Propranolol: Expert Cardiovascular and Neurological Management
Propranolol
| Product dosage: 40mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | 4.68 $ | 46.80 $ (0%) | 🛒 Add to cart |
| 20 | 2.63 $ | 93.60 $ 52.65 $ (44%) | 🛒 Add to cart |
| 30 | 1.95 $ | 140.40 $ 58.50 $ (58%) | 🛒 Add to cart |
| 60 | 1.07 $ | 280.80 $ 64.35 $ (77%) | 🛒 Add to cart |
| 90 | 0.78 $ | 421.20 $ 70.20 $ (83%) | 🛒 Add to cart |
| 120 | 0.63 $ | 561.60 $ 76.05 $ (86%) | 🛒 Add to cart |
| 180 | 0.52 $ | 842.40 $ 93.60 $ (89%) | 🛒 Add to cart |
| 270 | 0.43 $ | 1263.60 $ 117.00 $ (91%) | 🛒 Add to cart |
| 360 | 0.39 $
Best per pill | 1684.80 $ 140.40 $ (92%) | 🛒 Add to cart |
| Product dosage: 80mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | 5.26 $ | 52.65 $ (0%) | 🛒 Add to cart |
| 20 | 2.92 $ | 105.30 $ 58.50 $ (44%) | 🛒 Add to cart |
| 30 | 2.15 $ | 157.95 $ 64.35 $ (59%) | 🛒 Add to cart |
| 60 | 1.17 $ | 315.90 $ 70.20 $ (78%) | 🛒 Add to cart |
| 90 | 0.84 $ | 473.85 $ 76.05 $ (84%) | 🛒 Add to cart |
| 120 | 0.78 $ | 631.80 $ 93.60 $ (85%) | 🛒 Add to cart |
| 180 | 0.65 $ | 947.70 $ 117.00 $ (88%) | 🛒 Add to cart |
| 270 | 0.54 $ | 1421.55 $ 146.25 $ (90%) | 🛒 Add to cart |
| 360 | 0.50 $
Best per pill | 1895.40 $ 181.35 $ (90%) | 🛒 Add to cart |
Synonyms
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Similar products
Propranolol is a non-selective beta-adrenergic blocking agent, widely recognized for its efficacy in managing a spectrum of cardiovascular and neurological conditions. As a cornerstone in therapeutic regimens, it modulates sympathetic nervous system activity, offering precise control over heart rate, blood pressure, and situational anxiety. Its established safety profile and versatility make it a first-line option for clinicians seeking reliable, evidence-based treatment outcomes. This card provides a comprehensive overview tailored for healthcare professionals.
Features
- Active ingredient: Propranolol hydrochloride
- Pharmacological class: Non-selective beta-blocker
- Available formulations: Immediate-release tablets, extended-release capsules, oral solution, injectable
- Standard strengths: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg, 90 mg, 120 mg, 160 mg tablets/capsules
- Half-life: Approximately 3–6 hours (immediate-release); 8–11 hours (extended-release)
- Bioavailability: ~25% due to significant first-pass metabolism
- Protein binding: 90–95%
- Metabolism: Primarily hepatic via CYP2D6 and CYP1A2 isoenzymes
- Excretion: Renal (primarily as metabolites)
Benefits
- Reduces myocardial oxygen demand by lowering heart rate, contractility, and blood pressure, decreasing angina frequency and improving exercise tolerance.
- Provides effective prophylaxis for migraine headaches by modulating cerebral vascular tone and reducing cortical spreading depression.
- Manages essential tremor through central and peripheral beta-adrenergic blockade, improving functional capacity and quality of life.
- Controls symptomatic hyperthyroidism by attenuating catecholamine-mediated effects such as tachycardia and palpitations.
- Alleviates performance anxiety and situational stressors by blunting peripheral adrenergic symptoms like tremors and tachycardia.
- Decreases portal hypertension in cirrhotic patients, reducing risk of variceal bleeding.
Common use
Propranolol is indicated for the management of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is employed in the prophylaxis of angina pectoris, where it reduces ischemic episodes by decreasing cardiac workload. Additionally, it is FDA-approved for the prevention of migraine headaches, management of essential tremor, and as adjunctive therapy in pheochromocytoma. Off-label uses include treatment of anxiety disorders (particularly performance anxiety), arrhythmias, akathisia, and portal hypertension.
