Propranolol

— THERAPEUTIC CATEGORIES —
  • Angina
  • CHF and arrhythmias
  • Hypertension
  • Migraine and headache
PAGE CONTENTS
  • Jump to Section
  • Generic Name & Formulations
  • Indications
  • Dosage and Administration
  • Contraindications
  • Boxed Warnings
  • Warnings/Precautions
  • Pharmacokinetics
  • Interactions
  • Adverse Reactions
  • Clinical Trials
  • Note
  • Patient Counseling

    • Propranolol Generic Name & Formulations

    Legal Class

    Rx

    General Description

    Propranolol HCl 10mg, 20mg, 40mg, 60mg, 80mg; scored tabs.

    Pharmacological Class

    Beta-blocker.

    See Also

    How Supplied

    Tabs—contact supplier; LA—100

    Manufacturer

    Various generic manufacturers

    Mechanism of Action

    Propranolol, a nonselective β-adrenergic receptor blocker, does not possess autonomic nervous system activity. 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 Indications

    Indications

    Long-term management of angina. Hypertrophic subaortic stenosis.

    Propranolol Dosage and Administration

    Adult

    Angina: 80–320mg/day divided into 2, 3, or 4 doses. Stenosis: 20–40mg 3–4 times a day before meals and at bedtime.

    Children

    Not recommended.

    Propranolol Contraindications

    Contraindications

    Asthma. Sinus bradycardia. 2nd- or 3rd-degree AV block. Overt heart failure. Cardiogenic shock.

    Propranolol Boxed Warnings

    Not Applicable

    Propranolol Warnings/Precautions

    Warnings/Precautions

    CHF. Wolff-Parkinson-White syndrome. Renal or hepatic dysfunction. Bronchospastic disease, COPD. Diabetes. May mask signs and increase risk for hypoglycemia. Hyperthyroidism. Surgery. SLE. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.

    Propranolol Pharmacokinetics

    Absorption

    Peak plasma concentrations occur about 1–4 hours post-dose.

    Distribution

    Plasma protein bound: ~90%. Volume of distribution: ~4 L/kg. Propranolol crosses the blood-brain barrier and the placenta, ad is distributed into breast milk.

    Metabolism

    Hepatic (aromatic hydroxylation, N-dealkylation, glucuronidation).

    Elimination

    Renal. Half-life: 3–6hrs.

    Propranolol Interactions

    Interactions

    Potentiated by alcohol, CNS depressants, other antihypertensives, antithyroid drugs, haloperidol, chlorpromazine, cimetidine. Bradycardia with catecholamine-depleting drugs. Antagonized by NSAIDs, barbiturates, rifampin, phenytoin. May increase cardiac effects of calcium channel blockers, digitalis, lidocaine. Potentiates theophylline, antipyrine, lidocaine. May block epinephrine. May interfere with glaucoma screening tests.

    Propranolol Adverse Reactions

    Adverse Reactions

    Heart failure, hypotension, bronchospasm, bradycardia, heart block, fatigue, dizziness, depression, GI upset, skin reactions (eg, rash, Stevens-Johnson syndrome, urticaria), pharyngitis, agranulocytosis.

    Propranolol Clinical Trials

    See Literature

    Propranolol Note

    Not Applicable

    Propranolol Patient Counseling

    See Literature

    Propranolol Generic Name & Formulations

    Legal Class

    Rx

    General Description

    Propranolol HCl 10mg, 20mg, 40mg, 60mg, 80mg; scored tabs.

    Pharmacological Class

    Beta-blocker.

    See Also

      How Supplied

      Contact supplier

      Manufacturer

      Various generic manufacturers

      Mechanism of Action

      Propranolol, a nonselective β-adrenergic receptor blocker, does not possess autonomic nervous system activity. It exerts its antiarrhythmic effects in concentrations associated with β-adrenergic blockade.

      Propranolol Indications

      Indications

      Atrial and ventricular arrhythmias (see literature). Tachyarrhythmia due to digitalis intoxication. In stabilized patients after MI, to reduce mortality and risk of reinfarction.

