Propranolol should be used with caution in:
- The elderly
- People with a history of allergic reactions
- People with muscle weakness and fatigue (myasthenia gravis)
- People with heart disease
- People with the skin condition psoriasis
- People with diabetes
- People with first-degree heart block
- People with an overactive thyroid
- People with kidney disease
- People with liver disease
- People with blood circulation problems (that may cause your fingers and toes to tingle or turn pale or blue)
- People with breathing difficulties
It should not be used in:
- People with allergies to propranolol or any of the other ingredients
- People with a history of lung spasms or asthma
- People with bradycardia (a slow heart beat when you are resting)
- People with second or third degree heart block (condition where the heart does not beat properly and you may need a pacemaker)
- People with sick sinus syndrome (a type of irregular heart beat)
- People with cardiogenic shock (failure of the heart to pump leading to low blood pressure and lack of oxygen in the tissues)
- People with uncontrolled heart failure (the heart is unable to pump enough blood around the body; symptoms include shortness of breath at rest or with activity, shortness of breath while lying down, awakening at night short of breath, muscle weakness, fatigue, swollen ankles)
- People with low blood pressure (you may feel light-headed or dizzy if you stand or sit up quickly)
- People with severe peripheral arterial disease (you may feel pain in your legs when you walk)
- People with Prinzmetal's angina (chest pain that occurs at rest, often at night)
- People with untreated phaeochromocytoma (rare adrenal cancer)
- People who have prolonged periods of not eating or if prone to low blood sugar
- People with metabolic acidosis (blood is too acidic; symptoms may include chest pain, palpitations, headache)
Also see list of precautions and interactions
Store below 25°C away from strong light.
What is it used for?
- Propranolol is used to treat high blood pressure, chest pain caused by angina, and irregular heart beat. It is also used to protect the heart after a heart attack and to prevent migraines.
- It is a beta-blocker.
- It is used to slow down the activity of the heart and decrease blood pressure.
- In general this drug is used if you have high blood pressure, angina (by slowing down the activity of the heart, it reduces the heart's need for oxygen and reduces the risk of angina), irregular heartbeat, physical symptoms of anxiety (such as fast heartbeat, palpitations and trembling), fast or pounding heartbeat, trembling and sweating caused by overactive thyroid, after a heart attack to reduce the risk of a second attack, and to prevent or reducing the severity of migraines.
- Benefits of being on this drug can include reducing high blood pressure, reducing the episodes of angina, calming a fast or irregular heart beat, and preventing or reducing the severity of migraines.
Listed below are the typical uses of propranolol.
- High blood pressure
- Angina (chest pain)
- Reduce the risk of a second attack
- Irregular heart beat
- Anxiety and generalised anxiety symptoms
- Bleeding in the oesophagus in patients with portal hypertension (high blood pressure in the portal vein, which drains blood from the liver and spleen)
- Overactive thyroid
- Blocking of the flow of blood in the heart due to thickened heart muscle (hypertrophic cardiomyopathy)
On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below.
- Phaeochromocytoma (rare adrenal gland growth) when propranolol will be given together with an alpha blocker.
HOW TO USE/TAKE
How often do I take it?
- Take this medication by mouth usually twice or three times daily. Tablets should be taken with water. If taken as intravenously, the injection will be given by your doctor or another health care professional.
- Use this medication regularly in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told otherwise by your doctor.
- It may take up to a week before the full benefit of this drug takes effect.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- Alcohol may increase the blood pressure lowering effect of your medicine. If you feel dizzy or tired you should not drive or operate machines. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop. When treatment with this medicine is stopped it should be done gradually following the instructions given by your doctor
PROPRANOLOL SIDE EFFECTS
- Cold extremities
- Difficulty in sleeping
- Numbness and spasm in fingers, followed by warmth and pain (Raynaud’s disease)
- Feeling sick
- Being sick
- Slow or irregular heart beat
- Skin and hair problems, including rash, worsening of psoriasis, hair loss, dry flaky skin
- Mood changes
- Pins and needles
- Depression or psychoses
- Thinning of the hair
- Purplish marks on the skin
- Difficulty in breathing.
