Propranolol
INDERAL
What it isNonselective beta-1 and beta-2 antagonist with sodium-channel effects; tremor, migraine and hypertension.
Why this oneBeta-2 blockade makes it a first-line drug for essential tremor; peripheral adrenergic control underpins performance-anxiety use.
What limits itBronchospasm makes it unsuitable in asthma. It masks hypoglycemia; bradycardia and CYP2D6 interactions can limit use.
FDA-approved for
- hypertension (1967)
- essential tremor
- migraine prophylaxis
Off-label
- performance anxiety
- akathisia
- infantile hemangioma
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 40 mg BID | 120–240 mg/day | 640 mg/day |
| Angina pectoris | Adults | 80–320 mg/day divided BID–QID | 320 mg/day | |
| Atrial fibrillation | Adults | 10–30 mg TID–QID (before meals and at bedtime) | ||
| Myocardial infarction (mortality reduction) | Adults | 40 mg TID | 180–240 mg/day divided | |
| Migraine prophylaxis | Adults | 80 mg/day divided | 160–240 mg/day | |
| Essential tremor | Adults | 40 mg BID | 120 mg/day | 240–320 mg/day |
| Hypertrophic subaortic stenosis | Adults | 20–40 mg TID–QID (before meals and at bedtime) | ||
| Pheochromocytoma (adjunct to alpha-blockade) | Adults | 60 mg/day divided ×3 days preop; inoperable tumor 30 mg/day divided |
Renal Undefined
Hepatic Undefined
Instructions
- Individualize dose to response (variable bioavailability)
- Do not discontinue abruptly — reduce gradually over several weeks (angina, migraine)
- Atrial fibrillation and hypertrophic subaortic stenosis: give before meals and at bedtime
Contraindications
- Cardiogenic shock
- Sinus bradycardia and greater than first-degree block
- Bronchial asthma
Cautions
- Abrupt withdrawal may exacerbate angina or precipitate MI — taper gradually
- Bronchospasm in susceptible patients
- May precipitate or worsen congestive heart failure
Adverse reactions
- Bradycardia
- Congestive heart failure
- Intensification of AV block
- Hypotension
- Light-headedness
- Depression/insomnia/fatigue
- Vivid dreams/hallucinations
- Nausea/vomiting/GI distress
- Bronchospasm
- Agranulocytosis
- Thrombocytopenic purpura
- Raynaud-type arterial insufficiency
- Male impotence
Pregnancy Category C; intrauterine growth retardation, small placentas, congenital abnormalities reported; neonatal bradycardia, hypoglycemia, and/or respiratory depression — monitor infants at birth.
Lactation Undefined
NO BOXED WARNINGS
Principal riskBradycardia and bronchospasm; nonselective
Cost, est. cash$20–$1,500/dose or month
Generic entry1985
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityBradycardia, hypotension and bronchospasm; overdose can cause seizures and cardiogenic shock.
Mechanism of action: Propranolol ballicule
Open Propranolol in the interactive console ↗
Memory aids: mascots and interaction avatars
LOL hat with β prongs → beta blocker cue
Character is Ender from Ender’s Game
