Propranolol

Generic name: propranolol hydrochloride · Brand names: Inderal (no longer on the market per MedlinePlus), Inderal LA (extended-release capsule, not covered), Inderal XL (extended-release capsule, not covered), InnoPran XL (extended-release capsule, not covered), Pronol (no longer on the market per MedlinePlus), Hemangeol (oral solution, not covered)

Quick facts

Drug class
Beta blocker (nonselective beta-adrenergic receptor blocking agent). MedlinePlus also calls it a beta blocker. Propranolol did not return an openFDA pharmacologic class (EPC) in two searches.
Source
DailyMed Par Health label, Clinical Pharmacology: General; MedlinePlus
Source text (exact source wording)
Propranolol is a nonselective beta-adrenergic receptor blocking agent possessing no other autonomic nervous system activity.
Rx or otc
Rx (DailyMed Product Type: HUMAN PRESCRIPTION DRUG)
Forms and strengths
  • Tablets, USP: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg (Par: 10 mg orange, 20 mg blue, 40 mg green, 60 mg pink, 80 mg yellow; round scored tablets debossed 54 bisect 82/83/84/85/86 and V). Source: Description; How Supplied, DailyMed Par Health label
  • Other forms exist (extended-release capsule, oral solution, injection) and are not covered in this record
Generic available
Value
Yes; many ANDA tablet labels on DailyMed (Par ANDA070221, Amneal, Mylan, others)
Source
DailyMed list; Par label Marketing Information (ANDA ANDA070221)
Common use one line
Beta blocker used for high blood pressure, chest pain (angina), irregular heartbeat, migraine prevention and tremor (Indications and Usage).

What it is used for

Propranolol tablets are used to treat high blood pressure, to lower how often angina (chest pain) happens and improve exercise tolerance, to control the heart rate in atrial fibrillation with a rapid ventricular response, to lower the risk of cardiovascular death in stable patients who survived a heart attack, to prevent common migraine headaches, to treat familial or essential tremor, to improve symptoms in hypertrophic subaortic stenosis, and as an add-on to alpha blockers in pheochromocytoma. It is not for hypertensive emergencies, for stopping a migraine attack that has started, or for tremor linked to Parkinsonism.
Section
INDICATIONS AND USAGE
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Hypertension: Propranolol hydrochloride tablets, USP are indicated in the management of hypertension. It may be used alone or used in combination with other antihypertensive agents, particularly a thiazide diuretic. Propranolol hydrochloride tablets, USP are not indicated in the management of hypertensive emergencies. Angina Pectoris Due to Coronary Atherosclerosis: Propranolol hydrochloride tablets, USP are indicated to decrease angina frequency and increase exercise tolerance in patients with angina pectoris. Atrial Fibrillation: Propranolol hydrochloride tablets, USP are indicated to control ventricular rate in patients with atrial fibrillation and a rapid ventricular response. Myocardial Infarction: Propranolol hydrochloride tablets, USP are indicated to reduce cardiovascular mortality in patients who have survived the acute phase of myocardial infarction and are clinically stable. Migraine: Propranolol hydrochloride tablets, USP are indicated for the prophylaxis of common migraine headache. The efficacy of propranolol in the treatment of a migraine attack that has started has not been established, and propranolol is not indicated for such use. Essential Tremor: Propranolol hydrochloride tablets, USP are indicated in the management of familial or hereditary essential tremor. Familial or essential tremor consists of involuntary, rhythmic, oscillatory movements, usually limited to the upper limbs. It is absent at rest, but occurs when the limb is held in a fixed posture or position against gravity and during active movement. Propranolol hydrochloride tablets, USP cause a reduction in the tremor amplitude, but not in the tremor frequency. Propranolol hydrochloride tablets, USP are not indicated for the treatment of tremor associated with Parkinsonism. Hypertrophic Subaortic Stenosis: Propranolol hydrochloride tablets, USP improve NYHA functional class in symptomatic patients with hypertrophic subaortic stenosis. Pheochromocytoma: Propranolol hydrochloride tablets, USP are indicated as an adjunct to alpha-adrenergic blockade to control blood pressure and reduce symptoms of catecholamine-secreting tumors.

How it works

Propranolol blocks beta-adrenergic receptors, so the heart rate, the force of the heartbeat and vessel widening in response to adrenaline-like signals are reduced. The label says how it lowers blood pressure, how it eases angina, and how it works on the heart rhythm, and it says the exact way it works for blood pressure, migraine and tremor has not been established.
Section
CLINICAL PHARMACOLOGY: General; Mechanism of Action
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
General: Propranolol is a nonselective beta-adrenergic receptor blocking agent possessing no other autonomic nervous system activity. It specifically competes with beta-adrenergic receptor agonist agents for available receptor sites. When access to beta-receptor sites is blocked by propranolol, the chronotropic, inotropic, and vasodilator responses to beta-adrenergic stimulation are decreased proportionately. At dosages greater than required for beta blockade, propranolol also exerts a quinidine-like or anesthetic-like membrane action, which affects the cardiac action potential. The significance of the membrane action in the treatment of arrhythmias is uncertain. Mechanism of Action: The mechanism of the antihypertensive effect of propranolol has not been established. Factors that may contribute to the antihypertensive action include: (1) decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain. Although total peripheral resistance may increase initially, it readjusts to or below the pretreatment level with chronic use of propranolol. Effects of propranolol on plasma volume appear to be minor and somewhat variable. In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction. Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and systolic ejection period. The net physiologic effect of beta-adrenergic blockade is usually advantageous and is manifested during exercise by delayed onset of pain and increased work capacity. Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action. The mechanism of the antimigraine effect of propranolol has not been established. Beta-adrenergic receptors have been demonstrated in the pial vessels of the brain. The specific mechanism of propranolol's antitremor effects has not been established, but beta-2 (noncardiac) receptors may be involved. A central effect is also possible.

