From the Guidelines
Propranolol is a non-selective beta-blocker medication that is commonly prescribed for various conditions, including hypertension, angina, arrhythmias, essential tremor, anxiety, and migraine prevention, with a typical starting dose of 10-40mg taken two to three times daily. The medication works by blocking beta-adrenergic receptors in the heart and blood vessels, reducing heart rate, blood pressure, and the heart's workload. It also blocks beta receptors in other tissues, which explains its effectiveness for conditions like tremor and anxiety symptoms.
Key Points
- Propranolol should be used cautiously in patients with asthma, COPD, diabetes, or heart failure, and should never be stopped abruptly as this can trigger rebound hypertension or angina 1, 2, 3.
- The medication should be taken consistently at the same times each day for chronic conditions, and patients should monitor their pulse and blood pressure regularly while using it.
- Common side effects include fatigue, dizziness, cold extremities, and sleep disturbances.
- For anxiety or situational use, 10-40mg can be taken as needed before anxiety-provoking events.
- Maintenance doses range from 40-320mg per day depending on the condition being treated, as seen in studies such as 4.
Conditions Treated by Propranolol
- Hypertension
- Angina
- Arrhythmias
- Essential tremor
- Anxiety
- Migraine prevention ### Important Considerations
- Patients with marked first-degree AV block, any form of second- or third-degree AV block, a history of asthma, severe LV dysfunction or HF, or at high risk for shock should not receive beta blockers on an acute basis 1, 2.
- Patients with significant chronic obstructive pulmonary disease should be given beta blockers very cautiously, with initial selection favoring a short-acting beta-1–specific drug such as metoprolol or esmolol 1, 2.
From the FDA Drug Label
Propranolol is a nonselective, beta-adrenergic receptor-blocking agent possessing no other autonomic nervous system activity. The mechanism of the antihypertensive effect of propranolol has not been established Among the factors that may be involved in contributing to the antihypertensive action include: (1) decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action.
The use of Propranolol (beta blocker) is for:
- Hypertension: to decrease cardiac output, inhibit renin release, and diminish sympathetic nerve outflow
- Angina pectoris: to reduce oxygen requirement of the heart by blocking catecholamine-induced increases in heart rate and blood pressure
- Antiarrhythmic effects: through beta-adrenergic blockade, to treat arrhythmias 5
From the Research
Uses of Propranolol
- Propranolol is used to treat diseases such as hypertension and angina pectoris, where long-term therapy is often required 6
- It is also used to treat angina pectoris, with studies demonstrating a dose-dependent anti-anginal effect 7
- Propranolol is used to treat many conditions, including cardiac arrhythmias, heart failure, migraine, and tremors 8
- Beta-blockers, including Propranolol, are a highly effective treatment for patients with all grades of heart failure secondary to LV systolic dysfunction 9
Therapeutic Advantages
- Long acting propranolol provides clinically significant sustained beta-adrenoceptor blockade and offers the potential for improved patient compliance due to once-daily dosing 6
- Propranolol has a greater anti-anginal action compared to other beta-blocking agents such as practolol and sotalol 7
- The use of beta-blocking agents, including Propranolol, in angina pectoris is relatively safe, provided that contraindications are observed and treatment is commenced at a low dosage 7
Dosage and Administration
- The average optimum dosage of propranolol for angina pectoris is 500-800 mg a day 7
- Long acting propranolol can be administered once-daily, providing therapeutic plasma propranolol concentrations throughout a 24-hour period 6
- The dosage of propranolol may need to be adjusted to produce a supine heart rate of 55-60 beats/minute, provided this is not prevented by side effects 7