- Side Effects
- Drug Interactions
- Pregnancy & Breastfeeding
- What Else to Know
Generic Name: propranolol
Brand Names: Inderal, Inderal LA, Innopran XL
What is propranolol, and what is it used for?
Propranolol is a beta-adrenergic blocking agent that is used for treating high blood pressure, heart pain (angina), abnormal rhythms of the heart, and some neurologic conditions. Examples of other beta-adrenergic blockers include metoprolol (Lopressor), atenolol (Tenormin), and timolol (Blocadren).
- Neurotransmitters are chemicals that are produced and released by nerves in order to communicate with each other. The released neurotransmitters attach to receptors on other cells and induce changes within the receptor-containing cells.
- Norepinephrine is a neurotransmitter that is used by the sympathetic nervous system, a portion of the involuntary nervous system.
- Nerves of the sympathetic nervous system release norepinephrine that binds to beta receptors on other cells.
- Propranolol inhibits the sympathetic nervous system by blocking the beta receptors on the nerves of the sympathetic system.
- Since stimulation of the sympathetic nervous system is responsible for increasing the rate with which the heart beats, by blocking the action of these nerves propranolol reduces the heart rate and is useful in treating abnormally rapid heart rhythms.
Propranolol also reduces the force of contraction of the heart muscle and thereby lowers blood pressure. By reducing the heart rate and the force of muscle contraction, propranolol reduces the need for oxygen by the heart muscle. Since heart pain (angina pectoris) occurs when the oxygen demand of the heart muscle exceeds the supply of oxygen, propranolol, by reducing the demand for oxygen, is helpful in treating heart pain.
The FDA approved propranolol in November 1967.
What are the side effects of propranolol?
Common side effects are:
- abdominal cramps,
- memory loss,
- slow heart rate,
- low blood pressure,
- cold extremities,
- sore throat, and
- shortness of breath or wheezing.
Propranolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema. In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), propranolol can cause dangerously slow heart rates, and even shock. Propranolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure.
In patients with coronary artery disease, abruptly stopping propranolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue propranolol, its dosage should be reduced gradually over several weeks.
What is the dosage for propranolol?
- The recommended dose for hypertension using short acting formulations is 80-240 mg twice daily. The maximum dose is 640 mg daily.
- The usual dose using long acting formulations is 80-160 mg daily.
- The recommended dose for chest pain is 80-320 mg daily using short acting formulations and 80-160 mg daily using long acting formulations.
- The usual dose for treatment of abnormal heart rhythms is 10-30 mg 3-4 times daily of short acting formulations.
- The recommended dose for preventing migraines is 80-240 mg daily.
Which drugs interact with propranolol?
- Calcium channel blockers and digoxin (Lanoxin) can lower blood pressure and heart rate to dangerous levels when administered together with propranolol.
- Propranolol can mask the early warning symptoms of low blood sugar (hypoglycemia) and should be used with caution in patients receiving treatment for diabetes.
- Propranolol reduces the metabolism of thioridazine (Mellaril), increasing the concentration of thioridazine in the body and potentially causing abnormal heartbeats.
Pregnancy and breastfeeding
- Safe use during pregnancy has not been established. Growth retardation and congenital abnormalities have been reported in infants whose mothers received propranolol during pregnancy. Infants whose mothers received propranolol during labor have exhibited slow heart rate, hypoglycemia, and/or respiratory depression.
- Propranolol is secreted into breast milk. It should be avoided or used with caution in nursing women.
What else should I know about propranolol?
What preparations of propranolol are available?
- Tablets: 10, 20, 40, 60, and 80 mg. Capsules: 60, 80, 120, and 160 mg. Oral Solution: 20 mg/5 ml, Injection: 1 mg/ml
- Storage: Tablets and capsules should be stored at room temperature, 15 to 30 C (59 to 86 F), in a tightly closed container.
Propranolol is a medication prescribed for the treatment of high blood pressure, angina, certain heart rhythm disorders, migraine headache prevention, and certain types of tremors. Common side effects of propranolol are abdominal cramps, diarrhea, constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence, lightheadedness, slow heart rate, low blood pressure, cold extremities, sore throat, and shortness of breath or wheezing. Do not take propranolol if pregnant or breastfeeding.
