Propranolol ๐
Related Subjects:
|Hypertension
|Acute Heart Failure
|Chronic Heart Failure
๐ About
Always check the BNF link here for up-to-date dosing and guidance.
- ๐ First commercially available beta-blocker (introduced in the 1960s).
- Non-selective ฮฒ-blocker: antagonises ฮฒ1- and ฮฒ2-receptors.
- Highly lipophilic โ crosses bloodโbrain barrier โ CNS side effects (e.g. vivid dreams, nightmares).
โ๏ธ Action
- Blocks adrenaline/noradrenaline at ฮฒ1 (cardiac) and ฮฒ2 (vascular/bronchial) receptors.
- โ Heart rate, โ cardiac output, โ myocardial oxygen demand.
- โ Sympathetic symptoms (e.g. tremor, palpitations, anxiety).
๐ฏ Indications & Typical Oral Doses Propranolol
- ๐ฉธ Hypertension: 80 mg twice daily (range 160โ320 mg/day).
- โค๏ธ Angina: 40 mg three times daily, titrate up to 320 mg/day.
- ๐ Arrhythmias: 40 mg twiceโthree times daily.
- ๐ฐ Anxiety (somatic symptoms): 10โ40 mg three times daily.
- ๐ซ Portal hypertension: 40 mg twice daily (titrate for HR 55โ60 bpm).
- ๐ฉบ Post-MI: 40 mg three times daily โ 80 mg twice daily.
- ๐ง Migraine prophylaxis: 40โ80 mg twice daily.
โ Contraindications
- Bradycardia (<60 bpm) or systolic BP <100 mmHg.
- Asthma, COPD, or bronchospasm ๐ซ.
- 2nd or 3rd-degree heart block.
- Uncontrolled / decompensated / acute severe heart failure.
- Severe hypotension.
- Phaeochromocytoma (unless ฮฑ-blockade established).
- Sick sinus syndrome.
- Significant peripheral vascular disease ๐ฆต.
- โ ๏ธ Concomitant verapamil (risk of complete heart block/asystole).
- Caution in diabetes (masks hypoglycaemia, worsens control).
โ ๏ธ Side Effects
- Headache, fatigue, lethargy ๐ด.
- Cold peripheries, Raynaudโs worsening โ๏ธ.
- Bradycardia, hypotension, heart failure.
- Sleep disturbance: insomnia, nightmares ๐.
- Worsening diabetic control, hypoglycaemia unawareness.
๐ References
- BNF โ Propranolol
- Oxford Handbook of Clinical Medicine.
- ESC Guidelines โ Hypertension & Angina.
