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Propranolol

    Brands

    DEA Class;  Rx

    Common Brand Names; Inderal, Inderal LA, InnoPran XL, Hemangeol

    • Antidysrhythmics, II; 
    • Beta-Blockers, Nonselective; 
    • Antianginal Agents; 
    • Antimigraine Agents

    Competitive, nonselective beta-blocker without intrinsic sympathomimetic activity
    Used for many cardiac indications such as: angina, ventricular rate control, hypertension, PSVT, etc.
    Also used for non-cardiac indications: migraine prophylaxis, tremor, infantile hemangioma

    Indicated for management of hypertension

    Indicated for prophylaxis of common migraine headache

    Indicated to decrease angina frequency and increase exercise tolerance in patients with chronic stable angina

    Indiated as adjunct to alpha-adrenergic blockers to control blood pressure and symptoms of catecholamine-secreting tumors

    Indicated for symptomatic treatment of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction

    Indicated to reduce cardiovascular mortality in patients who have survived the acute phase of myocardial infarction (MI) and are clinically stable

    Indicated for control of supraventricular arrhythmias (eg, atrial fibrillation and flutter, atrioventricular nodal reentrant tachycardia) and ventricular tachycardias (eg, catecholamine-induced arrhythmias, digoxin toxicity)

    Indicated for management of familial or hereditary essential tremor

    Prevention of variceal bleeding

    Asthma, COPD

    Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker)

    Cardiogenic shock

    Uncompensated congestive heart failure

    Hypersensitivity

    Overt heart failure

    Sick sinus syndrome without permanent pacemaker

    • Aggravated congestive heart failure
    • Bradycardia
    • Hypotension
    • Arthropathy
    • Raynaud phenomenon
    • Hyper/hypoglycemia
    • Depression
    • Fatigue
    • Insomnia
    • Paresthesia
    • Psychotic disorder
    • Pruritus
    • Nausea
    • Vomiting
    • Hyperlipidemia
    • Hyperkalemia
    • Cramping
    • Bronchospasm
    • Dyspnea
    • Pulmonary edema
    • Respiratory distress
    • Wheezing

    Do not use InnoPran XL in pediatric patients

    Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

    Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions

    Sudden discontinuance can exacerbate angina and lead to myocardial infarction

    Use in pheochromocytoma

    Increased risk of stroke after surgery

    Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported

    Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported

    Exacerbation of myopathy and myotonia has been reported

    Less effective than thiazide diuretics in black and geriatric patients

    May worsen bradycardia or hypotension; monitor HR and BP

    Prolonged experience with propranolol in pregnant women over several decades, based on published interventional and observational studies, has not identified a drug-associated risk of major birth defects, miscarriage, or other adverse maternal outcomes

    The drug is present in human milk at low levels, but related risk to a breastfed infant is unknown; there are no data on effects on milk production

    Adults

    Hypertension

    Immediate release: 40 mg PO q12hr initially, increasing every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day

    Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day

    InnoPran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO

    Migraine

    80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr

    Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day

    Withdraw therapy if satisfactory response not seen after 6 weeks

    Angina

    80-320 mg/day PO divided q6-12hr

    Inderal LA: 80 mg/day PO; not to exceed 320 mg/day

    Pheochromocytoma

    30-60 mg/day PO in divided doses

    Hypertrophic Subaortic Stenosis

    20-40 mg PO q6-8hr

    Myocardial Infarction

    Initiate within 24 hr of MI and reevaluate for secondary prevention at later date

    Immediate-release: 60-120 mg/day divided BID/TID; titrate dose based on heart rate and blood pressure as tolerated up to 240 mg/day

    Supraventricular Arrhythmia

    PO: 10-30 mg q6-8hr

    IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg

    Once response or maximum dose achieved, do not give additional dose for at least 4 hr

    Essential Tremor

    40 mg PO q12hr initially; maintenance: 120-320 mg/day PO divided q8-12hr

    Portal Hypertension (Off-label)

    Prevention of variceal bleeding

    10-60 mg PO q6-8hr; 10 mg PO q8hr initially; titrate dose to reduce resting heart rate by 25%

    Antipsychotic-Induced Akathisia (Off-label)

    30-120 mg PO q8-12hr

    Esophageal Bleeding (Off-label)

    20-180 mg PO q12hr; adjust to maximum tolerated dose

    Panic Disorder (Off-label)

    40-320 mg/day PO

    Aggressive Behavior (Off-label)

    80-300 mg/day PO

    Pediatric

    Initiate treatment at aged 5 weeks to 5 months

    Starting dose: 0.6 mg/kg (0.15 mL/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 mL/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 mL/kg) BID 

    Propranolol hydrochloride

    oral solution

    • 20mg/5mL
    • 40mg/5mL

    injectable solution

    • 1mg/mL

    tablet

    • 10mg
    • 20mg
    • 40mg
    • 60mg
    • 80mg

    capsule, extended-release

    • 60mg
    • 80mg
    • 120mg
    • 160mg