Propranolol: How it Works, Dosage, Uses, Side Effects

Kristin Hall, FNP

Medically reviewed by Kristin Hall, FNP

Written by Our Editorial Team

Last updated 7/27/2021

As one of the earliest and most widely prescribed beta blockers, propranolol is used by millions of people in the United States alone.

Below, we’ve explained how propranolol works as a medication, as well as what it’s commonly used for. 

We’ve also covered the side effects of propranolol, potential propranolol interactions and tips for using it safely and effectively.

What is Propranolol?

Propranolol is an FDA approved beta blocker medication that’s used to treat several different medical conditions. 

Like other beta blockers, it works by relaxing blood vessels and lowering your heart rate, and subsequently reducing the physical effects of anxiety.

Conditions that are FDA approved for treatment by propranolol include angina (chest pain), hypertension (high blood pressure), irregular heart rhythm, tremors, the treatment or prevention of heart attack, and other heart or circulatory conditions. 

Additionally, propranolol can be used in the prevention or reduction of migraine frequency. Propranolol is frequently prescribed off-label to treat social and performance anxiety.

How Propranolol Works

Propranolol is a beta blocker. It works by blocking the action of stress hormones like adrenaline (epinephrine) and noradrenaline (norepinephrine) on your body’s beta ​​adrenergic receptors.

Adrenaline and noradrenaline are hormones used to signal the fight-or-flight response. If you’re in a stressful or dangerous situation, your body starts to secrete higher levels of these hormones, triggering your fight-or-flight response and causing your heart rate to suddenly increase.

Stress hormones like adrenaline and noradrenaline can also make you feel anxious, shaky and sweaty. 

In short, they’re the hormones that trigger nervousness and encourage you to make a decision in tense situations.

Fight-or-flight is a survival mechanism designed to protect you when you’re in danger. However, if you have an anxiety disorder, it can affect you in other situations, such as performing in front of other people, meeting someone new or making small talk with a friend or stranger.

By stopping adrenaline and noradrenaline from affecting your body’s beta receptors, propranolol can block the physical effects of anxiety. 

This means you won’t notice a faster heartbeat, sweaty hands or shaking when you’re in an environment that triggers feelings of fear or anxiety.

Instead, your heartbeat will slow down slightly and you’ll feel more relaxed, making it easier for you to function normally if you’re prone to anxiety.

Propranolol is not the same as anti-anxiety drugs like Xanax® or Valium®. Instead of targeting the brain, it works by affecting the way you physically respond to anxiety-producing hormones.

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Propranolol Uses

Propranolol is one of the oldest beta blocker medications. It was first discovered in the 1960s and was originally designed to treat heart conditions such as chest pain and to increase survival after a heart attack.

Today, propranolol is still widely used as a treatment for these and other cardiovascular conditions (such as managing high blood pressure/hypertension and heart rhythm problems such as arrhythmias. 

It’s also used to treat anxiety, migraines, tremors, effects of thyroid conditions such as hyperthyroidism, aggressive behavior after brain injuries, post-traumatic stress disorder and can also be used on a short-term basis to treat the effects of phobias. 

Additionally, propranolol is the only drug approved by the Food and Drug Administration to treat essential tremor (ET). 

Propranolol is one of the most widely used and effective medications available for performance anxiety. 

It’s used by musicians and other people who need to perform in front of others, many of whom are naturally affected by anxiety.  

In addition to heart disease and performance anxiety, propranolol is a common treatment for migraine headaches that don’t respond to conventional pain management drugs.

Propranolol Dosage

Propranolol dosing depends on the medical condition being treated, as well as the age of the patient. 

Here are the variations in propranolol dosage in adults and children aged 12 or older: 

Hypertension. Typical dosing will range from 80 mg two times per day to a typical maximum of 160 mg two times per day, depending on its effectiveness. Your healthcare professional will work with you to find the best dosage for you. 

Anxiety. Starting dose for using propranolol to treat anxiety is 40 mg at a rate of once per day. Depending on the severity of anxiety and the effectiveness of the dose, your healthcare professional may increase the dose to 40 mg three times a day. For performance anxiety, propranolol is typically prescribed at 40mg, taken as needed. 

Angina and Migraines. The starting dose of propranolol to treat angina and migraine is 40 mg two to three times per day. This can be adjusted up to a maximum of 120 to 240 mg in one day. 

Thyrotoxicosis. If your thyroid is overactive, your propranolol dose would typically be 10 to 40 mg one to three times a day to assist your body in adjusting to your thyroid medication. 

Arrhythmia (Irregular Heartbeat). Dosing for an arrhythmia is the same as thyrotoxicosis -- 10 to 40 mg -- except it is taken three to four times per day.  

Pediatric Dosing. Children under the age of 12 who need propranolol should have their dosage determined by their healthcare professional based on their weight. 

