Propranolol

The recommended adult dose of propranolol varies widely according to the condition being treated and circumstances of the person taking the medication. Propranolol may be taken with or without food. Do not stop taking Propranolol suddenly unless you have talked with your doctor first.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones given here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take Propranolol exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Propranolol at room temperature, protect it from light and moisture and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause mood changes and, occasionally, may lead to depression; it may cause diarrhea; it may cause dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause unusual tiredness; it may cause nausea or, rarely, vomiting; it may cause difficulty with erection. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

10 mg
Each orange-coloured, compressed tablet, engraved "N" and "10" on one side and scored on the reverse, contains 10 mg of propranolol. Nonmedicinal ingredients: colloidal silicon dioxide, D&C Yellow No. 10, FD&C Yellow No. 6, lactose, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

20 mg
Each blue, hexagonal tablet, engraved modified "N" on one side and "2" and "0" on the reverse, contains 20 mg of propranolol. Nonmedicinal ingredients: colloidal silicon dioxide, FD&C Blue No. 1, lactose, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

40 mg
Each green, round tablet, engraved "N" over "40" on one side and scored on the reverse, contains 40 mg of propranolol. Nonmedicinal ingredients: colloidal silicon dioxide, D&C Yellow No. 10, FD&C Blue No. 1, FD&C Yellow No. 6, lactose, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

80 mg
Each yellow, round tablet, engraved "N" over "80" on one side and scored on the reverse, contains 80 mg of propranolol. Nonmedicinal ingredients: colloidal silicon dioxide, D&C Yellow No. 10, FD&C Yellow No. 6, lactose, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

Do not take Propranolol if you:

• are allergic to propranolol or any ingredients of the medication
• are in cardiogenic shock
• are prone to low blood glucose
• have a severely slow heart rate
• have Allergic Rhinitis during the pollen season
• have Asthma or severe chronic obstructive respiratory diseases (e.g., emphysema, chronic Bronchitis)
• have Congestive Heart Failure
• have right ventricular failure secondary to pulmonary hypertension (excessive blood pressure in the lungs)
• have serious heart block (second- and third-degree AV block) or sick sinus syndrome
• have severe circulatory disorders
• have a condition where the blood is acidic
• have severely decreased blood pressure
• have untreated pheochromocytoma (a tumour of the adrenal glands)
• have Prinzmetal angina (a condition that causes angina or chest pain at rest)
• have uncontrolled heart failure

There may be an interaction between propranolol and any of the following:

• Abiraterone
• alcohol
• Aldesleukin
• Aliskiren
• alpha agonists (e.g., Clonidine, methyldopa)
• alpha blockers (e.g., Alfuzosin, Doxazosin, Tamsulosin)
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, lisdexamphetamine)
• angiotensin-converting enzyme inhibitors (ACEIs; Captopril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., candasartan, Irbesartan, Losartan)
• anti-malarial medications (e.g., chloroquine, hydroxychloroquine, Mefloquine, Primaquine)
• antipsychotic medications (e.g., Chlorpromazine, Clozapine, Haloperidol, Risperidone)
• asunaprevir
• barbiturates (e.g., butalbital, pentobarbital Phenobarbital)
• beta-2 agonists (e.g., salbutamol, formoterol, terbutaline, salmeterol)
• brimonidine
• Bupropion
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• cannabis
• Carbamazepine
• Celecoxib
• certain protein kinase inhibitors (e.g., Bosutinib, Ceritinib, Nilotinib, Pazopanib
• cetirizine
• Cholestyramine
• Cimetidine
• Clobazam
• Cobicistat
• Colchicine
• Colestipol
• Cyclosporine
• Cyproterone
• dabigatran
• Darifenacin
• Deferasirox
• delavirdine
• Dexamethasone
• diazoxide
• Digoxin
• Diphenhydramine
• Dipyridamole
• Disopyramide
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• Donepezil
• Dronedarone
• epinephrine
• ergot alkaloids (e.g., Dihydroergotamine, methysergide)
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• Fentanyl
• Fingolimod
• Galantamine
• Gemfibrozil
• “gliptin” diabetes medications (e.g., Linagliptin, Saxagliptin, Sitagliptin)
• grass pollen allergen extract
• Guanfacine
• HIV protease inhibitors (e.g., indinavir, nelfinavir, ritonavir, saquinavir)
• Hydralazine
• Hydrocortisone
• insulin
• isoniazid
• ivermectin
• ketoconazole
• Lacosamide
• Lanreotide
• levodopa
• Loperamide
• medications to treat cancer (e.g., brentuximab, Daunorubicin, Doxorubicin, Etoposide, Idarubicin, imatinib, Irinotecan, Methotrexate, Paclitaxel, Temsirolimus, Vinblastine, Vincristine)
• Methadone
• Methylphenidate
• Mexiletine
• Minoxidil
• Mirabegron
• Naloxegol
• nitrates (e.g., Nitroglycerin, isosorbide dinitrate, isosorbide mononitrate)
• nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., Diclofenac, Ibuprofen, Ketorolac, Naproxen)
• Octreotide
• Ondansetron
• other beta-adrenergic blockers (e.g., Atenolol, propranolol, Sotalol)
• Pasireotide
• peginterferon alfa-2b
• pentoxiphylline
• phosphodiesterase-5 inhibitors (e.g., Sildenafil, Tadalafil, Vardenafil)
• Pilocarpine
• primidone
• Propafenone
• Prucalopride
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, moxifloxacin)
• rifampin
• Rivaroxaban
• Rivastigmine
• Rizatriptan
• Romidepsin
• St. John's wort
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Fluvoxamine Paroxetine, Sertraline)
• Sirolimus
• "statin" anti-cholesterol medications (e.g., Atorvastatin, Lovastatin, Simvastatin)
• sulfonylureas (e.g., Gliclazide, Glyburide, Tolbutamide)
• Tacrolimus
• terfenadine
• Teriflunomide
• theophyllines (e.g., Theophylline, Aminophylline, Oxtriphylline)
• Ticlopidine
• Tizanidine
• Tolvaptan
• Tranylcypromine
• tricyclic antidepressants (e.g., Imipramine, Desipramine, Clomipramine)
• Warfarin
• Zolmitriptan

