Propranolol

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General

  • Type: Beta blockers, nonselective
  • Dosage Forms:
    • IV: 1mg/mL
    • PO conventional: 10, 20, 40, 60, 80mg
    • PO extended release: 60, 80, 120, 160mg
  • Common Trade Names: Inderal

Adult Dosing

  • Thyroid storm
    • 1-2mg IV over 10 min; if tolerates then 1-2mg boluses q15 minutes until HR <100
    • May follow with drip @ dose required for HR control (ie 3-5mg/hr)
    • Alternate 60-80mg PO q4h
  • Variceal bleed ppx
    • 20mg BID titrated up to max tolerated dose
  • Migraine ppx
    • Starting dose 80mg daily as either XL or divided q6-8hr. Max 160-240mg/day
  • Essential tremor
    • 40mg BID starting dose
  • HOCM
    • 80-160mg daily as either XL or divided q6-8 hr
  • Akathisia
    • 10mg bid-tid starting dose. Max 120mg / day

Pediatric Dosing

Special Populations

  • Pregnancy Rating: Category C; risk of IUGR, neonatal hypoglycemia/bradycardia/respiratory depression. Still preferred agent for thyrotoxicosis
  • Lactation: Enters breast milk
  • Renal Dosing: N/A
  • Hepatic Dosing: N/A

Contraindications

  • Allergy to class/drug
  • Decompensated heart failure, except high output failure secondary to tachyarrhythmia
  • Bradycardia / high degree heart block

Adverse Reactions

Serious

  • Rebound symptoms with abrupt withdrawal of treatment
  • Heart failure
  • Agranulocytosis, thrombocytopenia
  • Bronchospasm
  • SJS/TEN

Common

  • Bradycardia
  • Orthostasis

Pharmacology

  • Half-life: 3-6 hrs, 8-10 hrs extended release
  • Metabolism: Hepatic
  • Excretion: Urine
  • Mechanism of Action: Nonselective β-blocker

See Also

References

Lexicomp