Propranolol Does Not Typically Cause Rhinorrhea (Runny Nose)
Propranolol is not associated with rhinorrhea as a recognized adverse effect, and runny nose is not listed among the documented side effects in major cardiovascular guidelines or clinical trials.
Documented Respiratory Side Effects of Propranolol
The respiratory adverse effects of propranolol are well-characterized and do not include rhinorrhea:
- Bronchospasm is the primary respiratory concern, occurring in 3-13% of patients, particularly those with pre-existing reactive airway disease 1, 2.
- Propranolol is contraindicated in patients with asthma and should be used with extreme caution in chronic obstructive pulmonary disease due to beta-2 receptor blockade causing bronchoconstriction 3, 1.
- Bronchial irritation, hyperreactivity, and cold-induced wheezing represent the spectrum of respiratory effects 1.
- Life-threatening bronchospasm can occur even in patients without a history of asthma or allergy 4.
Established Adverse Effects at Therapeutic Doses
The well-documented side effects of propranolol at doses of 40-160 mg daily include 3, 1:
- Cardiovascular: Bradycardia, hypotension, worsening heart failure
- Respiratory: Bronchospasm (not rhinorrhea)
- Peripheral vascular: Cold extremities and arterial insufficiency due to peripheral vasoconstriction 1, 5
- Central nervous system: Sleep disorders, nightmares, fatigue, depression (2-18.5% incidence) 1, 6
- Metabolic: Hypoglycemia and hyperglycemia 1
- Musculoskeletal: Aches and pain, predominantly in legs and feet 1
Clinical Interpretation
If a patient on propranolol 40-80 mg twice daily develops rhinorrhea:
- Consider alternative etiologies such as viral upper respiratory infection, allergic rhinitis, vasomotor rhinitis, or other concurrent medications 6.
- The temporal relationship between propranolol initiation and symptom onset does not establish causation when the symptom is not a recognized adverse effect.
- Review for co-ingested medications that may cause rhinorrhea, as 74% of patients in overdose studies had co-ingestions 7.
Common Pitfalls to Avoid
- Do not attribute every new symptom to recently started medications without considering whether the symptom matches the known adverse effect profile.
- Bronchospasm from propranolol presents with wheezing, dyspnea, and chest tightness—not isolated rhinorrhea 4, 8.
- Cold extremities from peripheral vasoconstriction may be misinterpreted as "cold symptoms," but this does not include nasal discharge 1, 5.