Dosage and direction
Dosage must be individualized based on indication, patient response, and tolerability. For hypertension, initial dosing is typically 40 mg twice daily (immediate-release) or 80 mg once daily (extended-release), titrated upward at 3–7 day intervals. Maximum daily dose is 640 mg. For angina, start with 80–320 mg daily in divided doses. Migraine prophylaxis usually begins at 80 mg daily in divided doses, with maintenance ranging from 160–240 mg daily. Essential tremor dosing starts at 40 mg twice daily, titrated to 120–320 mg daily as needed. Administer with food to enhance bioavailability and minimize gastrointestinal upset. Abrupt discontinuation should be avoided; taper over 1–2 weeks to prevent rebound hypertension or angina.
Precautions
Use with caution in patients with compensated heart failure; monitor for worsening symptoms. May mask hypoglycemic symptoms in diabetics. Can exacerbate bronchospasm in patients with reactive airway disease. Use cautiously in hepatic impairment; reduce dose in significant liver dysfunction. May cause bradycardia or heart block; monitor heart rate regularly. Can precipitate or worsen depression or fatigue. Peripheral vasoconstriction may worsen Raynaud’s phenomenon or peripheral arterial disease. Not recommended during pregnancy unless potential benefit justifies potential risk (Category C). Excreted in breast milk; use with caution in nursing mothers.
Contraindications
Contraindicated in patients with sinus bradycardia, heart block greater than first degree, cardiogenic shock, decompensated heart failure, and sick sinus syndrome (unless a permanent pacemaker is present). Absolute contraindication in patients with bronchial asthma or history of bronchospasm. Avoid in severe peripheral arterial disease and uncontrolled pheochromocytoma (unless used with alpha-blockade). Hypersensitivity to propranolol or any component of the formulation is a contraindication.
Possible side effect
Common side effects include fatigue (10–15%), bradycardia (5–10%), nausea (5–10%), diarrhea (5–8%), and cold extremities (5–10%). Less frequently, patients may experience insomnia, vivid dreams, depression, or shortness of breath. Rare but serious adverse effects include heart failure exacerbation, bronchospasm, severe bradycardia, hypoglycemia, and masking of thyrotoxicosis symptoms. Dermatological reactions such as rash or psoriasiform eruptions may occur.
Drug interaction
Propranolol may potentiate hypotensive effects when combined with other antihypertensives, nitrates, or PDE5 inhibitors. Concurrent use with verapamil or diltiazem increases risk of bradycardia and AV block. CYP2D6 inhibitors (e.g., fluoxetine, quinidine) can increase propranolol levels. May reduce efficacy of beta-agonists like albuterol. Concomitant use with insulin or oral hypoglycemics may mask hypoglycemia and alter glucose metabolism. NSAIDs may attenuate antihypertensive effect. Use with clonidine may exacerbate rebound hypertension upon withdrawal.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. For extended-release formulations, taking a missed dose late in the day may interfere with sleep due to potential CNS effects.
Overdose
Symptoms of overdose include severe bradycardia, hypotension, heart failure, bronchospasm, hypoglycemia, and seizures. Management involves gastric lavage if presented early, followed by activated charcoal. Bradycardia may be treated with atropine; refractory cases may require isoproterenol or cardiac pacing. Hypotension should be managed with fluids and vasopressors like norepinephrine. Glucagon can be effective in reversing cardiac and metabolic effects. Hemodialysis is not effective due to high protein binding.
Storage
Store at controlled room temperature (20–25°C or 68–77°F). Protect from light and moisture. Keep in the original container with the lid tightly closed. Do not store in bathrooms or damp areas. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always consult prescribing information and relevant guidelines before initiation or modification of therapy. Dosage and indications may vary by formulation and jurisdiction. Monitor patients regularly for efficacy and adverse effects.
Reviews
Clinical trials and meta-analyses consistently demonstrate propranolol’s efficacy in reducing hypertension with a mean systolic reduction of 10–15 mmHg. In migraine prophylaxis, it shows a 50% or greater reduction in frequency in approximately 60–80% of patients. Essential tremor studies report significant improvement in tremor amplitude and functional capacity in 50–70% of cases. Patient satisfaction is generally high when titrated appropriately, though side effects like fatigue and bradycardia are noted in a subset of users. Long-term use is well-tolerated in most populations with ongoing monitoring.