Dosage: adults

The dose is individualized. For high blood pressure the usual starting dose is 40 mg twice daily and the usual maintenance dose is 120 mg to 240 mg per day. For angina the total daily dose is 80 mg to 320 mg. For atrial fibrillation it is 10 mg to 30 mg three or four times daily before meals and at bedtime. After a heart attack it is 180 mg to 240 mg per day in divided doses. For migraine it starts at 80 mg daily in divided doses with a usual range of 160 mg to 240 mg per day. For essential tremor it starts at 40 mg twice daily. For hypertrophic subaortic stenosis it is 20 mg to 40 mg three or four times daily. For pheochromocytoma it is 60 mg daily before surgery or 30 mg daily for inoperable tumors.
Section
DOSAGE AND ADMINISTRATION
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
General: Because of the variable bioavailability of propranolol, the dose should be individualized based on response. Hypertension: The usual initial dosage is 40 mg propranolol hydrochloride twice daily, whether used alone or added to a diuretic. Dosage may be increased gradually until adequate blood pressure control is achieved. The usual maintenance dosage is 120 mg to 240 mg per day. In some instances a dosage of 640 mg a day may be required. The time needed for full antihypertensive response to a given dosage is variable and may range from a few days to several weeks. Angina Pectoris: Total daily doses of 80 mg to 320 mg propranolol hydrochloride, when administered orally, twice a day, three times a day, or four times a day, have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG. If treatment is to be discontinued, reduce dosage gradually over a period of several weeks. Atrial Fibrillation: The recommended dose is 10 mg to 30 mg propranolol hydrochloride three or four times daily before meals and at bedtime. Myocardial Infarction: The recommended daily dosage is 180 mg to 240 mg propranolol hydrochloride per day in divided doses. The effectiveness and safety of daily dosages greater than 240 mg for prevention of cardiac mortality have not been established. Migraine: The initial dose is 80 mg propranolol hydrochloride daily in divided doses. The usual effective dose range is 160 mg to 240 mg per day. The dosage may be increased gradually to achieve optimum migraine prophylaxis. If a satisfactory response is not obtained within four to six weeks after reaching the maximum dose, propranolol hydrochloride therapy should be discontinued. It may be advisable to withdraw the drug gradually over a period of several weeks. Essential Tremor: The initial dosage is 40 mg propranolol hydrochloride twice daily. Optimum reduction of essential tremor is usually achieved with a dose of 120 mg per day. Occasionally, it may be necessary to administer 240 mg to 320 mg per day. Hypertrophic Subaortic Stenosis: The usual dosage is 20 mg to 40 mg propranolol hydrochloride three or four times daily before meals and at bedtime. Pheochromocytoma: The usual dosage is 60 mg propranolol hydrochloride daily in divided doses for three days prior to surgery as adjunctive therapy to alpha-adrenergic blockade. For the management of inoperable tumors, the usual dosage is 30 mg daily in divided doses as adjunctive therapy to alpha-adrenergic blockade.

Dosage: children

The safety and effectiveness of propranolol in children have not been established. Bronchospasm and heart failure have been reported in children treated with propranolol.
Section
PRECAUTIONS: Pediatric Use
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Safety and effectiveness of propranolol in pediatric patients have not been established. Bronchospasm and congestive heart failure have been reported coincident with the administration of propranolol therapy in pediatric patients.

