Non-selective β-blocker
Propranolol hydrochloride
Brand names: Inderal
Adult dose
Dose: Hypertension/angina: 80–160mg PO BD. Migraine prophylaxis: 80–160mg/day. Anxiety: 40–80mg PO PRN. Thyrotoxicosis: 40–80mg PO QDS. Essential tremor: 40–160mg/day
Route: PO/IV
Frequency: BD-QDS
Clinical pearls
- Migraine prophylaxis 1st-line per NICE
- Performance anxiety, thyroid storm, infantile haemangioma (high-dose specialist)
Contraindications
- Asthma
- Severe bradycardia
- 2nd/3rd-degree AV block
- Cardiogenic shock
- Severe peripheral vascular disease
- Untreated phaeochromocytoma
- Metabolic acidosis
Side effects
- Bradycardia
- Bronchospasm
- Cold extremities
- Sleep disturbance
- Fatigue
- Masking of hypoglycaemia
Interactions
- Verapamil/diltiazem (severe — avoid IV combination)
- NSAIDs
- Other antihypertensives
- Adrenaline (paradoxical hypertension)
Monitoring
- BP
- HR
- Symptoms
Reference: BNF; NICE NG136/CG150/NG217; https://bnf.nice.org.uk/drugs/propranolol-hydrochloride/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
Pathways
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines