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Propranolol is a beta-blocker. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).
Propranolol is used to treat tremors, angina (chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack, and to reduce the severity and frequency of migraine headaches.
Hemangeol (propranolol oral liquid 4.28 milligrams) is given to infants who are at least 5 weeks old to treat a genetic condition called infantile hemangiomas. Hemangiomas are caused by blood vessels grouping together in an abnormal way. These blood vessels form benign (non-cancerous) growths that can develop into ulcers or red marks on the skin. Hemangiomas can also cause more serious complications inside the body (in the liver, brain, or digestive system).
Propranolol may also be used for purposes not listed in this medication guide.
You should not use this medicine if you have asthma, very slow heart beats, or a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker).
Babies who weigh less than 4.5 pounds should not be given Hemangeol oral liquid.
You should not use propranolol if you are allergic to it, or if you have:
asthma;
very slow heart beats that have caused you to faint; or
a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker).
Babies who weigh less than 4.5 pounds should not be given Hemangeol oral liquid.
To make sure propranolol is safe for you, tell your doctor if you have:
a muscle disorder;
bronchitis, emphysema, or other breathing disorders;
low blood sugar, or diabetes (propranolol can make it harder for you to tell when you have low blood sugar);
slow heartbeats, low blood pressure;
congestive heart failure;
depression;
liver or kidney disease;
a thyroid disorder;
pheochromocytoma (tumor of the adrenal gland); or
problems with circulation (such as Raynaud's syndrome).
It is not known whether propranolol will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using propranolol.
Propranolol can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Take propranolol exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Adults may take propranolol with or without food, but take it the same way each time.
Take propranolol at the same time each day.
Do not crush, chew, break, or open an extended-release capsule. Swallow it whole.
Hemangeol must be given to an infant during or just after a feeding. Doses should be spaced at least 9 hours apart. Make sure your child gets fed regularly while taking this medicine. Tell your doctor when the child has any changes in weight. Hemangeol doses are based on weight in children, and any changes may affect your child's dose.
Call your doctor if a child taking Hemangeol is sick with vomiting, or has any loss of appetite.
Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Do not shake Hemangeol liquid.
Your blood pressure will need to be checked often.
If you need surgery, tell the surgeon ahead of time that you are using propranolol. You may need to stop using the medicine for a short time.
Do not skip doses or stop using propranolol suddenly. Stopping suddenly may make your condition worse. Follow your doctor's instructions about tapering your dose.
This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using propranolol.
If you are being treated for high blood pressure, keep using propranolol even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.
Propranolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
Store at room temperature away from moisture and heat. Do not allow liquid medicine to freeze. Throw away any unused Hemangeol 2 months after you first opened the bottle.
For regular (short-acting) propranolol: Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 4 hours away.
For extended-release propranolol (Inderal LA, InnoPran XL and others): Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 8 hours away.
Do not take extra medicine to make up the missed dose.
Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.
Overdose symptoms may include slow or uneven heartbeats, dizziness, weakness, or fainting.
Avoid drinking alcohol. It may increase your blood levels of propranolol.
Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.
Get emergency medical help if you have any signs of an allergic reaction to propranolol: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Call your doctor at once if you have:
slow or uneven heartbeats;
a light-headed feeling, like you might pass out;
wheezing or trouble breathing;
shortness of breath (even with mild exertion), swelling, rapid weight gain;
sudden weakness, vision problems, or loss of coordination (especially in a child with hemangioma that affects the face or head);
cold feeling in your hands and feet;
depression, confusion, hallucinations;
liver problems - nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
low blood sugar - headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery;
low blood sugar in a baby - pale skin, blue or purple skin, sweating, fussiness, crying, not wanting to eat, feeling cold, drowsiness, weak or shallow breathing (breathing may stop for short periods), seizure (convulsions), or loss of consciousness; or
severe skin reaction - fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.