Dosage adjustments

Drug interaction caps
The label gives no dose caps for drug interactions. It says caution should be used with drugs that affect the CYP2D6, 1A2 or 2C19 pathways.
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Kidney
Use with caution in kidney problems. In people with chronic renal failure, peak propranolol levels were 2 to 3-fold higher than in dialysis patients and healthy subjects. Propranolol is not significantly dialyzable. The label gives no specific dose adjustment.
Section
PRECAUTIONS: General; Clinical Pharmacology: Renal Insufficiency
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol should be used with caution in patients with impaired hepatic or renal function. (PRECAUTIONS, General) || In a study conducted in 5 patients with chronic renal failure, 6 patients on regular dialysis, and 5 healthy subjects, who received a single oral dose of 40 mg of propranolol, the peak plasma concentrations (Cmax) of propranolol in the chronic renal failure group were 2 to 3-fold higher (161±41 ng/mL) than those observed in the dialysis patients (47±9 ng/mL) and in the healthy subjects (26±1 ng/mL). Propranolol plasma clearance was also reduced in the patients with chronic renal failure. Propranolol is not significantly dialyzable. (Clinical Pharmacology, Renal Insufficiency)
Liver
Use with caution in liver problems. In patients with cirrhosis, unbound propranolol levels were increased 3-fold and the half-life rose to 11 hours compared to 4 hours. The label gives no specific dose adjustment.
Section
PRECAUTIONS: General; Clinical Pharmacology: Hepatic Insufficiency
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol should be used with caution in patients with impaired hepatic or renal function. (PRECAUTIONS, General) || Propranolol is extensively metabolized by the liver. In a study conducted in 7 patients with cirrhosis and 9 healthy subjects receiving 80 mg oral propranolol every 8 hours for 7 doses, the steady-state unbound propranolol concentration in patients with cirrhosis was increased 3-fold in comparison to controls. In cirrhosis, the half-life increased to 11 hours compared to 4 hours (see PRECAUTIONS). (Clinical Pharmacology, Hepatic Insufficiency)
Elderly
Dose selection for an older person should be cautious, usually starting at the low end of the dosing range, because liver, kidney or heart function may be lower and other diseases or drugs are more common.
Section
PRECAUTIONS: Geriatric Use
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Clinical studies of propranolol did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Missed dose

Medlineplus
Take the missed dose when you remember. If it is almost time for the next dose, skip the missed dose. Do not double up.
Section
MedlinePlus: What should I do if I forget a dose?
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Overdose

Label
Propranolol is not significantly dialyzable. The label lists hospital measures including emptying the stomach if the ingestion was recent, treating low blood pressure and slow heart rate, glucagon, and monitoring. Epinephrine may cause uncontrolled high blood pressure.
Section
OVERDOSAGE
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol is not significantly dialyzable. In the event of overdosage or exaggerated response, the following measures should be employed: General: If ingestion is or may have been recent, evacuate gastric contents, taking care to prevent pulmonary aspiration. Supportive Therapy: Hypotension and bradycardia have been reported following propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a propranolol overdose. Glucagon should be administered as 50 to 150 mcg/kg intravenously followed by continuous drip of 1 to 5 mg/hour for positive chronotropic effect. Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine, however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing. The electrocardiogram, pulse, blood pressure, neurobehavioral status and intake and output balance must be monitored. Isoproterenol and aminophylline may be used for bronchospasm.
Medlineplus
For overdose call poison control at 1-800-222-1222. Call 911 if the person has collapsed, had a seizure, has trouble breathing or can't be awakened. Symptoms may include slow heartbeat, dizziness, fatigue or weakness, fainting and trouble breathing.
Section
MedlinePlus: In case of emergency/overdose
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. Symptoms of overdose may include: slow heartbeat dizziness fatigue or weakness fainting difficulty breathing

Storage

Label
Store at 20° to 25°C (68° to 77°F). Keep in a well-closed, light-resistant container and protect from light.
Section
HOW SUPPLIED (Par label; storage details are labeler-specific)
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature]. Dispense in a well-closed, light-resistant container as defined in the USP. Protect from light.
Medlineplus
Keep it in the original container, tightly closed, out of reach of children, at room temperature, away from light, heat and moisture (not in the bathroom).
Section
MedlinePlus: storage and disposal
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat, and moisture (not in the bathroom).

Boxed warning

NONE

Contraindications

Do not use in cardiogenic shock, sinus bradycardia and greater than first degree block, bronchial asthma, or if allergic to propranolol hydrochloride.
Section
CONTRAINDICATIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia and greater than first degree block; 3) bronchial asthma; and 4) in patients with known hypersensitivity to propranolol hydrochloride.