      Propranolol Dosage and Administration

      Adult

      Arrhythmias: 10–30mg 3–4 times a day before meals and at bedtime. Post-MI: 180–240mg daily in divided doses.

      Children

      Not recommended.

      Propranolol Contraindications

      Contraindications

      Asthma. Sinus bradycardia. 2nd- or 3rd-degree AV block. Overt heart failure. Cardiogenic shock.

      Propranolol Boxed Warnings

      Not Applicable

      Propranolol Warnings/Precautions

      Warnings/Precautions

      CHF. Wolff-Parkinson-White syndrome. Renal or hepatic dysfunction. Bronchospastic disease, COPD. Diabetes. May mask signs and increase risk for hypoglycemia. Hyperthyroidism. Surgery. SLE. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.

      Propranolol Pharmacokinetics

      Absorption

      Peak plasma concentrations occur about 1–4 hours post-dose.

      Distribution

      Plasma protein bound: ~90%. Volume of distribution: ~4 L/kg. Propranolol crosses the blood-brain barrier and the placenta, ad is distributed into breast milk.

      Metabolism

      Hepatic (aromatic hydroxylation, N-dealkylation, glucuronidation).

      Elimination

      Renal. Half-life: 3–6hrs.

      Propranolol Interactions

      Interactions

      Potentiated by alcohol, CNS depressants, other antihypertensives, antithyroid drugs, haloperidol, chlorpromazine, cimetidine. Bradycardia with catecholamine-depleting drugs. Antagonized by NSAIDs, barbiturates, rifampin, phenytoin. May increase cardiac effects of calcium channel blockers, digitalis, lidocaine. Potentiates theophylline, antipyrine, lidocaine. May block epinephrine. May interfere with glaucoma screening tests.

      Propranolol Adverse Reactions

      Adverse Reactions

      Heart failure, hypotension, bronchospasm, bradycardia, heart block, fatigue, dizziness, depression, GI upset, skin reactions (eg, rash, Stevens-Johnson syndrome, urticaria), pharyngitis, agranulocytosis.

      Propranolol Clinical Trials

      See Literature

      Propranolol Note

      Not Applicable

      Propranolol Patient Counseling

      See Literature

      Propranolol Generic Name & Formulations

      Legal Class

      Rx

      General Description

      Propranolol HCl 10mg, 20mg, 40mg, 60mg, 80mg; scored tabs.

      Pharmacological Class

      Beta-blocker.

      See Also

      How Supplied

      Tabs—contact supplier; LA—100

      Manufacturer

      Various generic manufacturers

      Mechanism of Action

      Propranolol, a nonselective β-adrenergic receptor blocker, does not possess autonomic nervous system activity. Its antihypertensive effect is thought to include: decreased cardiac output, inhibition of renin release by the kidneys, and diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain.

      Propranolol Indications

      Indications

      Hypertension. Adjunct in pheochromocytoma.

      Propranolol Dosage and Administration

      Adult

      Initially 40mg twice a day. Usual maintenance: 120–240mg daily; max 640mg daily. Pheochromocytoma: 60mg daily in divided doses for 3 days pre-op or 30mg daily in inoperable cases.

      Children

      Initially 1mg/kg daily. Usual range: 2–4mg/kg per day in 2 divided doses; max 16mg/kg per day.

      Propranolol Contraindications

      Contraindications

      Asthma. Sinus bradycardia. 2nd- or 3rd-degree AV block. Overt heart failure. Cardiogenic shock.

      Propranolol Boxed Warnings

      Not Applicable

      Propranolol Warnings/Precautions

      Warnings/Precautions

      CHF. Wolff-Parkinson-White syndrome. Renal or hepatic dysfunction. Bronchospastic disease, COPD. Diabetes. May mask signs and increase risk for hypoglycemia. Hyperthyroidism. Surgery. SLE. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.

      Propranolol Pharmacokinetics

      Absorption

      Peak plasma concentrations occur about 1–4 hours post-dose.

      Distribution

      Plasma protein bound: ~90%. Volume of distribution: ~4 L/kg. Propranolol crosses the blood-brain barrier and the placenta, ad is distributed into breast milk.

