Propranolol

Dosage Forms

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Tablets

40 mg

Uses

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Hypertension
Angina
Arrhythmias
Migraine
Hyperthyroidism (specialist use only)

Dose and Duration

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Hypertension

Adult: 40–80 mg every 8–12 hours daily

Angina

Adult: initially 40–80 mg every 8–12 hours daily; maintenance 120–240 mg daily

Arrhythmias

Adult: initially 10–40 mg every 6–8 hours daily; maintenance 120–240 mg daily

Migraine prophylaxis

Adult: initially 40 mg every 8–12 hours, increased by same amount at weekly intervals if necessary. Usual maintenance dose is 80–160 mg daily

Child < 12 years: 20 mg every 8–12 hours daily

Hyperthyroidism

Adult: 40–80 mg every 12 hours for at least 1 month

Child: 250–500 micrograms/kg every 6–8 hours daily

Contraindications

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Asthma
Diabetes mellitus
Heart failure
Marked bradycardia
Hypotension
Cardiogenic shock
AV block
Sick sinus syndrome
Metabolic acidosis
Severe peripheral arterial disease
Pheochromocytoma

Side Effects

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Fatigue, sleep disturbances
Cold hands and feet, bradycardia, hypotension, peripheral vasoconstriction, conduction disorders
Bronchospasm
Stomach upset
Worsening of intermittent claudication

Interactions

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Bupivacaine (increased risk of bupivacaine toxicity)
Chlorpromazine (enhanced hypotensive effect)
Epinephrine (severe hypertension)
Lidocaine (increased risk of lidocaine toxicity)
Nifedipine (increased hypotensive effect; may be severe)
Verapamil (severe hypotension and heart failure)

Patient Instructions

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Report to health worker in case any severe rash occurs

Pregnancy

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Do not use

Breast-feeding

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Can be used

⚠️ Caution

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Can induce an asthma attack in asthmatic patients
May mask hypoglycaemic symptoms in diabetic patients
Patients on beta-blockers with anaphylaxis may not respond to epinephrine, and epinephrine may cause severe hypertension in these patients. Use salbutamol IV instead
Reduce dose in liver or kidney impairment