Warnings and precautions

Stopping propranolol suddenly has been linked to worse chest pain and, in some cases, heart attack. When stopping is planned, the dose should be lowered gradually over at least a few weeks. Do not stop without a doctor's advice.
Heading
Angina Pectoris (abrupt discontinuance)
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
There have been reports of exacerbation of angina and, in some cases, myocardial infarction, following abrupt discontinuance of propranolol therapy. Therefore, when discontinuance of propranolol is planned, the dosage should be gradually reduced over at least a few weeks and the patient should be cautioned against interruption or cessation of therapy without the physician's advice. If propranolol therapy is interrupted and exacerbation of angina occurs, it usually is advisable to reinstitute propranolol therapy and take other measures appropriate for the management of angina pectoris. Since coronary artery disease may be unrecognized, it may be prudent to follow the above advice in patients considered at risk of having occult atherosclerotic heart disease who are given propranolol for other indications.
Serious allergic reactions and serious skin reactions have been reported with propranolol.
Heading
Hypersensitivity and Skin Reactions
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, have been associated with the administration of propranolol (see ADVERSE REACTIONS). Cutaneous reactions, including Stevens-Johnson Syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported with use of propranolol (see ADVERSE REACTIONS).
Beta blockers can make heart failure worse and, in some cases, can lead to heart failure in people without a history of it.
Heading
Cardiac Failure
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failure, and its inhibition by beta blockade may precipitate more severe failure. Although beta blockers should be avoided in overt congestive heart failure, some have been shown to be highly beneficial when used with close follow-up in patients with a history of failure who are well compensated and are receiving additional therapies, including diuretics as needed. Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle. In Patients without a History of Heart Failure, continued use of beta blockers can, in some cases, lead to cardiac failure.
People with bronchospastic lung disease should generally not receive beta blockers. Propranolol may provoke an asthma attack.
Heading
Nonallergic Bronchospasm (e.g., Chronic Bronchitis, Emphysema)
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
In general, patients with bronchospastic lung disease should not receive beta blockers. Propranolol should be administered with caution in this setting since it may provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors.
Long-term beta-blocker treatment should not routinely be stopped before major surgery, but it may add to the risks of anesthesia and surgery.
Heading
Major Surgery
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
Propranolol can hide some warning signs of low blood sugar, especially in people with unstable insulin-dependent diabetes. Low blood sugar has been linked to propranolol, particularly in infants and children during fasting.
Heading
Diabetes and Hypoglycemia
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Beta-adrenergic blockade may prevent the appearance of certain premonitory signs and symptoms (pulse rate and pressure changes) of acute hypoglycemia, especially in labile insulin-dependent diabetics. In these patients, it may be more difficult to adjust the dosage of insulin. Propranolol therapy, particularly when given to infants and children, diabetic or not, has been associated with hypoglycemia, especially during fasting as in preparation for surgery. Hypoglycemia has been reported in patients taking propranolol after prolonged physical exertion and in patients with renal insufficiency.
Propranolol may mask signs of an overactive thyroid, and stopping it suddenly may worsen symptoms. It may change thyroid test results.
Heading
Thyrotoxicosis
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Beta-adrenergic blockade may mask certain clinical signs of hyperthyroidism. Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation of symptoms of hyperthyroidism, including thyroid storm. Propranolol may change thyroid-function tests, increasing T4 and reverse T3 and decreasing T3.
In people with Wolff-Parkinson-White syndrome and fast heart rate, beta blockade has been linked to severe slow heart rate needing a pacemaker.
Heading
Wolff-Parkinson-White Syndrome
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Beta-adrenergic blockade in patients with Wolf-Parkinson-White Syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol.
In pheochromocytoma, propranolol should be used as an add-on to alpha blockade, as the label describes.
Heading
Pheochromocytoma
Section
WARNINGS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Blocking only the peripheral dilator (beta) action of epinephrine with propranolol leaves its constrictor (alpha) action unopposed. In the event of hemorrhage or shock, there is a disadvantage in having both beta and alpha blockade since the combination prevents the increase in heart rate and peripheral vasoconstriction needed to maintain blood pressure.
Use with caution in liver or kidney problems. It may interfere with the glaucoma screening test. People with a history of severe allergic reactions may react more strongly and may not respond to the usual doses of epinephrine.
Heading
PRECAUTIONS: General
Section
PRECAUTIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol should be used with caution in patients with impaired hepatic or renal function. Propranolol is not indicated for the treatment of hypertensive emergencies. Beta-adrenergic receptor blockade can cause reduction of intraocular pressure. Patients should be told that propranolol may interfere with the glaucoma screening test. Withdrawal may lead to a return of increased intraocular pressure. While taking beta blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction.
Propranolol has been linked to higher serum potassium, serum transaminases and alkaline phosphatase in people with hypertension, and to higher Blood Urea Nitrogen in severe heart failure.
Heading
PRECAUTIONS: Clinical Laboratory Tests
Section
PRECAUTIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
In patients with hypertension, use of propranolol has been associated with elevated levels of serum potassium, serum transaminases and alkaline phosphatase. In severe heart failure, the use of propranolol has been associated with increases in Blood Urea Nitrogen.

Pregnancy and breastfeeding

Label
There are no adequate studies in pregnant women. Problems in newborns have been reported, including slow growth, small placentas, birth defects, slow heart rate, low blood sugar and breathing problems. Propranolol should be used in pregnancy only if the benefit justifies the risk to the baby. Propranolol passes into breast milk, so caution is advised for nursing women.
Section
Pregnancy; Nursing Mothers
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Pregnancy: In a series of reproductive and developmental toxicology studies, propranolol hydrochloride was given to rats by gavage or in the diet throughout pregnancy and lactation. At doses of 150 mg/kg/day, but not at doses of 80 mg/kg/day (equivalent to the MRHD on a body surface area basis), treatment was associated with embryotoxicity (reduced litter size and increased resorption rates) as well as neonatal toxicity (deaths). Propranolol hydrochloride also was administered (in the feed) to rabbits (throughout pregnancy and lactation) at doses as high as 150 mg/kg/day (about 5 times the maximum recommended human oral daily dose). No evidence of embryo or neonatal toxicity was noted. There are no adequate and well-controlled studies in pregnant women. Intrauterine growth retardation, small placentas, and congenital abnormalities have been reported in neonates whose mothers received propranolol during pregnancy. Neonates whose mothers received propranolol at parturition have exhibited bradycardia, hypoglycemia, and/or respiratory depression. Adequate facilities for monitoring such infants at birth should be available. Propranolol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. || Nursing Mothers: Propranolol is excreted in human milk. Caution should be exercised when propranolol is administered to a nursing woman.
Medlineplus
Tell your doctor if you are pregnant, plan to be, or are breast-feeding. If you become pregnant while taking propranolol, call your doctor.
Section
MedlinePlus: special precautions
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking propranolol, call your doctor.