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Propranolol. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Propranolol.

Breathing problems: In general, people who have asthma and certain other breathing problems or chronic lung disease should use propranolol cautiously, as it can cause breathing difficulty. Low doses of propranolol may be taken with caution by those with asthma who do not respond to or cannot tolerate other treatments. If you have breathing problems, discuss with your doctor how Propranolol may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Propranolol, and whether any special monitoring is needed.

Congestive heart failure: People with congestive heart failure should not take propranolol.

Diabetes: The signs of low blood sugar may not be as noticeable when taking propranolol. If you have diabetes and take insulin or other medications that affect blood glucose levels, discuss with your doctor how Propranolol may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Propranolol, and whether any special monitoring is needed. It may be necessary to monitor your blood glucose levels more often when you are taking Propranolol.

Low blood pressure: Occasionally, blood pressure drops too low after taking propranolol, causing dizziness or lightheadedness. Move slowly when moving from a lying down or sitting position to a standing position to prevent dizziness, especially when Propranolol is first being started.

Hyperthyroidism (high level of Thyroid hormones): Propranolol can reduce the symptoms that occur when you have hyperthyroidism (high levels of thyroid hormones). It does not affect the thyroid gland, it only hides the symptoms of an over-active thyroid gland. Stopping the medication suddenly could worsen this condition.

Kidney function: Kidney Disease or reduced kidney function may cause Propranolol to build up in the body, causing side effects. If you have kidney problems, discuss with your doctor how Propranolol may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Propranolol, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause Propranolol to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Propranolol may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Propranolol, and whether any special monitoring is needed.

If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Pheochromocytoma: Propranolol can worsen the symptoms of pheochromocytoma (a tumour of the adrenal gland) if it is taken alone. If you have a pheochromocytoma, discuss with your doctor how Propranolol may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Propranolol, and whether any special monitoring is needed.

Severe allergies: People with allergies severe enough to cause Anaphylaxis (severe allergic reaction) (a severe allergic reaction where swelling of the face, lips, and throat make it difficult to breathe) should talk to their doctor about what to do if they have an allergic reaction. Propranolol may make it more difficult to treat their allergic reaction with Epinephrine.

Stopping medication: Propranolol should not be stopped suddenly by people who are taking it to treat angina. There have been reports of severe worsening of angina and of heart attack or abnormal heart rhythms occurring for people with angina pectoris who have stopped the medication abruptly. If you feel that you need to stop Propranolol for any reason, talk to your doctor for the best way to taper the medication.

Surgery: If you are scheduled for surgery, inform all doctors involved in your care that you take propranolol.

Pregnancy: Not enough information exists on the safe use of propranolol by pregnant women; however, studies have shown that propranolol does cross the placenta. Propranolol should be used during pregnancy only if the potential benefits justify the potential risks. If you become pregnant while taking Propranolol, contact your doctor immediately.

Breast-feeding: Propranolol passes into breast milk. If you are a breast-feeding mother and are taking propranolol, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: There is limited experience in the use of propranolol by children. Caution is advised with its use by this age group.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. It is not advisable to stop using this product suddenly, particularly if you have been on it for several weeks. If you are considering stopping the medication, talk to your pharmacist first. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. The capsule of this medication should not be opened, crushed or chewed. If you forget a dose, take it as soon as you remember -- unless it is almost time for your next dose. In that case, skip the missed dose. Do not double the next dose to catch up. This medication may be taken with or without food.