- Dry eyes
- Visual disturbances.
- Increased bruising, nosebleeds, sore throats or infections
- Changes in sex drive
If any of these persist or you consider them severe then inform doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms:
- Intolerance to propranolol, such as slow heart rate and low blood pressure causing dizziness, light-headedness, fainting or blurred vision
- Allergic reaction such as itching, difficulty breathing or swelling of the face, lips, throat or tongue
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking propranolol, tell your doctor or pharmacist if you are allergic to it; or to other beta-blockers; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if:
- You are allergic to propranolol or any of the other ingredients
- You are pregnant
- You are breast feeding
- You have a history of lung spasms or asthma
- You have bradycardia (a slow heart beat when you are resting)
- You have second or third degree heart block (a condition where the heart does not beat properly and you may need a pacemaker)
- You have sick sinus syndrome (a type of irregular heart beat)
- You have cardiogenic shock (failure of the heart to pump leading to low blood pressure and lack of oxygen in the tissues)
- You have uncontrolled heart failure (the heart is unable to pump enough blood around the body; symptoms include shortness of breath at rest or with activity, shortness of breath while lying down, awakening at night short of breath, muscle weakness, fatigue or swollen ankles)
- You have low blood pressure (you may feel light-headed or dizzy if you stand or sit up quickly
- You have severe peripheral arterial disease (you may feel pain in your legs when you walk)
- You have Prinzmetal's angina (chest pain that occurs at rest, often at night)
- You have untreated phaeochromocytoma (rare adrenal cancer)
- You have prolonged periods of not eating or prone to low blood sugar
- You have metabolic acidosis (blood is too acidic; symptoms may include chest pain, palpitations, headache).
Before using this medication, tell your doctor or pharmacist your medical history, especially any of the following:
- A history of allergic reactions
- A history of muscle weakness and fatigue (myasthenia gravis)
- Heart disease
- First-degree heart block
- Kidney disease
- Liver disease
- Blood circulation problems (that may cause your fingers and toes to tingle or turn pale or blue)
- Breathing difficulties
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- You should avoid alcohol while taking propranolol.
The elderly: propranolol should be used with caution in the elderly as you may need a reduced dose.
Pregnancy and breast-feeding - please ensure you read the detailed information below
Propranolol is not safe to take if you are, or are planning to become, pregnant.
First trimester: not recommended
Second trimester: not recommended
Third trimester: not recommended
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Propranolol is not safe to take if you are breastfeeding
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
There are medicines that are known to interact with propranolol and your doctor may well have considered this, however if you are taking any of the following medicines please make sure your doctor or pharmacist is aware of this. Do not start, stop or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:
If you are currently using any of these medications, tell your doctor or pharmacist before starting propranolol.
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Verapamil, diltiazem, nifedipine, nisoldipine, nicardipine, isradipine, lacidipine, clonidine, hydralazine (used to treat hypertension and angina)
- Disopyramide, lignocaine, quinidine or propafenone (for irregular heartbeat)
- Digoxin (for heart conditions)
- Adrenaline (epinephrine, a heart stimulant used in anaphylactic shock)
- Ibuprofen and indomethacin (NSAIDs for pain and inflammation)
- Ergotamine and dihydroergotamine (for migraine)
- Chlorpromazine and thioridazine (for certain mental illnesses)
- Cimetidine (for stomach ulcers)
- Rifampicin (an antibiotic for the treatment of tuberculosis)
- Theophylline (for asthma)
- Insulin and other drugs for diabetes
- Warfarin (to thin the blood)
This information does not contain all possible interactions. Therefore, before using propranolol, tell your doctor or pharmacist of all the products you use.
If you have accidentally taken more than the prescribed dose, contact your nearest casualty department or tell your doctor or pharmacist at once. Overdose causes an excessively slowed heart beat with symptoms such as dizziness, breathlessness on exertion or fainting.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of propranolol or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.