Side effects

Common
The label does not say which side effects are most common or give percentages.
Section
ADVERSE REACTIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Threshold
none stated
Common medlineplus
MedlinePlus lists side effects to report if severe or not going away: dizziness or lightheadedness, tiredness, diarrhea and constipation.
Section
MedlinePlus: side effects
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
Propranolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: dizziness or lightheadedness tiredness diarrhea constipation
Less common
The label has no table of side effect percentages.
Section
ADVERSE REACTIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Reported events
The label lists reported events by body system, including slow heartbeat, heart failure, low blood pressure, light-headedness, depression, fatigue, hallucinations, vivid dreams, nausea, vomiting, diarrhea, constipation, allergic reactions, bronchospasm, blood cell problems, lupus, serious skin reactions, hair loss, male impotence and Peyronie's disease. Fatigue, lethargy and vivid dreams appear dose-related for immediate-release forms.
Section
ADVERSE REACTIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
The following adverse events were observed and have been reported in patients using propranolol. Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type. Central Nervous System: Light-headedness, mental depression manifested by insomnia, lassitude, weakness, fatigue; catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics. For immediate-release formulations, fatigue, lethargy, and vivid dreams appear dose-related. Gastrointestinal: Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, ischemic colitis. Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, pharyngitis and agranulocytosis; erythematous rash, fever combined with aching and sore throat; laryngospasm, and respiratory distress. Respiratory: Bronchospasm. Hematologic: Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura. Autoimmune: Systemic lupus erythematosus (SLE). Skin and mucous membranes: Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema multiforme, urticaria, alopecia, SLE-like reactions, and psoriasiform rashes. Oculomucocutaneous syndrome involving the skin, serous membranes and conjunctivae reported for a beta blocker (practolol) have not been associated with propranolol. Genitourinary: Male impotence; Peyronie's disease.
Serious
Label warnings
See warnings_and_precautions (abrupt stopping and angina or heart attack, hypersensitivity and serious skin reactions, cardiac failure, bronchospasm, hypoglycemia, thyrotoxicosis, Wolff-Parkinson-White syndrome).
Medlineplus
MedlinePlus lists symptoms that need a call to the doctor or emergency care: rash, itching, hives, blistering or peeling skin, trouble breathing or swallowing, swelling of the face, throat, tongue or lips, feeling faint, unusual weight gain, shortness of breath, irregular heartbeat.
Section
MedlinePlus: side effects
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: rash, itching, hives, blistering or peeling skin, difficulty breathing or swallowing, or swelling of the face, throat, tongue, or lips feeling faint unusual weight gain shortness of breath irregular heartbeat
Led to discontinuation
The label does not give discontinuation rates.
Section
ADVERSE REACTIONS
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display

