What is the use of Propranolol (beta blocker)?

From the Guidelines

Propranolol is a beta-blocker medication that is commonly used to treat high blood pressure, angina, irregular heartbeats, essential tremor, anxiety, and to prevent migraines. The typical starting dose for hypertension is 40mg twice daily, which can be increased gradually to 120-240mg daily if needed 1. For anxiety, lower doses of 10-40mg are often used as needed before stressful situations or 40-80mg daily for ongoing treatment. For migraine prevention, 80-240mg daily in divided doses is standard 1. Propranolol works by blocking beta-adrenergic receptors, reducing the effects of adrenaline and lowering heart rate and blood pressure.

Some of the key uses of propranolol include:

• Treating high blood pressure: Propranolol can help lower blood pressure by reducing the heart rate and the force of the heart's contractions 1.
• Preventing migraines: Propranolol can help prevent migraines by reducing the frequency and severity of migraine attacks 1.
• Treating anxiety: Propranolol can help reduce anxiety symptoms such as tremors, rapid heartbeat, and sweating 1.
• Treating essential tremor: Propranolol can help reduce the symptoms of essential tremor, such as shaking and tremors 1.

Common side effects of propranolol include fatigue, dizziness, cold extremities, and sleep disturbances. It should be used cautiously in patients with asthma, COPD, diabetes, or heart failure, and should never be stopped abruptly as this can trigger rebound effects. Always take propranolol with food or immediately after meals to enhance absorption, and maintain consistent timing of doses to ensure stable blood levels.

It's worth noting that propranolol has been shown to be effective in treating infantile hemangioma, with a large randomized controlled trial showing effectiveness when dosed at 3.4 mg/kg per day for 6 months 1. Additionally, propranolol has been used to treat hypertrophic cardiomyopathy, with reports of subjective symptomatic improvement and enhanced exercise capacity in a dose range of up to 480 mg per day 1.

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) includes:

• Hypertension: to decrease cardiac output and inhibit renin release
• Angina pectoris: to reduce oxygen requirement of the heart
• Antiarrhythmic effects: to block beta-adrenergic stimulation and affect the cardiac action potential
• Antimigraine effect: although the mechanism is not established, beta-adrenergic receptors have been demonstrated in the pial vessels of the brain 2

From the Research

Uses of Propranolol

• Propranolol is used to treat various conditions, including:
  • Hypertension 3, 4, 5, 6
  • Angina pectoris 3, 4, 5, 7
  • Cardiac arrhythmias 4, 5
  • Hyperthrophic obstructive cardiomyopathy 4, 5
  • Mitral stenosis 4
  • Pheochromocytoma 4, 5
  • Hyperthyroidism 4, 5
  • Porphyria 4
  • Cirrhosis 4
  • Migraine 4, 5
  • Neuropsychiatric disorders 4
  • Anxiety disorders 5
  • Tremor 5
  • Upper gastrointestinal bleeding in patients with portal hypertension 5

Pharmacological Properties

• Propranolol is a noncardioselective β-blocker 5
• It has membrane-stabilizing properties, but does not have intrinsic sympathomimetic activity 5
• The drug is available in a sustained release formulation, allowing for once-daily dosing 3

Therapeutic Applications

• Propranolol is effective in controlling symptoms of sympathetic overactivity in various conditions 5
• It is used to control hypertension, pheochromocytoma, myocardial infarction, cardiac arrhythmias, angina pectoris, and hypertrophic cardiomyopathy 5
• The drug has been shown to be effective in the treatment of angina pectoris, with a dose-dependent anti-anginal effect 7