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High Blood Pressure (Hypertension)
High blood pressure (hypertension) is a disease in which pressure within the arteries of the body is elevated. About 75 million people in the US have hypertension (1 in 3 adults), and only half of them are able to manage it. Many people do not know that they have high blood pressure because it often has no has no warning signs or symptoms. Systolic and diastolic are the two readings in which blood pressure is measured. The American College of Cardiology released new guidelines for high blood pressure in 2017. The guidelines now state that blood normal blood pressure is 120/80 mmHg. If either one of those numbers is higher, you have high blood pressure. The American Academy of Cardiology defines high blood pressure slightly differently. The AAC considers 130/80 mm Hg. or greater (either number) stage 1 hypertension. Stage 2 hypertension is considered 140/90 mm Hg. or greater. If you have high blood pressure you are at risk of developing life threatening diseases like stroke and heart attack.REFERENCE: CDC. High Blood Pressure. Updated: Nov 13, 2017.
What Is Considered Stroke-Level High Blood Pressure?
Blood pressure readings above 180/120 mmHg are considered stroke-level and require immediate medical attention. Check out the center below for more medical references on hypertension, including multimedia (slideshows, images, and quizzes), related diseases, treatment, diagnosis, medications, and prevention or wellness.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Dizziness is a symptom that often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and other medical conditions. Treatment of dizziness depends on the cause.
Raynaud's phenomenon is characterized by a pale-blue-red sequence of color changes of the digits, most commonly after exposure to cold. Occurring as a result of spasms of blood vessels, the cause is unknown. Symptoms and signs of Raynaud's phenomenon depend on the severity, frequency, and duration of the blood vessel spasm. Treatments include protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
Arrhythmias (Abnormal Heart Rhythms)
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus bradycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-Parkinson-White syndrome, brachycardia, or heart blocks. Treatment is dependent upon the type of heart rhythm disorder.
Atrial Fibrillation (AFib)
Atrial fibrillation (AF or AFib) is an abnormality in the heart rhythm, which involves irregular and often rapid beating of the heart. Symptoms may include heart palpitations, dizziness, fainting, fatigue, shortness of breath, and chest pain. Atrial fibrillation treatment may include medication or procedures like cardioversion or ablation to normalize the heart rate.
Hyperthyroidism is an excess of thyroid hormone due to an overactive thyroid gland. Symptoms can include increased heart rate, weight loss, heart palpitations, frequent bowel movements, depression, fatigue, fine or brittle hair, sleep problems, thinning skin, and irregular vaginal bleeding. Graves' disease is the most common cause of hyperthyroidism. Many other health problems or taking excess thyroid hormone medication can cause an overactive thyroid gland. Treatment for the condition is with medication, radioactive iodine, thyroid surgery (rarely), or reducing the dose of thyroid hormone. No diet has been shown to treat hyperthyroidism or its symptoms and signs.
Panic attacks are sudden feelings of terror that strike without warning. These episodes can occur at any time, even during sleep. A person experiencing a panic attack may believe that he or she is having a heart attack or that death is imminent. The fear and terror that a person experiences during a panic attack are not in proportion to the true situation and may be unrelated to what is happening around them. Most people with panic attacks experience several of the following symptoms: racing heartbeat, faintness, dizziness, numbness or tingling in the hands and fingers, chills, chest pains, difficulty breathing, and a feeling of loss or control. There are several treatments for panic attacks.
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Migraine headache is a type of headache associated with a sensitivity to light, smells, or sounds, eye pain, severe pounding on one side of the head, and sometimes nausea and vomiting. The exact cause of migraine headaches is not known. Triggers for migraine headaches include certain foods, stress, hormonal changes, strong stimuli (loud noises), and oversleeping. Treatment guidelines for migraines include medicine, pain management, diet changes, avoiding foods that trigger migraines, staying hydrated, getting adequate sleep, and exercising regularly. Prevention of migraine triggers include getting regular exercise, drinking water daily, reducing stress, and avoiding trigger foods.
Heart Attack (Myocardial Infarction)
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Abdominal Aortic Aneurysm
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Is Sinus Arrhythmia Serious?
Sinus arrhythmia is a common, harmless condition that is not necessarily dangerous; however, it should be evaluated if accompanied by other signs of heart problems.
Angina is chest pain due to inadequate blood supply to the heart. Angina symptoms may include chest tightness, burning, squeezing, and aching. Coronary artery disease is the main cause of angina but there are other causes. Angina is diagnosed by taking the patient's medical history and performing tests such as an electrocardiogram (EKG), blood test, stress test, echocardiogram, cardiac CT scan, and heart catheterization. Treatment of angina usually includes lifestyle modification, medication, and sometimes, surgery. The risk of angina can be reduced by following a heart healthy lifestyle.