Interactions

Drugs
Drugs that block CYP2D6, such as amiodarone, cimetidine, delavudin (as spelled in the label), fluoxetine, paroxetine, quinidine and ritonavir, may raise propranolol levels or toxicity.
Name
CYP2D6 substrates or inhibitors
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP2D6, such as amiodarone, cimetidine, delavudin, fluoxetine, paroxetine, quinidine, and ritonavir. No interactions were observed with either ranitidine or lansoprazole.
Drugs that block CYP1A2, such as imipramine, cimetidine, ciprofloxacin, fluvoxamine, isoniazid, ritonavir, theophylline, zileuton, zolmitriptan and rizatriptan, may raise propranolol levels or toxicity.
Name
CYP1A2 substrates or inhibitors
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP1A2, such as imipramine, cimetidine, ciprofloxacin, fluvoxamine, isoniazid, ritonavir, theophylline, zileuton, zolmitriptan, and rizatriptan.
Drugs that block CYP2C19, such as fluconazole, cimetidine, fluoxetine, fluvoxamine, teniposide and tolbutamide, may raise propranolol levels or toxicity.
Name
CYP2C19 substrates or inhibitors
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP2C19, such as fluconazole, cimetidine, fluoxetine, fluvoxamine, teniposide, and tolbutamide. No interaction was observed with omeprazole.
Rifampin, ethanol, phenytoin and phenobarbital may lower propranolol levels. Cigarette smoking can increase propranolol clearance by up to 77%, lowering levels.
Name
Inducers of hepatic drug metabolism
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Blood levels of propranolol may be decreased by co-administration with inducers such as rifampin, ethanol, phenytoin, and phenobarbital. Cigarette smoking also induces hepatic metabolism and has been shown to increase up to 77% the clearance of propranolol, resulting in decreased plasma concentrations.
Propafenone, quinidine, amiodarone and lidocaine can interact with propranolol, with added beta-blocking effects, higher propranolol levels or lidocaine toxicity. Caution is advised with drugs that slow A-V nodal conduction.
Name
Antiarrhythmics
Section
PRECAUTIONS: Drug Interactions - Antiarrhythmics
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propafenone has negative inotropic and beta-blocking properties that can be additive to those of propranolol. Quinidine increases the concentration of propranolol and produces greater degrees of clinical beta-blockade and may cause postural hypotension. Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with β-blockers such as propranolol. The clearance of lidocaine is reduced with administration of propranolol. Lidocaine toxicity has been reported following coadministration with propranolol. Caution should be exercised when administering propranolol with drugs that slow A-V nodal conduction, e.g., digitalis, lidocaine and calcium channel blockers.
Digitalis and beta blockers both slow the heart rate, so using them together can raise the risk of a slow heartbeat.
Name
Digitalis glycosides
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
Using propranolol with calcium channel blockers, especially verapamil or diltiazem, has been linked to slow heartbeat, low blood pressure, heart block and heart failure.
Name
Calcium channel blockers
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Caution should be exercised when patients receiving a beta blocker are administered a calcium-channel-blocking drug with negative inotropic and/or chronotropic effects. Both agents may depress myocardial contractility or atrioventricular conduction. There have been reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers. Co-administration of propranolol and diltiazem in patients with cardiac disease has been associated with bradycardia, hypotension, high-degree heart block, and heart failure.
ACE inhibitors, clonidine, prazosin, terazosin, doxazosin and reserpine can interact with propranolol, causing low blood pressure or other effects. Tell your prescriber about all blood pressure medicines.
Name
ACE inhibitors, clonidine, alpha blockers, reserpine
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
When combined with beta-blockers, ACE inhibitors can cause hypotension, particularly in the setting of acute myocardial infarction. The antihypertensive effects of clonidine may be antagonized by beta-blockers. Propranolol should be administered cautiously to patients withdrawing from clonidine. Prazosin has been associated with prolongation of first dose hypotension in the presence of beta-blockers. Postural hypotension has been reported in patients taking both beta-blockers and terazosin or doxazosin. Patients receiving catecholamine-depleting drugs, such as reserpine, should be closely observed for excessive reduction of resting sympathetic nervous activity, which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic hypotension.
Epinephrine can cause uncontrolled high blood pressure in people on long-term propranolol. Dobutamine or isoproterenol can reverse propranolol's effects.
Name
Epinephrine, isoproterenol and dobutamine
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Patients on long-term therapy with propranolol may experience uncontrolled hypertension if administered epinephrine as a consequence of unopposed alpha-receptor stimulation. Epinephrine is therefore not indicated in the treatment of propranolol overdose (see OVERDOSAGE). Propranolol is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, e.g., dobutamine or isoproterenol. Also, propranolol may reduce sensitivity to dobutamine stress echocardiography in patients undergoing evaluation for myocardial ischemia.
NSAIDs may blunt the blood pressure lowering effect of propranolol. Indomethacin may reduce its effect on blood pressure and heart rate.
Name
NSAIDs (including indomethacin)
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Nonsteroidal anti-inflammatory drugs (NSAIDS) have been reported to blunt the antihypertensive effect of beta-adrenoreceptor blocking agents. Administration of indomethacin with propranolol may reduce the efficacy of propranolol in reducing blood pressure and heart rate.
MAO inhibitors and tricyclic antidepressants may have stronger blood pressure lowering effects when used with propranolol.
Name
Antidepressants (MAO inhibitors, tricyclics)
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
The hypotensive effects of MAO inhibitors or tricyclic antidepressants may be exacerbated when administered with beta-blockers by interfering with the beta blocking activity of propranolol.