      Metabolism

      Hepatic (aromatic hydroxylation, N-dealkylation, glucuronidation).

      Elimination

      Renal. Half-life: 3–6hrs.

      Propranolol Interactions

      Interactions

      Potentiated by alcohol, CNS depressants, other antihypertensives, antithyroid drugs, haloperidol, chlorpromazine, cimetidine. Bradycardia with catecholamine-depleting drugs. Antagonized by NSAIDs, barbiturates, rifampin, phenytoin. May increase cardiac effects of calcium channel blockers, digitalis, lidocaine. Potentiates theophylline, antipyrine, lidocaine. May block epinephrine. May interfere with glaucoma screening tests.

      Propranolol Adverse Reactions

      Adverse Reactions

      Heart failure, hypotension, bronchospasm, bradycardia, heart block, fatigue, dizziness, depression, GI upset, skin reactions (eg, rash, Stevens-Johnson syndrome, urticaria), pharyngitis, agranulocytosis.

      Propranolol Clinical Trials

      See Literature

      Propranolol Note

      Not Applicable

      Propranolol Patient Counseling

      See Literature

      Propranolol Generic Name & Formulations

      Legal Class

      Rx

      General Description

      Propranolol HCl 10mg, 20mg, 40mg, 60mg, 80mg; scored tabs.

      Pharmacological Class

      Beta-blocker.

      See Also

      How Supplied

      Tabs—contact supplier; LA—100

      Manufacturer

      Various generic manufacturers

      Mechanism of Action

      Propranolol, a nonselective β-adrenergic receptor blocker, does not possess autonomic nervous system activity. The mechanism of the antimigraine effect has not been established. β-adrenergic receptors have been demonstrated in the pial vessels of the brain.

      Propranolol Indications

      Indications

      Migraine prophylaxis.

      Propranolol Dosage and Administration

      Adult

      Initially 80mg daily in divided doses. Usual range: 160–240mg daily. Discontinue if poor result after 4–6 weeks.

      Children

      Not recommended.

      Propranolol Contraindications

      Contraindications

      Asthma. Sinus bradycardia. 2nd- or 3rd-degree AV block. Overt heart failure. Cardiogenic shock.

      Propranolol Boxed Warnings

      Not Applicable

      Propranolol Warnings/Precautions

      Warnings/Precautions

      CHF. Wolff-Parkinson-White syndrome. Renal or hepatic dysfunction. Bronchospastic disease, COPD. Diabetes. May mask signs and increase risk for hypoglycemia. Hyperthyroidism. Surgery. SLE. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.

      Propranolol Pharmacokinetics

      Absorption

      Peak plasma concentrations occur about 1–4 hours post-dose.

      Distribution

      Plasma protein bound: ~90%. Volume of distribution: ~4 L/kg. Propranolol crosses the blood-brain barrier and the placenta, ad is distributed into breast milk.

      Metabolism

      Hepatic (aromatic hydroxylation, N-dealkylation, glucuronidation).

      Elimination

      Renal. Half-life: 3–6hrs.

      Propranolol Interactions

      Interactions

      Potentiated by alcohol, CNS depressants, other antihypertensives, antithyroid drugs, haloperidol, chlorpromazine, cimetidine. Bradycardia with catecholamine-depleting drugs. Antagonized by NSAIDs, barbiturates, rifampin, phenytoin. May increase cardiac effects of calcium channel blockers, digitalis, lidocaine. Potentiates theophylline, antipyrine, lidocaine. May block epinephrine. May interfere with glaucoma screening tests.

      Propranolol Adverse Reactions

      Adverse Reactions

      Heart failure, hypotension, bronchospasm, bradycardia, heart block, fatigue, dizziness, depression, GI upset, skin reactions (eg, rash, Stevens-Johnson syndrome, urticaria), pharyngitis, agranulocytosis.

      Propranolol Clinical Trials

      See Literature

      Propranolol Note

      Not Applicable

      Propranolol Patient Counseling

      See Literature

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