Experiences with

Propranolol

About propranolol

Propranolol belongs to a group of medicines called beta blockers. It's used to treat heart problems, help with anxiety and prevent migraines.

If you have a heart problem, you can take propranolol to:

• treat high blood pressure
• treat illnesses that cause an irregular heartbeat, like atrial fibrillation
• prevent future heart disease, heart attacks and strokes
• prevent chest pain caused by angina

Propranolol can help reduce your symptoms if you have too much thyroid hormone in your body (thyrotoxicosis). You'll usually take it together with medicines to treat an overactive thyroid.

This medicine is only available on prescription. It comes as tablets, capsules, or as a liquid to swallow.

Key facts

• Propranolol slows down your heart rate and makes it easier for your heart to pump blood around your body.
• It is usually prescribed for high blood pressure and other heart problems, but it can also help with the physical signs of anxiety, like sweating and shaking.
• Your very first dose of propranolol may make you feel dizzy, so take it at bedtime. After that, if you do not feel dizzy, you can take it in the morning.
• The main side effects of propranolol are feeling dizzy or tired, cold hands or feet, difficulties sleeping and nightmares. These side effects are usually mild and short lived.

Who can and cannot take propranolol

Propranolol can be taken by adults and children. But it is not officially approved for treating high blood pressure in children under 12 years old.

It is not suitable for everyone. To make sure it is safe for you, tell your doctor before starting propranolol if you have:

• ever had an allergic reaction to propranolol or any other medicine
• low blood pressure or a slow heart rate
• heart failure which is getting worse
• severe blood circulation problems in your limbs (such as Raynaud's phenomenon), which may make your fingers and toes tingle or turn pale or blue
• metabolic acidosis – when there is too much acid in your blood
• lung disease or asthma

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

How and when to take propranolol

Propranolol comes as 2 different types of medicine:

• standard release – releases propranolol into your body quickly, you may need to take it several times a day depending on your dose
• sustained release (SR) – this dissolves slowly so you do not have to take it as often, once a day is usually enough

If you are taking it once a day, your doctor may advise you to take your first dose before bedtime, because it can make you feel dizzy. After the first dose, if you do not feel dizzy, take propranolol in the morning.

Important

Keep taking propranolol even if you feel well. You will still be getting the benefits of the medicine.

Dosage

How much you take depends on why you need propranolol.

Doses for adults and children over the age of 12 for:

• high blood pressure, the starting dose is usually 80mg twice a day. If this dose is not working well enough (if your blood pressure does not go down enough), your doctor may increase it to a maximum of 160mg twice a day.
• migraine or angina (chest pain), the usual dose is 40mg taken 2 or 3 times a day. This can be increased to 120mg to 240mg a day. Your doctor or pharmacist will explain how to split the dose over the day.
• irregular heartbeat (arrhythmia), the usual dose is 10mg to 40mg 3 or 4 times a day.
• anxiety, the usual dose is 40mg once a day which can be increased to 40mg 3 times a day.
• too much thyroid hormone (thyrotoxicosis), the dose is 10mg to 40mg taken 3 or 4 times a day.

Doses are usually lower for the elderly or people with a kidney or liver problem.

If your child is under 12 years old and they need propranolol, your doctor will usually use your child's weight to work out the right dose.

How to take it

Propranolol does not usually upset your tummy so you can take it with or without food. It's best to do the same each day.

Swallow the tablets whole with a drink of water. If you find them difficult to swallow, some brands have a score line to help you break the tablet in half. Check the information leaflet for your brand to see if you can do this.

If you're taking propranolol as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give you the right amount of medicine.

What if I forget to take it?

If you forget to take a dose of propranolol, take it as soon as you remember, unless it is nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

An overdose of propranolol can slow down your heart rate and make it difficult to breathe. It can also cause dizziness and trembling.

The amount of propranolol that can lead to an overdose varies from person to person.

If you need to go to hospital, do not drive yourself – get someone else to drive you or call for an ambulance.

Take the propranolol packet or leaflet inside it plus any remaining medicine with you.

Find your nearest A&E.

Side effects

Like all medicines, propranolol can cause side effects in some people but many people have no side effects or only minor ones.

Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people. They're usually mild and short lived.

Talk to your doctor or pharmacist if the side effects bother you or last more than a few days:

• feeling tired, dizzy or light headed (these can be signs of a slow heart rate)
• cold fingers or toes (propranolol may affect the blood supply to your hands and feet)
• difficulties sleeping or nightmares
• feeling sick (nausea)

Serious side effects

It happens rarely, but some people have serious side effects when taking propranolol.

Tell a doctor straight away if you have:

• shortness of breath with a cough which gets worse when you exercise (like walking up stairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these are signs of heart problems
• shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
• yellow skin or the whites of your eyes turn yellow – these can be signs of liver problems

Serious allergic reaction

In rare cases, propranolol may cause a serious allergic reaction (anaphylaxis).

These are not all the side effects of propranolol. For a full list, see the leaflet inside your medicine packet.

How to cope with side effects of propranolol

What to do about:

• feeling tired, dizzy or light-headed – as your body gets used to propranolol, these side effects should wear off. If propranolol makes you feel dizzy, sit or lie down until you feel better. Try to avoid alcohol as it will make you feel worse.
• cold fingers or toes – put your hands or feet under warm running water, massage them and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in – this can make your blood vessels narrower and further restrict blood flow to your hands and feet. Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.
• difficulties sleeping or nightmares – try taking your propranolol in the morning. If you have to take it more than once a day, speak to your doctor. They may be able to change your propranolol to the slow release form.
• feeling sick (nausea) – stick to simple meals and do not eat rich or spicy food. It might help to take your propranolol after a meal or snack.

Pregnancy and breastfeeding

Propranolol and pregnancy

Propranolol is not thought to be harmful during pregnancy, but it is not possible to be certain.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking propranolol. There may be other medicines that are safer for you.

Propranolol and breastfeeding

It is usually safe to take propranolol if you're breastfeeding. This is because only small amounts get into breast milk, which is not enough to cause any problems to your baby.

However, speak to your doctor before taking propranolol if your baby was premature or has any health problems.

For more information about how propranolol can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPs) website.

Cautions with other medicines

There are some medicines that may interfere with the way propranolol works.

Tell your doctor if you're taking:

• other medicines for high blood pressure. The combination with propranolol can sometimes lower your blood pressure too much. This may make you feel dizzy or faint. If this keeps happening to you, tell your doctor - they may change your dose.
• other medicines for an irregular heartbeat such as amiodarone or flecainide
• other medicines which can lower your blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson's disease medicines such as levodopa.
• asthma or chronic obstructive pulmonary disease (COPD) medicines
• diabetes medicines, particularly insulin – propranolol may make it more difficult to recognise the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any of the usual warning signs. You should check your blood sugar after exercise, and follow usual advice about checking it before driving, or operating machinery.
• medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
• medicines for allergies, such as ephedrine, noradrenaline or adrenaline
• non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen, diclofenac and naproxen. These medicines may increase your blood pressure, so it's best to keep them to a minimum.

Mixing propranolol with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with propranolol.

Common questions about propranolol

HealthUnlocked contains information from NHS Digital, licensed under the current version of the Open Government Licence