Methoxyflurane and trichloroethylene may depress heart muscle contraction when used with propranolol.
Name
Anesthetic agents
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Methoxyflurane and trichloroethylene may depress myocardial contractility when administered with propranolol.
Propranolol raises warfarin levels, so prothrombin time should be monitored.
Name
Warfarin
Section
PRECAUTIONS: Drug Interactions; Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol when administered with warfarin increases the concentration of warfarin. Prothrombin time, therefore, should be monitored. || Concomitant administration of propranolol and warfarin has been shown to increase warfarin bioavailability and increase prothrombin time.
Low blood pressure and cardiac arrest have been reported with haloperidol. Thioridazine and chlorpromazine levels can rise when used with propranolol.
Name
Neuroleptic drugs (haloperidol, thioridazine, chlorpromazine)
Section
PRECAUTIONS: Drug Interactions; Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Hypotension and cardiac arrest have been reported with the concomitant use of propranolol and haloperidol. || Co-administration of long-acting propranolol at doses greater than or equal to 160 mg/day resulted in increased thioridazine plasma concentrations ranging from 55% to 369% and increased thioridazine metabolite (mesoridazine) concentrations ranging from 33% to 209%. Co-administration of chlorpromazine with propranolol resulted in a 70% increase in propranolol plasma level.
Thyroxine may give a lower than expected T3 level when used with propranolol.
Name
Thyroxine
Section
PRECAUTIONS: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Thyroxine may result in a lower than expected T3 concentration when used concomitantly with propranolol.
Propranolol lowers theophylline oral clearance by 30% to 52%.
Name
Theophylline
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Co-administration of theophylline with propranolol decreases theophylline oral clearance by 30% to 52%.
Propranolol raises zolmitriptan and rizatriptan levels.
Name
Migraine drugs (zolmitriptan, rizatriptan)
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Administration of zolmitriptan or rizatriptan with propranolol resulted in increased concentrations of zolmitriptan (AUC increased by 56% and Cmax by 37%) or rizatriptan (the AUC and Cmax were increased by 67% and 75%, respectively).
Propranolol can raise diazepam levels. The label says oxazepam, triazolam, lorazepam and alprazolam are not affected.
Name
Benzodiazepines
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Propranolol can inhibit the metabolism of diazepam, resulting in increased concentrations of diazepam and its metabolites. Diazepam does not alter the pharmacokinetics of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.
Cimetidine raised propranolol AUC and Cmax by 46% and 35%. Aluminum hydroxide gel may lower propranolol levels.
Name
Anti-ulcer drugs
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Co-administration of propranolol with cimetidine, a non-specific CYP450 inhibitor, increased propranolol AUC and Cmax by 46% and 35%, respectively. Co-administration with aluminum hydroxide gel (1200 mg) may result in a decrease in propranolol concentrations.
Cholestyramine or colestipol can lower propranolol levels by up to 50%.
Name
Lipid lowering drugs
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Co-administration of cholestyramine or colestipol with propranolol resulted in up to 50% decrease in propranolol concentrations. Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics. Propranolol did not have an effect on the pharmacokinetics of fluvastatin.
Nisoldipine and nicardipine raise propranolol levels, and propranolol raises nifedipine levels.
Name
Nisoldipine and nicardipine; nifedipine
Section
Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
The mean Cmax and AUC of propranolol are increased, respectively, by 50% and 30% by coadministration of nisoldipine and by 80% and 47%, by coadministration of nicardipine. The mean Cmax and AUC of nifedipine are increased by 64% and 79%, respectively, by coadministration of propranolol.
Food and alcohol
Alcohol may increase propranolol levels in the blood.
Name
Alcohol (label)
Section
PRECAUTIONS: Drug Interactions; Clinical Pharmacology: Drug Interactions
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Alcohol, when used concomitantly with propranolol, may increase plasma levels of propranolol. || Concomitant use of alcohol may increase plasma levels of propranolol.
Protein-rich foods raise how much propranolol the body absorbs by about 50%.
Name
Protein-rich foods (label)
Section
Pharmacokinetics: Absorption
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Administration of protein-rich foods increase the bioavailability of propranolol by about 50% with no change in time to peak concentration, plasma binding, half-life, or the amount of unchanged drug in the urine.
MedlinePlus says to ask your doctor about alcohol, and to continue your normal diet unless told otherwise.
Name
Alcohol and diet (MedlinePlus)
Section
MedlinePlus: special precautions; special dietary instructions
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
ask your doctor about the safe use of alcoholic beverages while you are taking propranolol. Alcohol may increase the amount of propranolol in your body. Unless your doctor tells you otherwise, continue your normal diet.
Other
Cigarette smoking may make propranolol work less well.
Name
Tobacco (MedlinePlus)
Section
MedlinePlus: special precautions
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
MedlinePlus lists aluminum antacids, cimetidine, and NSAIDs such as ibuprofen and naproxen as products that may interact.
Name
OTC and herbal products (MedlinePlus)
Section
MedlinePlus: special precautions
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
the following nonprescription or herbal products may interact with propranolol: antacids containing aluminum, cimetidine, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. Be sure to let your doctor and pharmacist know that you are taking this medication before you start taking propranolol. Do not start this medication while taking propranolol without discussing with your healthcare provider.
Propranolol may interfere with the glaucoma screening test.
Name
Glaucoma screening test
Section
PRECAUTIONS: General
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Source text (exact source wording)
Patients should be told that propranolol may interfere with the glaucoma screening test.

