patient comorbidities, and potential drug interactions to optimize both efficacy and safety.