What is propranololol?
Propranolol is the first clinically used beta blocker ever and was developed in the 1960s. Development was awarded the Nobel Prize for Medicine in 1988. Propranolol unselectively blocks both beta-1 and beta-2 receptors.
In addition to high blood pressure, propanolol is used in numerous other diseases: migraine prophylaxis, essential tremor, anxiety disorders with physical symptoms (lamp fever), hyperthyroidism and infantile hemangiomas. Known preparations are Propra-ratiopharm® and Obsidan®.
Since Propranolol is not cardioselective, it is more rarely prescribed in pure high blood pressure than bisoprolol or metoprolol. However, its versatility continues to make it an important drug.
Active Ingredients & Mechanism of Action
Active ingredient: Propranolol
Propranolol unselectively blocks beta-1- and beta-2-receptors:
Beta-1 blockade (heart):
- Lowers heart rate and blood pressure
- Reduces the oxygen consumption of the heart
- Inhibits renin release
Beta-2 blockade (lung, vessels, metabolism):
- Can condense bronchi (cave: Asthma)
- Can deteriorate peripheral blood flow
- Influences glucose and fat metabolism
- inhibits glycogenolysis in the liver
Special Features:
- Lipophil – good passage of the blood-brain barrier
- Central action (migrine prophylaxis, tremor treatment, anxiety solution)
- membrane-stabilizing effect
- inhibits the conversion of T4 to T3 (usually in hyperthyroidism)
Initiation of action: Fast action after 1-2 hours. half-life 3-6 hours, therefore several times daily intake necessary (except retard form).
Who is it suitable for?
Propranolol is suitable for:
- Adults with high blood pressure
- Migraine prophylaxis
- Essential Tremor
- Hyperthyroidism (symptom control)
- Situation scare / lamp fever
- Angina pectoris
- After heart attack
Especially suitable for:
- Migraine
- Tremor
- thyroid hyperfunction
- Fear with physical symptoms (cracking, sweating, trembling)
Not suitable:
- Asthma bronchiale (strict contraindicated!)
- Heavy COPD
- AV block II/III. Grades
- Heavy bradycardia
- Decompensated heart failure
- Prince metal angina
Available Dosages
High blood pressure:
- start dose: 40 mg twice a day
- usual dose: 80-160 mg daily (divided to 2-3 doses)
- Maximum dose: 320 mg daily
- Retard form: 80-160 mg once a day
Migrine prophylaxis:
- 40-80 mg twice to three times a day
- titration over 2-3 weeks
Essentieller Tremor:
- 40 mg two to three times a day
- Increase to 120-240 mg daily
Lamp fever (situative):
- 10-40 mg about 30-60 minutes before the situation
Available starches:
- 10 mg, 40 mg, 80 mg tablets
- 80 mg, 160 mg retard capsules
How to Take
Intake (normal):
- Two to three times a day
- Before meals (more uniform admission)
- Take with water
Intake (retard form):
- Once a day
- Do not open or chew capsules
- Independent meals
Important notes:
- Never drop abruptly (slowly over 1-2 weeks)
- Regular pulse and blood pressure control
- In diabetics: control blood sugar tightly
- Do not take asthma
- Informing anaesthesia before operations
Contraindications
**Propranolol must not be taken at:* *
- Asthma bronchiale (strict contraindicated!)
- Heavy COPD with bronchospastic
- AV block II/III. Grades
- Sick sine syndrome
- Heavy bradycardia (under 50/min)
- Cardiogenic shock
- Heavy hypotension
- Untreated phenochromocytoma
- Metabolic aziosis
- Prince metal angina
- Heavy peripheral blood flow disorders
Preview at:
- Diabetes mellitus (strong masking of hypoglycemia symptoms)
- Light COPD
- Psoriasis
- Myasthenia gravis
- Heavy kidney failure
pregnant: Only with strict indication. Can lead to neonatal bradycardia and hypoglycemia.
Possible Side Effects
Acid (1-10%):
- fatigue, exhaustion
- Cold hands and feet (more powerful than selective beta blockers)
- Bradykardie
- Gastrointestinal complaints
- Sleep disorders, lively dreams
** Occasionally (0,1-1%):* *
- Depressive detuning
- Potency disorders
- Bronchospasmus
- Squeeze
- Weight gain
- deterioration of glucose and fat metabolism
Selten:
- Raynaud syndrome (white fingers)
- Hallucinations
- Deterioration of Psoriasis
- Alopezie
Important: Since Propranolol also blocks beta-2 receptors, side effects such as cold extremities, bronchospasm and metabolic changes occur more frequently than in cardioselective beta blockers.
Interactions
Contraint with:
- MAO inhibitors (except MAO-B inhibitors)
Preview at:
- Insulin and oral antidiabetics → strong masking of hypoglycemia
- Adrenalin → paradoxical blood pressure increase and bradycardia
- Clonidine → Rebound hypertension while simultaneously setting
- Ergotamine preparations → enhanced vasoconstriction
- Rifampicin → accelerated propanolol degradation
- Cimetidine → increased propanolol level
- CYP1A2- and CYP2D6 inhibitor → raised mirror
** Protein-rich meals can increase the bioavailability of propanolol. Grapefruit juice can also easily increase the mirrors.
Frequently Asked Questions
Similar Medications
Is propranololol right for you?
A licensed doctor will review your information and issue a prescription if suitable. Discreet and secure.
Important Notice
This information does not replace medical advice. If you have questions about your health or the suitability of this medication, please consult a doctor. Read the package leaflet before use.