Patient tips

Label counseling statements
Tell the eye doctor you take propranolol before a glaucoma test. Do not stop or interrupt propranolol without a doctor's advice.
Source
DailyMed Par Health USA propranolol hydrochloride tablets label (set ID 0d74bb04-8227-4afa-b523-ce1556150e07), Revised: 07/2026
Source url
https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
Section
PRECAUTIONS General; WARNINGS Angina Pectoris (sentences from two sections, joined)
Source text (exact source wording)
Patients should be told that propranolol may interfere with the glaucoma screening test. The patient should be cautioned against interruption or cessation of therapy without the physician's advice.
Medlineplus how to take
Tablets are taken 2 to 4 times a day, at around the same times every day, exactly as directed. Propranolol helps control your condition but will not cure it. Keep taking it even if you feel well. If you suddenly stop, you may have serious heart problems.
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
All other forms of propranolol are taken 2 to 4 times a day. Take propranolol at around the same time(s) every day. Take propranolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Propranolol helps control your condition but will not cure it. Continue to take propranolol even if you feel well. Do not stop taking propranolol without talking to your doctor. If you suddenly stop taking propranolol, you may experience serious heart problems.
Medlineplus avoid
Ask your doctor about alcohol. Tell your doctor if you use tobacco. Propranolol may raise the risk of low blood sugar and hide its warning signs.
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
ask your doctor about the safe use of alcoholic beverages while you are taking propranolol. Alcohol may increase the amount of propranolol in your body. tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication. you should know that propranolol may increase the risk of hypoglycemia (low blood sugar) and prevent the warning signs and symptoms that would tell you that your blood sugar is low.
Medlineplus when to call
Call your doctor right away or get emergency care for rash, itching, hives, blistering or peeling skin, trouble breathing or swallowing, swelling of the face, throat, tongue or lips, feeling faint, unusual weight gain, shortness of breath, or an irregular heartbeat.
Source
MedlinePlus Propranolol (Last Revised - 03/15/2026)
Source url
https://medlineplus.gov/druginfo/meds/a682607.html
Source text (exact source wording)
Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment: rash, itching, hives, blistering or peeling skin, difficulty breathing or swallowing, or swelling of the face, throat, tongue, or lips feeling faint unusual weight gain shortness of breath irregular heartbeat

Alternatives

Class source
Label Clinical Pharmacology: nonselective beta-adrenergic receptor blocking agent; MedlinePlus: beta blockers; openFDA beta-adrenergic Blocker [EPC] generic-name list (propranolol itself did not return an EPC in openFDA)
Class source urls
  • https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0d74bb04-8227-4afa-b523-ce1556150e07&type=display
  • https://medlineplus.gov/druginfo/meds/a682607.html
  • https://api.fda.gov/drug/label.json?search=openfda.pharm_class_epc.exact:%22beta-Adrenergic%20Blocker%20[EPC]%22&count=openfda.generic_name.exact&limit=30
Candidates same class
  • carvedilol
  • atenolol
  • nadolol
  • labetalol hydrochloride
  • pindolol
  • nebivolol
  • timolol hemihydrate

Frequently asked questions

Question
What is propranolol used for?
Answer
The label lists high blood pressure, angina (chest pain), atrial fibrillation, preventing death after a heart attack in stable patients, preventing common migraine headaches, essential tremor, hypertrophic subaortic stenosis, and pheochromocytoma as an add-on to alpha blockade.
Source section
INDICATIONS AND USAGE
Source
DailyMed Par Health label
Question
How is propranolol usually dosed for high blood pressure?
Answer
The label says the usual starting dose is 40 mg twice daily, with the usual maintenance dosage 120 mg to 240 mg per day. The dose is individualized based on response.
Source section
DOSAGE AND ADMINISTRATION: Hypertension; General
Source
DailyMed Par Health label
Question
What should I do if I miss a dose?
Answer
The label text read gives no missed-dose instructions. MedlinePlus says to take the missed dose as soon as you remember, but if it is almost time for the next dose, to skip the missed dose and not to take a double dose.
Source section
MedlinePlus: forget a dose
Source
MedlinePlus
Question
Can I drink alcohol with propranolol?
Answer
The label says alcohol may increase propranolol levels in the blood. MedlinePlus says to ask your doctor about the safe use of alcoholic beverages.
Source section
PRECAUTIONS: Drug Interactions; MedlinePlus
Source
DailyMed Par Health label; MedlinePlus
Question
What are the possible side effects?
Answer
The label lists many reported events, including bradycardia, low blood pressure, light-headedness, fatigue, vivid dreams, nausea, diarrhea and constipation, but gives no incidence percentages or most-common list. MedlinePlus lists dizziness or lightheadedness, tiredness, diarrhea and constipation to report if severe or not going away.
Source section
ADVERSE REACTIONS; MedlinePlus: side effects
Source
DailyMed Par Health label; MedlinePlus
Question
Is propranolol safe in pregnancy or while breastfeeding?
Answer
The label says there are no adequate and well-controlled studies in pregnant women, and that it should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It also says propranolol is excreted in human milk and caution should be exercised in a nursing woman.
Source section
Pregnancy; Nursing Mothers
Source
DailyMed Par Health label
Question
Should I stop propranolol when I feel well?
Answer
No. MedlinePlus says to continue taking it even if you feel well and not to stop without talking to your doctor, because suddenly stopping may cause serious heart problems. The label says that when stopping is planned, the dose should be gradually reduced over at least a few weeks.
Source section
MedlinePlus: how should this medicine be used; WARNINGS: Angina Pectoris
Source
DailyMed Par Health label; MedlinePlus
Question
Who should not take propranolol?
Answer
The label says it is contraindicated in cardiogenic shock, sinus bradycardia and greater than first degree block, bronchial asthma, and known hypersensitivity to propranolol hydrochloride.
Source section
CONTRAINDICATIONS
Source
DailyMed Par Health label

Sources

Information is taken from the cited sources and is for general reference only. It is not medical advice. Report side effects to FDA MedWatch at 1-800-FDA-1088. For a poison emergency call 1-800-222-1222. See prices for this drug