Common propranolol side effects may include:
nausea, vomiting, diarrhea, constipation, stomach cramps;
decreased sex drive, impotence, or difficulty having an orgasm;
sleep problems (insomnia); or
tired feeling.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
Tell your doctor about all medicines you use, and those you start or stop using during your treatment with propranolol, especially:
a blood thinner - warfarin, Coumadin, Jantoven;
an antidepressant - amitriptyline, clomipramine, desipramine, imipramine, and others;
drugs to treat high blood pressure or a prostate disorder - doxazosin, prazosin, terazosin;
heart or blood pressure medicine - amiodarone, diltiazem, propafenone, quinidine, verapamil, and others;
NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or
steroid medicine - prednisone and others.
This list is not complete. Other drugs may interact with propranolol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use propranolol only for the indication prescribed.
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Propranolol Hcl (www.drugs.com/propranolol.html).
Applies to propranolol: oral capsule extended release, oral solution, oral tablet
Other dosage forms:
Oral route (Capsule, Extended Release)
Following abrupt cessation of therapy with beta-blockers, exacerbations of angina pectoris and myocardial infarction have occurred. Warn patients against interruption or discontinuation of therapy without physician advice.
Along with its needed effects, propranolol may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking propranolol:
More common
- in childrenIncidence not known
Some side effects of propranolol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- in childrenLess common
- in childrenIncidence not known
Applies to propranolol: intravenous solution, oral capsule extended release, oral concentrate, oral liquid, oral solution, oral tablet
Use of a nonselective beta-blocker like propranolol may at least blunt cardiac output in some patients, especially those with preexisting left ventricular systolic dysfunction and during exertion. Data have shown that cardiac conditioning can delay or attenuate this side effect of propranolol.
Abrupt cessation of propranolol therapy may result in hypertension, myocardial infarction, and angina pectoris in some patients.
Paradoxical hypertension may occur in patients with pheochromocytoma, unless alpha-adrenergic blockade is already instituted.
At least two cases of electrical alternans associated with propranolol are reported from pediatric cases. In one case, electrical alternans was clearly not rate-related (since it occurred during propranolol therapy at a slower rate than the patient's "native" ventricular tachycardia) and was associated with echocardiographically-demonstrated mechanical alternans.
Common (1% to 10%): Hypotension, cold extremities, Raynaud's phenomenon
Uncommon (0.1% to 1%): Heart failure, precipitation of heart block
Rare (less than 0.1%): Exacerbation of claudication, postural hypotension (which may be associated with syncope)
Frequency not reported: Bradycardia, congestive heart failure
Rare cases of paresthesias and myasthenia gravis have been associated with propranolol.
Common (1% to 10%): Fatigue and/or lassitude (often transient), sleep disturbances, nightmares, sleep disorder, agitation, somnolence, irritability
Rare (less than 0.1%): Dizziness, paresthesia (especially of the hands)
Very rare (less than 0.01%): Seizure (linked to hypoglycemia)
Frequency not reported: Reduction or loss of libido, lightheadedness, mental depression (manifested by insomnia), weakness, catatonia, hallucinations, an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium
There are reports of patients who experienced reversible renal insufficiency with no decline in systemic blood pressure, but these patients had preexisting renal disease. This may be important in patients with preexisting renal insufficiency. New or worsened renal dysfunction has been reported in patients with underlying renal disease and no decline in systemic blood pressure.
Uncommon (0.1% to 1%): Renal insufficiency (related to lowering of systemic blood pressure)
Rare (less than 0.1%): Dyspnea, worsening of reactive airways diseases, bronchospasm in patients with bronchial asthma or a history of asthmatic complaints (sometimes fatal)
Limited data have shown a mean fall in maximal midexpiratory flow rate (MMFR) during propranolol therapy relative to placebo in nine of ten patients whose lung function was assessed. Interestingly, the fall was not related to smoking or to atopic status, suggestive of resting beta-adrenergic bronchodilator activity in nonasthmatic subjects.
