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Non-selective β-blocker Pregnancy: Should not be given in pregnancy unless essential; no evidence of teratogenicity, but beta-blockers reduce placental perfusion (risk of intra-uterine foetal death, immature/premature delivery) and may cause neonatal hypoglycaemia and bradycardia. Breast-feeding not recommended (§4.6).

Propranolol hydrochloride

Brand names: Inderal

Used in: Liver Disease & Cirrhosis Headache & Migraine

Propranolol is a non-selective beta-blocker used for arrhythmias, angina, hypertension, migraine prophylaxis, essential tremor, performance/somatic anxiety, and symptom control in thyrotoxicosis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Hypertension: start 80 mg twice daily, increased at weekly intervals according to response; usual dose range 160 to 320 mg/day
Route: Oral
Frequency: Twice daily (indication-dependent)
With concurrent diuretic or other antihypertensive a further reduction of blood pressure is obtained. Other indications: angina, migraine and essential tremor - start 40 mg two or three times daily, increased at weekly intervals (migraine/essential tremor usual 80-160 mg/day; angina 120-240 mg/day); situational anxiety - 40 mg daily; generalised anxiety - 40 mg twice daily (up to three times daily); arrhythmias, anxiety tachycardia, hypertrophic obstructive cardiomyopathy and thyrotoxicosis - 10 to 40 mg three or four times a day; post-MI - 40 mg four times a day for 2-3 days then 80 mg twice daily; portal hypertension - start 40 mg twice daily, titrate to ~25% reduction in resting heart rate, up to max 160 mg twice daily; phaeochromocytoma (only with an alpha-blocker) - pre-operative 60 mg daily for 3 days, non-operable 30 mg daily. Elderly: start at the lowest dose. Avoid abrupt withdrawal - reduce gradually over 7 to 14 days.

Paediatric dose

Dose: 0.25 mg/kg
Route: Oral
Frequency: 3-4 times daily
Max: Not stated (dose individually determined)
Dysrhythmias, phaeochromocytoma, thyrotoxicosis: 0.25 to 0.5 mg/kg three or four times daily as required (individually determined). Fallot's tetralogy: up to 1 mg/kg three or four times daily as required. Migraine: under 12 years 20 mg two or three times daily; over 12 years the adult dose. Verify against a children's formulary.

Dose adjustments

Renal

Half-life may be increased in significant renal impairment; exercise caution when starting treatment and selecting dose (§4.4). No specific dose stated.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Dysrhythmias, phaeochromocytoma, thyrotoxicosis: 0.25 to 0.5 mg/kg three or four times daily as required (individually determined). Fallot's tetralogy: up to 1 mg/kg three or four times daily as required. Migraine: under 12 years 20 mg two or three times daily; over 12 years the adult dose. Verify against a children's formulary.

Verify in a children's formulary

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION 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/day 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. While twice-daily dosing is effective and can maintain a reduction in blood pressure …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2024-08-09. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

  • Hypersensitivity to propranolol or any excipient
  • History of bronchial asthma or bronchospasm
  • Bradycardia; cardiogenic shock; hypotension; metabolic acidosis
  • Second or third degree heart block; sick sinus syndrome
  • Severe peripheral arterial circulatory disturbances; untreated phaeochromocytoma; uncontrolled heart failure; Prinzmetal's angina
  • Patients prone to hypoglycaemia (e.g. after prolonged fasting or with restricted counter-regulatory reserves)

Side effects

  • Fatigue and/or lassitude, often transient (common)
  • Sleep disturbances, nightmares (common)
  • Bradycardia, cold extremities, Raynaud's phenomenon (common)
  • Gastrointestinal disturbance - nausea, vomiting, diarrhoea (uncommon)
  • Bronchospasm in patients with asthma or asthmatic history, sometimes fatal (rare)

Interactions

  • Negative-inotrope calcium channel blockers (verapamil, diltiazem) - do not combine; risk of severe hypotension, bradycardia and cardiac failure; do not give either IV within 48 h of the other (§4.4)
  • Other antihypertensives / diuretics - additive blood pressure lowering
  • Hypoglycaemic / antidiabetic therapy - may mask signs of and prolong hypoglycaemia (§4.3, §4.4)
  • May mask the signs of thyrotoxicosis

Clinical monograph

How it works

It blocks both β1 and β2 adrenoceptors, reducing heart rate and contractility and blunting the effects of circulating catecholamines.

Prescribing in practice

  • Avoid in asthma — being non-selective it can cause severe bronchospasm.
  • Do not stop abruptly in ischaemic heart disease (rebound), and be aware it can mask the warning signs of hypoglycaemia.
  • It is used at different doses for its different indications.

Monitoring

Monitor heart rate and blood pressure and review the response for the specific indication.

Counselling the patient

  • Do not stop it suddenly.
  • Report wheeze, a very slow pulse, or dizziness.
  • Tiredness or cold hands can occur, especially early on.

Evidence & guidelines

Used across cardiac and non-cardiac indications, including migraine prophylaxis (NICE NG150).

Reference: NICE NG136/CG150/NG217; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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