Propranolol is a non-selective beta-blocker (β1+β2) indicated for hypertension, angina, arrhythmias, essential tremor, migraine, and situational anxiety. It is lipophilic and crosses the blood-brain barrier.
Also known as: Inderal
Beta-blocker + calcium channel blocker: risk of severe AV block and cardiac arrest.
Propranolol (non-selective beta-1+beta-2) and verapamil profoundly depress AV conduction and contractility. Propranolol adds beta-2 blockade (bronchospasm) to verapamil's depressant effect. The combination can cause complete AV block, sinus arrest, cardiovascular collapse, and death. Absolutely CONTRAINDICATED — no safe dose exists for this combination.
Non-selective beta-blocker + non-dihydropyridine CCB: severe AV block and cardiac arrest. CONTRAINDICATED — risk of death.
Both depress AV conduction and contractility. The combination can cause high-grade AV block and cardiac arrest.
DailyMed/FDA (NIH/NLM) — approved Propranolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d5ac315-df2b-4b3a-bc7e-ad04752865c4
Beta-blocker + H2 blocker: inhibition of hepatic metabolism of propranolol.
Cimetidine inhibits multiple CYPs (1A2, 2D6, 3A4), reducing first-pass metabolism of propranolol. AUC may increase 3-5 fold. Use ranitidine or famotidine as alternatives (do not significantly inhibit CYP).
Beta-blocker + H2 blocker: cimetidine inhibits CYP, increasing propranolol levels. Risk of excessive bradycardia.
Cimetidine inhibits CYP, increasing propranolol plasma levels. Risk of excessive bradycardia and hypotension.
DailyMed/FDA (NIH/NLM) — approved Propranolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d5ac315-df2b-4b3a-bc7e-ad04752865c4
No documented food or drink interactions.
CONTRAINDICATED in bronchial asthma — beta-2 blockade causes severe bronchospasm.
CONTRAINDICATED in any form of asthma or severe COPD.
DailyMed/FDA (NIH/NLM) — approved Propranolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d5ac315-df2b-4b3a-bc7e-ad04752865c4
Masks the adrenergic symptoms of hypoglycaemia (tachycardia, tremor).
Monitor blood glucose frequently. Prefer cardioselective beta-blocker.
DailyMed/FDA (NIH/NLM) — approved Propranolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d5ac315-df2b-4b3a-bc7e-ad04752865c4
Use only if benefit justifies risk. May cause neonatal bradycardia, hypoglycaemia, and respiratory distress.
Avoid in 3rd trimester if possible.
Excreted in breast milk in low concentrations. Generally compatible.
Monitor neonate for bradycardia, hypoglycaemia, and respiratory distress.
DailyMed/FDA (NIH/NLM) — approved Propranolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0d5ac315-df2b-4b3a-bc7e-ad04752865c4
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Non-selective lipophilic beta-blocker (β1+β2) that crosses the blood-brain barrier. Membrane-stabilising activity (local anaesthetic effect).
Non-selectively blocks beta-1 and beta-2 receptors, reducing heart rate, contractility, AV conduction, and causing bronchospasm (via beta-2).
Oral bioavailability: ~25% (extensive first-pass metabolism). Food increases absorption. Tmax: 1-2 hours.
Extensively metabolised by CYP2D6 and CYP1A2. Inhibited by fluoxetine, cimetidine. Induced by rifampicin. Genetic polymorphism.
3-6 hours. Elimination: ~90% urine (metabolites), <1% unchanged. Adjust in hepatic impairment.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
