Propranolol

Propranolol is a beta-blocker. The label we reviewed is for propranolol hydrochloride tablets taken by mouth.

The label lists several uses, from high blood pressure and angina to migraine prevention and essential tremor.

It is not for hypertensive emergencies, not for treating a migraine attack that has already started, and not for tremor linked to Parkinson's disease.

• Hypertension
• Angina pectoris due to coronary atherosclerosis
• Control of fast heart rate in atrial fibrillation
• Reducing cardiovascular death after a heart attack in stable patients
• Prevention of common migraine
• Familial or essential tremor
• Hypertrophic subaortic stenosis
• Pheochromocytoma, as an add-on to alpha-blockade

The label says the way it lowers blood pressure has not been established. Several factors may contribute, including lower cardiac output, less renin release by the kidneys and less nerve signalling from the brain.

In angina, it generally lowers the heart's oxygen need by blocking increases in heart rate, blood pressure and heart contraction strength.

The label says how it prevents migraine and reduces tremor has not been established.

This section covers the propranolol hydrochloride tablet label for adults (oral route). Indian tablets and capsules differ, and your prescriber decides. The label says the dose should be set by response.

For hypertension, the US label gives a usual starting dose of 40 mg twice daily, raised step by step. It gives a usual maintenance range of 120 to 240 mg a day.

For angina, the label gives total daily doses of 80 to 320 mg, divided into two to four doses. For atrial fibrillation, it gives 10 to 30 mg three or four times daily before meals and at bedtime.

After a heart attack, the label gives 180 to 240 mg a day in divided doses. For migraine prevention, it gives a starting dose of 80 mg a day in divided doses, with a usual range of 160 to 240 mg a day.

The label says to reduce the dose gradually over several weeks if treatment is to be stopped.

• Dose is individualised on the label
• Hypertension start: 40 mg twice daily on the US label
• Reduce gradually over weeks when stopping

The label says propranolol must not be used in cardiogenic shock, sinus bradycardia, heart block beyond first degree, bronchial asthma, or with a known allergy to the drug.

Angina can worsen, and heart attacks have occurred, after sudden stopping. The label advises against stopping without your doctor's advice.

Beta-blockers can hide some warning signs of low blood sugar, such as changes in pulse and blood pressure. People with diabetes should tell their doctor.

Use with caution in heart failure, lung disease such as chronic bronchitis or emphysema, and liver or kidney impairment. The label says chronic therapy should not usually be withdrawn before major surgery.

Pregnancy: the label says use only if the potential benefit justifies the risk to the fetus. Newborns exposed at delivery have shown slow heartbeat, low blood sugar or breathing depression. Breastfeeding: propranolol passes into human milk, so caution is advised.

Children: safety and effectiveness have not been established. Older adults: start at the low end of the dose range.

• Contraindicated in bronchial asthma
• Contraindicated in sinus bradycardia and heart block beyond first degree
• Do not stop suddenly
• May hide signs of low blood sugar
• Pregnancy: only if benefit justifies risk

• Quinidine: higher propranolol levels
• Verapamil and digitalis: more slowing of the heart
• Lidocaine: toxicity reported
• Epinephrine: may work less well in severe allergy
• The label warns about medicines that act on the CYP2D6, 1A2 and 2C19 pathways, which can change propranolol levels.
• Among heart medicines, quinidine raises propranolol levels.
• Propafenone and amiodarone can add to its effects.
• Digitalis and calcium channel blockers such as verapamil can add to slowing of the heartbeat, with reports of heart failure and collapse.
• Propranolol reduces lidocaine clearance, and lidocaine toxicity has been reported.
• People with severe allergies may be less responsive to the usual epinephrine doses while taking beta-blockers.

No match in this label text. Ask your pharmacist about any medicine you take.

The label says slow heartbeat and low blood pressure are reported after overdose. Propranolol is not significantly removed by dialysis.

Treatment is supportive and given in hospital. Treat any overdose as an emergency.

The US label says to store tablets at 20 to 25 degrees C in a tight, light-resistant container and to protect from light.

Indian packs may carry their own storage line. Follow your pack, and keep all medicines away from children.

We did not find propranolol in the Schedule H, H1 or X rows of the Drugs Rules lists we checked. This does not say how a particular pack is sold, so check the pack.

The National List of Essential Medicines 2022 includes propranolol as 20 mg and 40 mg tablets (page 68).

NPPA has ceiling prices for propranolol capsules and tablets, shown below.

Banned combinations: the list we checked has 2 mentions of propranolol. Use the checker for your exact combination.

NPPA ceiling prices set the most a seller can charge per unit before local taxes. Check the pack and the seller.

Jan Aushadhi lists propranolol tablets of 10 mg, 20 mg and 40 mg, plus one combination with flunarizine. Combination products also contain other medicines, so read the label. We have not shown a brand price here.

• Propranolol Tablets IP 10 mg (pack 10's)
• Propranolol Tablets IP 20 mg (pack 10's)
• Propranolol Tablets IP 40 mg (pack 10's)