Propranolol

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Oct 13, 2023

Warnings

Propranolol Risks, Warnings, and Complications

Propranolol can cause or worsen health problems in some people. Talk to your doctor or pharmacist about taking other medications for your condition if you are at an increased risk of complications from this drug.

WORSENING CHEST PAIN OR HEART ATTACK: There are reports of worsening angina (chest pain), and in some cases, heart attack, when therapy was stopped suddenly in patients receiving propranolol. If you have coronary artery disease, do not stop taking propranolol suddenly without talking to your healthcare provider. Your doctor will tell you how to lower the dose gradually over several weeks. Tell your doctor if you develop worsening angina symptoms after stopping propranolol therapy - you may need other treatments for angina.
SEVERE SKIN REACTION: In a very small number of people, propranolol can cause serious and potentially life-threatening skin reactions. Tell your doctor immediately or seek emergency medical attention if you develop a sudden, severe skin rash.
HEART FAILURE: Some people with congestive heart failure develop worsening symptoms after starting propranolol. Taking propranolol can also cause heart failure in people with no history of this condition. Tell your healthcare provider without delay if you develop swelling in your feet or ankles, trouble breathing, shortness of breath, fast or slow heart beats, irregular heartbeat, or rapid weight gain.
BRONCHOSPASTIC DISEASES: Propranolol and other beta blockers are not typically prescribed to people with asthma and other breathing disorders because they can cause difficulty breathing. Before starting propranolol, tell your doctor if you have asthma, COPD, or other lung problems.
MAJOR SURGERY: Beta blockers can reduce the ability of your heart to respond to certain stimuli in the body and increase the risks associated with anesthesia. The need to stop beta blocker (propranolol) treatment before a major surgery remains controversial. Your surgeon will discuss the pros and cons with you.
HYPOGLYCEMIA: Diabetic patients on propranolol may not notice certain symptoms of insulin-induced hypoglycemia (low blood sugar), such as changes in pulse rate and blood pressure. If you have diabetes, talk to your healthcare provider about how often you should monitor blood sugar levels while on propranolol.
THYROTOXICOSIS: Propranolol can mask some of the clinical signs of hyperthyroidism (overactive thyroid gland), such as a rapid heart rate. Abruptly stopping propranolol can lead to an exacerbation of hyperthyroidism symptoms, including thyrotoxicosis or thyroid storm. Propranolol can also interfere with thyroid function tests. Before starting propranolol, tell your healthcare provider if you have a thyroid disorder.

Precautions Before Starting Propranolol

Tell your doctor if you are allergic to propranolol, any of the active or inactive ingredients in propranolol formulations, other beta blockers, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug-drug interactions.

Give your doctor a complete medical history. Propranolol may not be right for people with certain medical conditions such as congestive heart failure, slow or irregular heartbeat, asthma, or other lung disease. Also, tell your doctor if you have heart disease, kidney disease, liver disease, pheochromocytoma, hyperthyroidism (overactive thyroid), or a history of a severe allergic reaction to any substance, including certain foods.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Propranolol

Keep all your medical appointments while on this medication. Your doctor may order certain medical tests and adjust your dose based on your response to the medicine.

If you take medications for diabetes, propranolol can mask some of the symptoms of hypoglycemia (low blood sugar). Make sure you know how to recognize hypoglycemia and what to do if it occurs. Tell your doctor if you are unable to eat or drink normally or have vomiting during propranolol treatment.

You should know that propranolol can result in more severe allergic reactions to various substances and also reduce your response to the usual treatments for hypersensitivity reactions, such as injectable epinephrine.

Side effects of propranolol include dizziness and weakness. Do not drive, operate heavy machinery, or do any other hazardous activities until you know how this medicine affects you. Alcohol can make these side effects worse, so avoid drinking. Arise slowly from a sitting or lying position to avoid lightheadedness due to low blood pressure.

Tell your healthcare provider if you use tobacco products. Using tobacco while on propranolol can make the medicine less effective.

Tell your doctor if you become pregnant while on propranolol.

Tell all your healthcare providers you are on propranolol before any surgery, including dental procedures.

Propranolol Drug Interactions

Certain other drugs can affect how propranolol works. Possible interactions with other medicines can increase the risk of severe adverse effects. The following medications can have drug interactions with propranolol:

Aluminum-containing antacids such as Mylanta, Maalox, and others
H2 blockers (acid reducers) such as cimetidine (Tagamet HB)
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen sodium (Aleve, Naprosyn)

The above list may not include all the potential drug interactions of propranolol. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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