Propranolol, Propranolol ER, Propranolol Hydrochlorideer

Introduction

Written by Sarah Lewis, PharmD
Medically reviewed by Patricia Weiser, PharmD
Updated on August 25, 2023

Propranolol (proe PRAN oh lole) is a generic medication prescribed for high blood pressure, certain heart problems, and various other conditions. Propranolol belongs to a group of drugs called beta-blockers.

The Food and Drug Administration (FDA) has approved propranolol to:

• treat high blood pressure
• treat angina (chest pain) due to coronary artery disease
• treat atrial fibrillation (AFib) and other heart rhythm problems
• lower the risk of death after a heart attack
• prevent migraine headache
• manage essential tremor (a brain condition that causes shaking in your hands or other areas of your body)
• treat hypertrophic subaortic stenosis (a form of heart muscle disease)
• treat symptoms in people with pheochromocytoma (a rare tumor of the adrenal gland)

These approved uses differ based on the form of propranolol your doctor prescribes.

This article doesn’t provide coupons for all forms of propranolol. To find coupons for propranolol extended-release oral capsule, see this article.

Side effects of propranolol

Propranolol may cause mild or serious side effects. More common mild side effects of propranolol and its serious side effects are listed below. This article doesn’t include all possible side effects of the drug. Side effects can vary based on your age, overall health, and any other medications you take.

To learn more about propranolol’s side effects, ask your doctor or pharmacist. You can also refer to the prescribing information for propranolol listed in the “Resources” section.

Mild side effects

More common mild side effects reported with some forms of propranolol are listed below.

This article doesn’t include all possible mild side effects of the drug. To learn more about propranolol’s side effects, refer to the prescribing information for propranolol listed in the “Resources” section.

With many drugs, mild side effects may go away within a few days or a couple of weeks. If the side effects are bothersome, tell your doctor or pharmacist. They may be able to suggest ways to manage them.

Mild side effects of propranolol oral tablet and propranolol intravenous (IV) injection (an infusion given into your vein over time) include:

• digestive issues, such as nausea and abdominal pain
• fatigue (low energy)
• lightheadedness
• erectile dysfunction
• mild allergic reaction*

* For details about this side effect, see the “Interactions and warnings for propranolol” section.

Serious side effects

Serious side effects of propranolol are listed below.

This article doesn’t include all possible serious side effects of the drug. To learn more about propranolol’s side effects, refer to the prescribing information for propranolol listed in the “Resources” section.

With many drugs, serious side effects are possible but not common. If you have serious side effects from this drug, call your doctor right away. If you’re having severe symptoms or a medical emergency, call 911 or a local emergency number.

In general, propranolol’s serious side effects include:

• breathing problems
• circulation problems
• low blood sugar
• slow heart rate
• severe low white blood cell count
• systemic lupus erythematosus (an autoimmune disorder)
• vision problems
• hallucinations (seeing or hearing things that aren’t there), depression, or other mental health changes
• worsening heart problems
• severe allergic reaction*

* For details about this side effect, see the “Interactions and warnings for propranolol” section.

Common questions about propranolol

Below you’ll find answers to a few commonly asked questions about propranolol.

Can propranolol be used for anxiety?

Possibly. Propranolol isn’t approved to treat anxiety. But doctors may choose to prescribe it off-label for this condition. With off-label use, doctors prescribe a drug for a purpose other than what it’s approved for.

You can learn more about using propranolol to treat symptoms of anxiety by talking with your doctor.

How does propranolol work? And how long does it take to start working?

Propranolol works by relaxing your blood vessels. This lowers your blood pressure. It also makes it easier for your heart to pump and slow your heart rate. As a result, your heart doesn’t have to work as hard to pump blood.

Propranolol will usually start to work within a few hours of taking it. But it can take a few days to weeks to see the full effects of the drug. 

If you’d like to know more about how propranolol works, talk with your doctor or pharmacist.

Uses of propranolol

The Food and Drug Administration (FDA) approves prescription drugs such as propranolol for certain conditions. Approved uses for propranolol are described below.

Use for certain heart and blood pressure problems

Doctors may prescribe the following forms of propranolol for treating certain heart conditions:

• oral tablet
• oral liquid
• extended-release (ER) oral capsule*
• injection given by intravenous (IV) infusion into your vein over time

They’re used for this purpose in adults. The oral tablet, oral liquid, and ER oral capsule* are usually prescribed as a long-term treatment. The IV injection is for short-term treatment, usually in a hospital or emergency room.

Propranolol can help lower the risk of dying after a heart attack. It can also help relieve symptoms of the following heart conditions:

• angina (chest pain) due to coronary artery disease
• heart muscle disease
• heart rhythm problems, including atrial fibrillation (AFib)

Doctors may prescribe propranolol oral tablet, oral liquid, or ER oral capsule* for treating high blood pressure. They’re used for this purpose in adults. They’re usually prescribed as a long-term treatment.

With high blood pressure, you usually don’t have any symptoms. But having high blood pressure puts you at risk of having serious, sometimes fatal, problems. This includes heart attack and stroke. Lowering your blood pressure with propranolol can help prevent these life threatening problems.

Propranolol can be prescribed together with other medications to lower blood pressure.

