Propranolol is a prescription medication belonging to the family of beta-blockers and used to treat high blood pressure (hypertension), migraines, anxiety, and other conditions. Beta-blockers are a class of medications that slow down the heart rate and reduce the heart contractility by blocking the action of the hormone adrenaline (aka epinephrine).
In most countries worldwide, propranolol hydrochloride is marketed under the brand name Inderal by AstraZeneca, with a few other companies marketing it under other names such as Deralin and APO-Propranolol (Australia), Norten and Ciplar (India).
Propranolol hydrochloride is available as standard release tablet and extended-release capsule, in IV liquid form for hospital use and as oral liquid solution for patients with trouble swallowing, the elderlies and children. Depending on your country, it may be available in strength of 10mg, 20mg, 40mg, 60mg, 80mg, 120mg, 160mg for the regular release formulation.
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Indications and usage of Propranolol (Inderal – Ciplar)
Among the many uses of propranolol hydrochloride there are the treatment of:
- Hypertension (High blood pressure)
- Angina pectoris prevention
- Migraine prevention
- Essential tremor
- Anxiety and Performance anxiety
- Pheochromocytoma
- Cardiac arrhythmias and dysrhythmias
- Myocardial Infarction treatment and prophylaxis (prevention)
- Hypertrophic subaortic stenosis
These are just the main indications approved in most countries worldwide, but Inderal may also be prescribed off-label or to treat other conditions depending on the country of residence.
Inderal 40mg – Ciplar 40mg for hypertension
The standard dose for propranolol for the treatment of high blood pressure is 40mg twice daily. The dose may be increased over a few weeks’ time up to 320mg per day, according to your prescribing doctor’s indications.
Inderal 10mg – Ciplar/Norten 10mg for anxiety
For short term relief of acute situational anxiety, propranolol can be taken as a single 10mg to 40mg dose 1-2 hours before the event that may cause anxiety. For generalized anxiety and long-term treatment, it is usually prescribed 40mg twice daily.
Inderal for Migraine
The standard initial dose of propranolol for migraine is 80mg divided in two doses which may be increased to the usual effective range of 160-240mg per day.
Propranolol for cardiac dysrhythmias and arrhythmias
The usual dose ranges between 10-40mg to be taken three to four times per day.
How to take propranolol (Inderal – Ciplar)?
Propranolol should be taken at the same time every day and following the prescription by your physician: the dose and the number of times you need to take Inderal daily will depend upon your specific conditions, your anamnesis, what other medications you are taking, risk factors, etc.
You should swallow the tablet whole with a glass of water, without chewing it or crushing it.
Propranolol can be taken both with and without food, it does not matter.
What to do if you forgot to take one dose of propranolol (Inderal – Ciplar)?
For regular propranolol, take the missed dose as soon as possible, unless the next dose is less than 4-6 hours away in which case it is advised to skip it entirely and take the next dose on time.
For extended-release propranolol, take the missed dose immediately, unless the next dose is less than 8 hours away in which case it is advised to skip it entirely and take the next dose on time.
Do not take a double dose to make up for missed doses.
Always consult your GP or pharmacist for tailored advice.
Propranolol (Inderal – Ciplar) during pregnancy and lactation
Inderal should not be taken during pregnancy unless its use is determined to be essential by your specialist. Although it should not cause defects in the developing fetus (no evidence of teratogenicity), its mechanism of action may cause decreased perfusion of the placenta with reduced blood flow to the fetus and increased risk of death, premature delivery, and other complications.
Breastfeeding is also not recommended as propranolol will pass into breast milk, although to a variable extent.
Side effects
Common side effects of Inderal include bradycardia (slow heart rate), gastrointestinal issues, abdominal pain, nausea, erectile dysfunction, cold extremities, insomnia and fatigue.
Although less common, propranolol can also cause serious side effects such as bronchospasm, allergic reactions, extreme fatigue; contact your GP or the medical emergency number for an evaluation of symptoms arising from use of this medication.
Warnings
Propranolol may cause dizziness, tiredness and/or drowsiness: be sure you are in the right conditions to drive or operate vehicles while taking this medication.
Do not drink alcohol as it may make side effects worse as well as increase the effects of propranolol itself.
If you suffer from diabetes and/or hypoglycemic episodes (low blood sugar), make sure to check your blood sugar level regularly as propranolol may cover up some of the symptoms of hypoglycemia.
Ask your GP or pharmacist for a comprehensive list of warnings.
Sources
- Inderal (Propranolol Hydrochloride) product label
US Food and Drug Administration (FDA)
https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/016418s080,016762s017,017683s008lbl.pdf - Propranolol
M Shahrokhi – StatPearls, Jan 2021
https://pubmed.ncbi.nlm.nih.gov/32491733/ - DERALIN (Propranolol Hydrochloride) Australian product label
https://apps.medicines.org.au/files/afpderal.pdf - Propranolol hydrochloride
UK Electronic Medicines Compendium
https://www.medicines.org.uk/emc/product/12858/smpc
