Propranolol

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

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 beta blocker

References

Lexicomp

Authors

Joe Carpenter, Ross Donaldson, Neil Young, Daniel Ostermayer