* “Extended release” means the drug is slowly released into your body over a long period of time.

Use for a certain type of tumor

Doctors may prescribe propranolol oral tablet or oral liquid for treating symptoms of pheochromocytoma (a rare tumor of the adrenal gland). It’s used for this purpose in adults. It may be prescribed as a short-term or long-term treatment.

With pheochromocytoma, tumors in your adrenal glands cause them to produce increased levels of certain hormones. These hormones support blood pressure, heart rate, how you respond to stress, and more. When these hormones are elevated, you may experience symptoms, including:     

• fast heart rate
• high blood pressure
• headaches
• sweating

For this use, propranolol is prescribed together with an alpha-blocker drug, such as prazosin.

Use for migraine

Doctors may prescribe propranolol oral tablet, oral liquid, or ER oral capsule* to help prevent migraine headache. They’re used for this purpose in adults. They’re usually prescribed as a long-term treatment.

With migraine headache, people get attacks of pain, throbbing, or pounding in the head. Symptoms usually affect one side of the head and can be severe. Propranolol can help lower how often migraine headaches occur and their severity. Propranolol won’t stop a migraine headache once it has started.

* “ER” means the drug is slowly released into your body over a long period of time.

Use for tremor

Doctors may prescribe propranolol oral tablet or oral liquid for treating essential tremor. They’re used for this purpose in adults. They’re usually prescribed as a long-term treatment.

With essential tremor, you have shakiness that usually affects the hands or arms. The tremor happens when using your hands or arms or when holding them out. It doesn’t occur when resting your hands or arms. It’s a form of tremor that’s genetic, so children inherit it from a parent.

Interactions and warnings for propranolol

Below, you’ll find information about propranolol’s possible interactions and warnings.

Interactions of propranolol

Certain things may affect how a drug works. These include getting vaccines, consuming alcohol or certain foods, or taking the drug with other medications. This effect is called a drug interaction.

Before you take propranolol, ask your doctor to check for possible interactions. Be sure to tell them about any of the following you take or use:

• prescription or over-the-counter drugs
• vitamins, herbs, or supplements

To learn about drug-condition interactions, see the “Warnings for propranolol” section below.

Warnings for propranolol

Some people should not take propranolol, and others should take it cautiously.

Propranolol could cause harm to people with certain health conditions. This effect is called a drug-condition interaction. Other factors can also affect whether propranolol is a safe option for you.

Ask your doctor about specific warnings for propranolol, and be sure to tell your doctor about your:

• current health, including any allergies to medications
• past health conditions or surgeries

Allergic reaction

Propranolol can cause an allergic reaction in some people. Severe allergic reactions are rare but possible.

If you’ve had an allergic reaction to propranolol or any of its ingredients, your doctor will likely not prescribe propranolol. They can tell you about medications that are safer options for you.

A mild allergic reaction may cause the following symptoms:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)

A severe allergic reaction may cause the following symptoms:

• severe skin rashes that may blister and peel
• swelling under your skin, usually in your hands, feet, eyelids, or lips
• swelling of your mouth, throat, or tongue, which can cause breathing problems

If you have an allergic reaction to propranolol, call your doctor right away. If you have severe symptoms, call 911 or a local emergency number.

Overdose of propranolol

If you take propranolol by mouth, you should not take more propranolol than your doctor prescribes. For some drugs, doing so may lead to harmful effects or overdose.

If you think you’ve taken too much propranolol, call your doctor or pharmacist right away. Or you could call 800-222-1222 to speak with someone at America’s Poison Centers. You can also use its online resource. If you have concerning symptoms, call 911 or a local emergency number immediately. You can also go to the closest emergency room.

Pregnancy or breastfeeding and propranolol

Information about propranolol and pregnancy and breastfeeding is described below.

Propranolol and pregnancy

It’s not known whether propranolol should be taken during pregnancy. If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication.

Propranolol and breastfeeding

It’s not known whether propranolol should be taken while breastfeeding. If you’re currently breastfeeding or planning to do so, talk with your doctor before taking this medication.

What to ask your doctor

Let your doctor know if you have questions about propranolol or would like more details about it.

Here’s a list of some possible questions you may want to ask your doctor:

• How does propranolol compare to other beta-blockers?
• How does propranolol compare to other drugs that could treat my condition?
• Am I at higher risk of side effects than other people?
• What’s the most important information I should know about propranolol?

Resources

• Food and Drug Administration. (2023). Orange Book: Approved drug products with therapeutic equivalence evaluations. https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm
• Propranolol hydrochloride extended-release capsules, USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/e0241448-5727-4c68-ae2a-6f41cd962d7c/spl-doc
• Propranolol hydrochloride injection USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/f14ea537-dd5c-4c78-9037-9a85e9e610ef/spl-doc
• Propranolol hydrochloride oral solution. (2021). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/b609cc7c-1f6a-452b-8ada-c4d2989b83dc/spl-doc
• Propranolol hydrochloride tablets, USP. (2023). https://nctr-crs.fda.gov/fdalabel/services/spl/set-ids/5e05a9e2-289b-40d8-911a-d142ebf58882/spl-doc

Disclaimer: Optum Perks has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.