From the Guidelines
Propranolol commonly causes side effects including sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension, as noted in the clinical practice guideline for the management of infantile hemangiomas 1.
Common Side Effects
- Sleep disturbances, including vivid dreams or insomnia, occur in 2% to 18.5% of patients treated with propranolol 1
- Bronchial irritation, such as hyperreactivity, bronchospasm, bronchiolitis, and cold-induced wheezing, can occur in patients with asthma or COPD
- Clinically symptomatic bradycardia and hypotension, although rare, can manifest as extreme dizziness or fainting
Serious Side Effects
- Hypoglycemia, particularly in infants and children, can be masked by propranolol's beta-blocking effects, leading to delayed recognition of hypoglycemic symptoms 1
- Respiratory adverse effects, including labored breathing, breathing-related problems, and wheezing, can occur in patients with preexisting respiratory conditions
Management of Side Effects
- Clinicians should evaluate patients for and educate caregivers about potential adverse effects of propranolol, including sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension 1
- Patients should be monitored for signs of bradycardia or hypotension and seek medical attention if these occur
- Propranolol should be administered with or after feeding, and doses should be held at times of diminished oral intake or vomiting to reduce the risk of hypoglycemia 1
From the FDA Drug Label
ADVERSE REACTIONS The following adverse events were observed and have been reported in patients using propranolol. Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type Central Nervous System: Lightheadedness; mental depression manifested by insomnia, lassitude, weakness, fatigue; catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics For immediate release formulations, fatigue, lethargy, and vivid dreams appear dose related. Gastrointestinal: Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, ischemic colitis Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions; pharyngitis and agranulocytosis; erythematous rash; fever combined with aching and sore throat; laryngospasm; respiratory distress. Respiratory: Bronchospasm. Hematologic: Agranulocytosis, nonthrombocytopenic purpura, and thrombocytopenic purpura. Autoimmune: Systemic lupus erythematosus (SLE) Skin and mucous membranes: Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema multiforme, urticaria, alopecia, SLE-like reactions, and psoriasisiform rashes. Oculomucocutaneous syndrome involving the skin, serous membranes, and conjunctivae reported for a beta-blocker (practolol) have not been associated with propranolol. Genitourinary: Male impotence; Peyronie’s disease. The common side effects of propranolol include:
- Cardiovascular: Bradycardia, congestive heart failure, hypotension
- Central Nervous System: Lightheadedness, mental depression, fatigue
- Gastrointestinal: Nausea, vomiting, diarrhea
- Allergic: Hypersensitivity reactions, anaphylactic/anaphylactoid reactions
- Respiratory: Bronchospasm
- Hematologic: Agranulocytosis, thrombocytopenic purpura
- Autoimmune: Systemic lupus erythematosus (SLE)
- Skin and mucous membranes: Stevens-Johnson Syndrome, toxic epidermal necrolysis, urticaria
- Genitourinary: Male impotence, Peyronie’s disease 2
From the Research
Propranolol Side Effects
- Fatigue (1.1%) 3
- Dizziness (0.4%) 3
- Headache (0.2%) 3
- Pain in chest (0.2%) 3
- Heart block (0.1%) 3
- Hypoglycemia (0.1%) 3
- Loss of libido (0.1%) 3
- Shock (0.03%) 3
Adverse Reactions
- The incidence of adverse reactions to propranolol was reported to be 2.1% in a collaborative study of 2661 hypertensive patients 3
- The study also noted that the incidence of adverse reactions may vary due to differences in methodology, patient selection, or racial variation 3
Pharmacological Properties
- Propranolol is a noncardioselective β-blocker with membrane-stabilizing properties, but it does not have intrinsic sympathomimetic activity 4
- Propranolol hydrochloride is used to control various conditions, including hypertension, pheochromocytoma, myocardial infarction, cardiac arrhythmias, angina pectoris, and hypertrophic cardiomyopathy 4
- The drug is also used to control symptoms of sympathetic overactivity in the management of hyperthyroidism, anxiety disorders, and tremor 4