Propranolol by Ray Sahelian, M.D.

Propranolol, a type of medication known as a beta blocker, is used in the treatment of high blood pressure, angina pectoris (chest pain, usually caused by lack of oxygen to the heart due to clogged arteries), changes in heart rhythm, prevention of migraine headache, hereditary tremors, and tumors of the adrenal gland. Propranolol is also used to reduce the risk of death from recurring heart attack.

Propranolol helpful for Stage Fright

Propranolol, in a dosage of 20 mg or 40 mg, taken an hour or two before a speech, can be helpful in reducing stage anxiety. Some people may need propranolol in a 60 mg dosage.

How should you take Propranolol?
Propranolol works best when taken before meals.

Propranolol side effects
Propranolol side effects may include: Abdominal cramps, congestive heart failure, constipation, decreased sexual ability, depression, diarrhea, difficulty breathing, disorientation, dry eyes, fever with sore throat, hair loss, hallucinations, headache, light-headedness, low blood pressure, lupus erythematosus (a disease of the connective tissue), nausea, rash, reddish or purplish spots on the skin, short-term memory loss, slow heartbeat, tingling, prickling in hands, tiredness, trouble sleeping, upset stomach, visual changes, vivid dreams, vomiting, weakness, worsening of certain heartbeat irregularities.

Who should not take Propranolol
If you have inadequate blood supply to the circulatory system (cardiogenic shock), certain types of irregular heartbeat, a slow heartbeat, bronchial asthma, or severe congestive heart failure, you should not take propranolol. If you have a history of congestive heart failure, your doctor will prescribe propranolol cautiously. If you suffer from asthma or other bronchial conditions, coronary artery disease, or kidney or liver disease, propranolol should be used with caution. Notify your doctor or dentist that you are taking propranolol if you have a medical emergency, and before you have surgery or dental treatment.

Possible food and drug interactions when taking Propranolol
If propranolol is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining propranolol with the following:

Alcohol
Aluminum hydroxide gel (Amphojel)
Calcium-blocking blood pressure drugs such as Cardizem, Procardia, and Calan
Certain high blood pressure medications such as Diupres and Ser-Ap-Es
Cimetidine (Tagamet)
Epinephrine (EpiPen)
Haloperidol (Haldol)
Insulin
Lidocaine (Xylocaine)
Nonsteroidal anti-inflammatory drugs such as ibuprofen and Naprosyn
Oral diabetes drugs such as Micronase
Phenytoin (Dilantin)
Rifampin (Rifadin)
Theophylline (Theo-Dur and others)
Thyroid medications such as Synthroid

If you are pregnant or breastfeeding
The effects of propranolol during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Propranolol appears in breast milk and could affect a nursing infant. If propranolol is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with propranolol is finished.

Recommended dosage for Propranolol
ADULTS: All dosages of propranolol, for any problem, must be tailored to the individual. Your doctor will determine when and how often you should take propranolol. If you are over 65, the doctor will probably start with a relatively low dosage. Propranolol is also available in a sustained-release formulation, called Propranolol LA, for once-a-day dosing.

Propranolol dosage for Hypertension
The usual starting dose is 40 milligrams 2 times a day. This dose may be in combination with a diuretic. Dosages above 80 mg a day increase the risk for side effects. When used for the treatment of high blood pressure, propranolol is effective alone or combined with other high blood pressure medications, particularly thiazide-type diuretics. Beta blockers decrease the force and rate of heart contractions, reducing the heart's demand for oxygen and lowering blood pressure.

Angina Pectoris
The usual daily dosage is 80 milligrams to 120 milligrams, divided into 2, 3, or 4 smaller doses. When your treatment is being discontinued, your doctor will reduce the dosage gradually over a period of several weeks.

Irregular Heartbeat
The usual dose is 10 milligrams to 30 milligrams 3 or 4 times a day, before meals and at bedtime. Propranolol may be used for irregular heart beats or very fast heart beats due to anxiety or or from overdose of certain herbs and supplements.

Heart Attack
The usual daily dosage is 100 milligrams to 200 milligrams divided into smaller doses. The usual maximum dose is 200 milligrams, although your doctor may increase the dose when treating heart attack with angina or high blood pressure.

Migraine
The usual starting dosage is 60 milligrams per day divided into smaller doses. Dosages can be increased gradually to between 120 milligrams and 200 milligrams per day. If this dose does not relieve your symptoms in 4 to 6 weeks, your doctor will slowly take you off the drug.

Tremors
The usual starting dose is 40 milligrams, 2 times per day. Symptoms will usually be relieved with a dose of 120 milligrams per day; however, on occasion, dosages of up to 200 milligrams per day may be necessary.

Before Adrenal Gland Surgery
The usual dose is 60 milligrams a day divided into smaller doses for 3 days before surgery in combination with an alpha-blocker drug.

Propranolol for Children
Propranolol will be carefully individualized for use in children and is used only for high blood pressure. Doses in children are calculated by body weight, and range from 2 milligrams to 4 milligrams per 2.2 pounds daily, divided into 2 equal doses. The maximum dose is 16 milligrams per 2.2 pounds per day. If treatment is stopped, Propranolol must be gradually reduced over a 7 day period.

Propranolol Overdosage
Overdose symptoms with beta blockers include: Extremely slow heartbeat, irregular heartbeat, low blood pressure, severe congestive heart failure, seizures wheezing.

Propranolol emails

Q. I took a tablet of Sudafed once about five years ago and the side effects of a headache and a pounding heartbeat would not go away for weeks. A nurse prescribed to me propranolol to get rid of them so I took 2 to 4 tablets in two days, but the side effects of Propanolol has stayed with me since. I believe that my body is not strong enough to fight off medications after their initial effects wears off. I still feel the almost paralyzed effects of propanolol where it blocks beta receptors so that my body moves sluggishly and my heart beats very slowly...too slowly. It is hard to move because I feel almost paralyze from the effects of the medication. Are there anything to unblock the receptors that propanolol has blocked?
   A. I can't imagine the use of propranolol would have an effect several years later.

Q. Can propranolol reduce libido?
   A. Propranolol may reduce libido but more often causes difficulty with maintaining a full erection.