Propranolol Uses

Propranolol belongs to a group of drugs called beta blockers. It is used to treat hypertension (high blood pressure), either alone or in combination with other antihypertensive drugs such as diuretics (water pills). 

Propranolol is also used to decrease the frequency of angina attacks and improve exercise tolerance in patients with coronary atherosclerosis. 

In addition, this medicine is used to control the ventricular rate in people who have atrial fibrillation with rapid ventricular response, which is a heart rhythm abnormality. 

Propranolol increases survival rates in patients who have had heart attacks. 

It is also used for prophylaxis (prevention) of migraine headaches. 

Additional uses of propranolol include the management of hereditary or familial essential tremor, a condition associated with rhythmic involuntary movements that are absent at rest but occur during active movement or when a limb is held in a fixed posture or against gravity. 

Propranolol may be prescribed to symptomatic patients with hypertrophic subaortic stenosis, a condition affecting the heart muscle. 

Another use of propranolol is the management of catecholamine-secreting tumors like pheochromocytoma (a rare, benign tumor of the adrenal glands) for which propranolol is prescribed, along with alpha-adrenergic blockers.

Propranolol hydrochloride oral solution (brand name: Hemangeol) is used to treat proliferating infantile hemangiomas (strawberry marks caused by an overgrowth of blood vessels in the skin that grow rapidly in early infancy).

There may be other uses of propranolol—your pharmacist or doctor can give you further drug information.

Propranolol Mechanism of Action

Propranolol slows the heart rate and relaxes the blood vessels. This helps to improve blood flow, lower blood pressure, and decrease the workload of the heart.

Propranolol Doses

Propranolol is available as: 

• 10 mg, 20 mg, 40 mg, 60 mg, and 80 mg immediate-release (regular) tablets 
• 80 mg and 120 mg extended-release capsules (Inderal XL)
• 60 mg, 80 mg, 120 mg, and 160 mg long-acting capsules (Inderal LA)
• 20 mg/5 mL and 40 mg/5 mL oral solution
  
  

The usual doses are as follows:

For hypertension (high blood pressure)

The usual starting dose of propranolol to control blood pressure is 40 mg twice daily, either alone or with a diuretic. The dose may be increased slowly until blood pressure is controlled. The maintenance dose is typically 120 mg to 240 mg per day in divided doses. Some people may need a maximum dose of up to 640 mg per day of propranolol. It can take anywhere from a few days to several weeks to get the full antihypertensive effect of this medicine. With twice-daily dosing (every 12 hours), especially at lower doses, some people experience a rise in blood pressure towards the end of the 12-hour period. In such individuals, it may be necessary to increase the dose or use thrice-daily dosing to maintain blood pressure control throughout the day. 

For angina pectoris (chest pain)

The usual daily dose of propranolol is 80 mg to 320 mg, taken in 2-4 divided doses to decrease angina frequency. If propranolol is to be discontinued, this should be done by reducing the dose gradually over several weeks. 

For atrial fibrillation

The recommended dose of propranolol for heart rhythm disorders such as atrial fibrillation with rapid ventricular response is 10 mg to 30 mg 3-4 times a day before meals and at bedtime.

For myocardial infarction (heart attack)

The initial dose is typically 40 mg three times a day. This can be increased to 60 mg to 80 mg three times a day after one month as tolerated to reduce cardiovascular mortality. The recommended maintenance dose is 180 mg to 240 mg per day in divided doses. A twice-daily regimen instead of a thrice-daily regimen may also be used to improve survival after heart attacks. 

For prevention of common migraine headache

The usual starting dose is 80 mg daily in divided doses. The typical maintenance dose ranges from 160 mg to 240 mg per day. Your healthcare provider will increase the dose gradually to achieve optimum migraine prevention. If you do not get a satisfactory response in 4-6 weeks at the maximum recommended dose, your provider may ask you to discontinue propranolol therapy. This medication should be withdrawn gradually over several weeks.

For essential tremor

The initial dose of propranolol for essential tremor is 40 mg twice daily. Most people achieve a reduction in essential tremors at a maintenance dose of 120 mg per day, but some people need higher doses of 240 mg to 320 mg per day in divided doses. 

For hypertrophic subaortic stenosis

The usual dose is propranolol 20 mg to 40 mg 3-4 times a day before meals and at bedtime. 

For pheochromocytoma

The typical dose is propranolol 60 mg daily in divided doses for 3 days before surgery, along with alpha-adrenergic blockers. In case the tumor is inoperable, the usual dose of propranolol is 30 mg daily in divided doses, along with alpha-adrenergic blockade as adjunctive therapy.