Propranolol Dosing for Various Indications
The typical dosing of propranolol varies by indication, with hypertension requiring 120-160 mg once daily, angina pectoris 160 mg once daily, migraine prophylaxis 160-240 mg once daily, and hypertrophic subaortic stenosis 80-160 mg once daily when using extended-release formulations. 1
Dosing by Indication
Hypertension
- Initial dose: 80 mg once daily (extended-release) 1
- Maintenance dose: 120-160 mg once daily 1
- Maximum dose: Up to 640 mg may be required in some cases 1
- Note: The American College of Cardiology does not recommend propranolol as first-line for hypertension unless the patient has ischemic heart disease or heart failure 2
Angina Pectoris
- Initial dose: 80 mg once daily (extended-release) 1
- Titration: Increase gradually at 3-7 day intervals 1
- Optimal dose: Average 160 mg once daily 1
- Maximum dose: 320 mg daily (safety not established above this dose) 1
Migraine Prophylaxis
- Initial dose: 80 mg once daily (extended-release) 1
- Effective dose range: 160-240 mg once daily 1
- Duration: If no response after 4-6 weeks at maximum dose, discontinue therapy 1
Hypertrophic Subaortic Stenosis
- Usual dose: 80-160 mg once daily (extended-release) 1
Infantile Hemangioma
- Starting dose: 1 mg/kg/day 2
- Maintenance dose: 2 mg/kg/day for uncomplicated patients 2
- Maximum dose: 3 mg/kg/day for non-responders 2
Important Considerations
Formulation Differences
- Extended-release capsules are not a simple mg-for-mg substitute for immediate-release tablets 1
- Retitration may be necessary when switching formulations to maintain effectiveness 1
Dosage Adjustment
- Time needed for full hypertensive response may range from days to several weeks 1
- Gradual discontinuation is recommended to avoid withdrawal effects, particularly in angina patients 1
Contraindications and Precautions
- Contraindicated in second/third-degree heart block 2
- Use with caution in patients with reactive airway disease 2
- Avoid routine use with non-dihydropyridine calcium channel blockers (diltiazem, verapamil) due to increased risk of bradycardia and heart block 2
Monitoring Parameters
- Target heart rate: The American College of Cardiology recommends dosing to achieve heart rate control 2
- Blood pressure response: Assess regularly to determine if dose adjustments are needed 1
Practical Tips
- Start with lower doses and titrate gradually to minimize side effects
- When discontinuing, taper gradually over several weeks, especially in patients with angina or after long-term use 1
- For hypertension, if propranolol monotherapy is insufficient, consider adding a diuretic rather than increasing propranolol beyond recommended doses