Atrial Fibrillation (AFib) Treatment Drugs
Atrial fibrillation (AFib) is a heart rhythm disorder that causes irregular and often rapid heartbeat. The medications to treat AFib include beta-blockers, blood thinners, and heart rhythm drugs. Atrial fibrillation drugs can cause serious side effects like seizures, vision changes, shortness of breath, fainting, other abnormal heart rhythms, excessive bleeding while coughing or vomiting, blood in the stool, and bleeding into the brain.
Mitral Valve Prolapse
Mitral valve prolapse (MVP), also called "click murmur syndrome" and "Barlow's syndrome," is the most common type of heart valve abnormality. Usually, people with mitral valve prolapse have no signs and symptoms; however, if the prolapsed valve is severe, symptoms may appear. When symptoms of severe mitral valve prolapse do appear, they may include, fatigue, palpitations, chest pain, anxiety, migraine headaches, and pulmonary edema. Echocardiography is the most useful test for mitral valve prolapse. Most people with mitral valve prolapse need no treatment. However, if the valve prolapse is severe, treatment medications or surgery may be necessary to repair the heart valve.
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Things to Know About High Blood Pressure Treatment
High blood pressure (hypertension) means high pressure (tension) in the arteries. Treatment for high blood pressure include lifestyle modifications (alcohol, smoking, coffee, salt, diet, exercise), drugs and medications such as ACE inhibitors, angiotensin receptor blockers, beta blockers, diuretics, calcium channel blockers (CCBs), alpha blockers, clonidine, minoxidil, and Exforge.
Cyclic Vomiting Syndrome (CVS)
Cyclic vomiting syndrome is a condition in which affected individuals have severe nausea and vomiting that come in cycles. Researchers believe that cyclic vomiting syndrome and migraine headaches are related. Triggers of cyclic vomiting syndrome are emotional stress and infections. People with cyclic vomiting syndrome are at an increased risk of dehydration. Cyclic vomiting syndrome is difficult to diagnose. Treatment varies from person to person, but is generally directed toward relief of the symptoms of the condition.
Can High Blood Pressure (HBP) Cause Blood in Urine?
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Cocaine and Crack Addiction
Cocaine is an addictive stimulant that is smoked, snorted, and injected. Crack is cocaine that comes in a rock crystal that is heated to form vapors, which are then smoked. Cocaine has various effects on the body, including dilating pupils, constricting blood vessels, increasing body temperature, heart rate, and blood pressure.
Post-traumatic Stress Disorder
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Heart Attack Treatment
A heart attack involves damage or death of part of the heart muscle due to a blood clot. The aim of heart attack treatment is to prevent or stop this damage to the heart muscle. Heart attack treatments included medications, procedures, and surgeries to protect the heart muscle against injury.
Primary Biliary Cirrhosis (PBC) Treatment
Primary biliary cirrhosis (PBC) is thought to be an autoimmune disorder that involves the deterioration of the liver's small bile ducts. These ducts are crucial to transport bile to the small intestine, digesting fats and removing wastes. Symptoms of PBC are edema, itching, elevated cholesterol, malabsorption of fat, liver cancer, gallstones, urinary tract infections (UTIs), and hypothyroidism. Treatments include ursodeoxycholic acid (UDCA); colchicine (Colcrys); and immunosuppressive medications, such as corticosteroids; obeticholic acid (Ocaliva); and medications that treat PBC symptoms. For PBC that is associated with cirrhosis of the liver, liver transplantation may be indicated in extreme cases.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heartbeat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta-blockers.
Febrile seizures, or convulsions caused by fever, can be frightening in small children or infants. However, in general, febrile seizures are harmless. Febrile seizure is not epilepsy. It is estimated that one in every 25 children will have at least one febrile seizure. It is important to know what to do to help your child if he/she has a febrile seizure. Some of the features of a febrile seizure include losing consciousness, shaking, moving limbs on both sides of the body, and lasts 1-2 minutes. Less commonly, a febrile seizure may only affect one side of the body.
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Can High Blood Pressure Hurt My Eyes?
Unfortunately, yes. Suffering from untreated or poorly controlled high blood pressure for a long time can be detrimental to your eyes. Several eye diseases are directly or indirectly caused by high blood pressure (hypertension).
Agoraphobia is a fear of being outside or of being in a situation from which escape would be impossible. Symptoms include anxiety, fear, disorientation, rapid heartbeat, diarrhea, or dizziness. Treatment may incorporate psychotherapy, self-exposure to the anxiety-causing situation, and medications such as SSRIs, benzodiazepines, and beta-blockers.