Non-selective beta-blockers, such as propranolol, are used with caution in patients with asthma and chronic obstructive pulmonary disease due to inhibition of bronchodilation.
Beta-blockers, such as propranolol, are used with caution in patients with diabetes due to masking of the catecholamine response to hypoglycemia. Propranolol may also mask the signs of hyperthyroidism by the same mechanism.
Propranolol has been associated with significant increases in serum triglycerides, fasting blood glucose, and LDL and VLDL cholesterol, and significant decreases in HDL cholesterol.
Very rare (less than 0.01%): Hypoglycemia (particularly in neonates, infants, children, elderly patients, patients on hemodialysis, patients on concomitant antidiabetic therapy, patients with prolonged fasting and patients with chronic liver disease), hypertriglyceridemia
Uncommon (0.1% to 1%): Anorexia, nausea, vomiting, diarrhea, abdominal pain, flatulence, decreased appetite
One study of 34 hypertensive patients who were taking propranolol found the incidence of depressive symptoms in this population to be 50% to 74% (depending on the criteria used). Propranolol-induced depression may be more likely in patients with a personal or family history of depression. Of the 34 patients, 12 had a history of depression and 8 had a history of substance abuse, alcoholism, or a family history of psychiatric disorders. Since none of the 12 patients with a history of depression were clinically depressed at the start of propranolol therapy and were comparable by age, diagnosis, and propranolol dosage to the other 22 patients, a comparison was made. Patients with a personal or family history of depression had significantly higher scores on depression scales than those without such histories.
A 72-year-old retired college professor with no history of affective disorders developed progressive sadness, tearfulness, hopelessness, decreased energy, social withdrawal, anhedonia, insomnia, and decreased memory and concentration within two weeks after beginning propranolol monotherapy for hypertension. The signs and symptoms of depression resolved upon substitution with a thiazide diuretic. Interestingly, the patient later was treated for recurrent depression while not receiving propranolol.
Rare cases of psychoses associated with propranolol have been reported.
Rare (less than 0.1%): Depression (dose dependent), hallucinations, psychoses, mood changes, confusion, memory loss
Rare (less than 0.1%): Anaphylaxis, contact dermatitis
Uncommon (0.1% to 1%): Reduction of platelet adhesiveness, thrombocytopenic purpura, nonthrombocytopenic purpura, agranulocytosis, eosinophilia
Rare (less than 0.1%): Psoriatic flares
Frequency not reported: Stevens - Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria, purpura, alopecia, skin rashes, SLE-like reactions
Postmarketing reports: Enhanced immune system
Propranolol can enhance the immune system by causing an increase in the number of circulating T cells, increased interleukin-2 (IL-2) secretion, increased expression of IL-2 receptors, and increased lymphocyte production in response to the T cell mitogen Con A. Interestingly, NK (natural killer) cell activity may be decreased during propranolol therapy, although the number of circulating NK cells may remain unchanged. These results are consistent with previous data showing decreased immunologic function during periods of elevated sympathetic activity, such as congestive heart failure, uremia, or life-threatening events.
Frequency not reported: Male impotence, Peyronie's disease
Frequency not reported: Weight gain
The mechanism by which propranolol induces weight gain is unknown. Some investigators have reported a 4% to 9% reduction in total energy expenditure and a 25% reduction in thermogenic response to food during beta-blocker treatment.
Very rare (less than 0.01%): Myasthenia gravis like syndrome or exacerbation of myasthenia gravis
Frequency not reported: Myopathy, myotonia
Very rare (less than 0.01%): Elevated liver function tests
Rare (less than 0.1%): Dry eyes, visual disturbances
Medically reviewed by USARx EDITORIAL TEAM Last updated on 1/1/2020.
Source: Drugs.com Propranolol Hcl (www.drugs.com/propranolol.html).
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