What Happens If Arrhythmia Is Left Untreated?
Untreated arrhythmia in some individuals may increase the risk of stroke, heart attack, dementia, and heart failure. It may lead to the inadequate blood supply to multiple organs because the heart may not function properly.
What Can I Do to Relieve Angina Pain?
Learn what medical treatments can help ease your angina pain symptoms and help you manage this condition.
Can You Be Physically Fit and Have High Blood Pressure?
It is entirely possible and common for physically fit people to have high blood pressure (hypertension). Check out the center below for more medical references on high blood pressure, including multimedia (slideshows, images, and quizzes), related disease conditions, treatment and diagnosis, medications, and prevention or wellness.
What Is High Blood Pressure (Hypertension)?
High blood pressure or hypertension is when the blood pressure readings consistently range from 140 or higher for systolic or 90 or higher for diastolic. Blood pressure readings above 180/120 mmHg are dangerously high and require immediate medical attention.
Can You Reset Your Heart Rhythm?
Image Source: iStock Image Rosenthal L. Atrial Fibrillation Treatment & Management. Medscape. https://emedicine.medscape.com/article/151066-treatment
What Does an Angina Attack Feel Like?
Angina is chest pain caused by a lack of oxygen supply to the heart. Learn the signs of an angina attack, what causes it, how doctors diagnose it, and what you can do to treat it.
Can Angina Lead to a Heart Attack?
Angina, or angina pectoris, is a sudden chest pain caused by low blood flow to the heart. Yes, some types of angina attacks can lead to heart complications.
What Happens If You Get High Blood Pressure During Pregnancy?
High blood pressure during pregnancy may result in decreased blood flow to the placenta. Check out the center below for more medical references on high blood pressure, including multimedia (slideshows, images, and quizzes), related disease conditions, treatment and diagnosis, medications, and prevention or wellness.
What Causes High Blood Pressure in Children?
Research states that kidney disease is the main cause of high blood pressure in children; however, here are the other potential causes of hypertension in kids.
How Does High Blood Pressure Affect Pregnancy?
High blood pressure during pregnancy can cause serious complications. Learn more about the signs of and risks associated with the condition.
Treatment & Diagnosis
- Low Blood Pressure (Hypotension)
- High Blood Pressure (Hypertension)
- Panic Attack
- Atrial Fibrillation (AFib)
- Posttraumatic Stress Disorder (PTSD)
- Doctor: Checklist to Take To Your Doctor's Appointment
- Mitral Valve Prolapse
- Generalized Anxiety Disorder
- Heart Failure
- Heart Rhythms: Treating Life-Threatening
- High Blood Pressure FAQs
- Heart Disease FAQs
- Thyroid FAQs
- Atrial Fibrillation A-Fib FAQs
- High Blood Pressure Symptoms
- Medication Disposal
- Angina: Don't Take It Lightly
- Dangers of Mixing Medications
- High Blood Pressure: Questions To Ask Your Doctor
- Inherited High Blood Pressure in a Teenager
- Hypertension In The Elderly - Deserves More Attention
- How To Reduce Your Medication Costs
- Salt, DASH, High Blood Pressure
- Pharmacy Visit, How To Get The Most Out of Your Visit
- High Blood Pressure and Exercise
- Indications for Drugs: Approved vs. Non-approved
- Drugs: Buying Prescription Drugs Online Safely
- Drugs: The Most Common Medication Errors
- What Is the Difference Between ACE Inhibitors and A Beta Blockers?
- Do I Have Angina?
- Does Menopause Cause High Blood Pressure?
- Can I Lift Weights with High Blood Pressure?
- Angina Diagnosis
- Angina Symptoms
- Thyroid Storm
- Pain Relievers and High Blood Pressure
- Generic Drugs, Are They as Good as Brand-Names?
- High Blood Pressure: Improve Your Lifestyle
Medications & Supplements
- Drugs: Questions to Ask Your Doctor or Pharmacist about Your Drugs
- Beta Blockers
- Drug Interactions
- Types of High Blood Pressure Medications
- Beta Blocker Side Effects (Adverse Effects)
- bisoprolol (Zebeta)
- nadolol (Corgard)
- Side Effects of Inderal (propranolol)
- Types of High Blood Pressure (Hypertension) Medications
- timolol (Betimol)
Prevention & Wellness
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.