How to Take Propranolol

Propranolol is a prescription drug, meaning you’ll need to talk to your healthcare provider before you can buy and use it. It’s available in four different forms:

  • As a tablet. Propranolol is widely sold as an oral tablet. It’s a generic drug, meaning it’s usually sold simply as “propranolol” without a brand name, and is the generic for the brand name drug, Inderal. The propranolol oral tablet is the most common form of this medication and can last for up to 12 hours at a time. 

  • As an extended-release capsule. The extended-release version of propranolol lasts for longer than the oral tablet.

  • As an oral liquid solution. The oral solution version of propranolol has the same effects as the oral capsule.

  • As an injection. This version of propranolol is designed for IV injection and is typically only used in a medical setting.

If you have an anxiety disorder, you’ll usually be prescribed propranolol as an oral tablet. 

This form of propranolol is easy and convenient to use, with a variety of strengths available to suit your needs.

If you miss a dose of propranolol, be sure to talk with your healthcare professional and take your missed dose as soon as you remember. 

However, if it's close to the time of your next dose, skip your missed dose and continue with your next. 

If using propranolol for performance or social anxiety, you can continue to take your dose only as needed, as long as this is approved by your healthcare professional.  

Propranolol Side Effects

Propranolol is a safe, effective medication that has been used for decades to treat heart issues, anxiety and other conditions. 

Side effects are typically mild and uncommon but can still affect you, especially after you first begin using the medication. Common side effects of propranolol include:

  • Slower-than-normal heart rate. Because propranolol blocks the effects of adrenaline on your heart, it can give you a slow heart rate. It’s completely normal to experience a lower heart rate after you take propranolol. However, if your resting daytime heart rate drops below 50 beats per minute while using propranolol, you should contact your healthcare provider as soon as possible.

  • Sleep problems. There are reports of insomnia, awakenings at night and other sleep problems while taking propranolol for hypertension. Several beta blockers are also linked to vivid and unusual dreams.

  • Fatigue. Propranolol can make you feel more tired than normal due to its effects on the way your body responds to stress hormones. This is most common after you first start to use the medication and usually stops occurring after several days or weeks.

  • Diarrhea. Some people who use propranolol might experience diarrhea shortly after taking the medication. Propranolol can also cause nausea, especially in the first few weeks of treatment.

  • Hair loss. Propranolol is one of several beta blockers that can cause hair loss. The hair loss from propranolol is not permanent and is typically a result of the medication causing some hair follicles to enter their shedding phase prematurely.

  • Dry eye syndrome. Propranolol and other beta blockers can cause you to develop dry eyes, potentially resulting in eye irritation.

Propranolol is generally safe and side effects are usually mild and can be managed. If you experience any of the above side effects from propranolol, it’s best to contact your healthcare provider. 

Many of these effects can be reduced or avoided by adjusting your propranolol dose or switching beta blockers.

Propranolol also has the potential for several serious potential side effects. These are rare and only affect a tiny percentage of users. 

However, if you experience any of the side effects listed below, or experience an allergic reaction to propranolol, you should seek help from your healthcare provider as soon as possible:

  • Noticeably cold hands and/or feet

  • Chest pains (angina)

  • Congestion or sinus issues

  • Low blood sugar

  • Persistent insomnia or nightmares

  • Hallucinations

  • Difficulty breathing

  • Resting heart rate below 50 beats per minute (bradycardia)

  • Rapid weight gain and/or fluid retention in the legs and ankles

  • Severe nausea, diarrhea or vomiting

Failure to seek immediate medical attention for serious side effects could result in heart failure, kidney disease or failure, or death. 

Signs of an allergic reaction to propranolol include rash, wheezing, chest or throat tightness, trouble breathing or talking, and facial, lip, mouth or throat swelling. 

For more on propranolol’s complete list of common side effects and more serious adverse effects, head on over to our Complete Guide to Propranolol Side Effects.

Propranolol Interactions

Propranolol interactions occur with a variety of other medications. Some of these interactions are listed below.

Major propranolol interactions can occur with antiarrhythmic drugs (which are used to treat heart rhythm problems) and hypertension drugs, such as calcium channel blockers, alpha blockers and angiotensin-converting enzyme (ACE) inhibitors.

Propranolol can also interact with other beta blockers, meaning you should never take it with drugs such as acebutolol, atenolol, bisoprolol, carteolol, esmolol, metoprolol, nadolol, nebivolol or sotalol. Used with propranolol, these drugs can cause a dangerous drop in your heart rate.

Propranolol should not be used with lisinopril or enalapril (both ACE inhibitors), with diltiazem (a calcium channel blocker), or with prazosin, terazosin or doxazosin (all alpha blockers). Propranolol interactions may also occur with certain asthma medications, such as theophylline or any nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Due to its effects on heart rate and blood pressure, propranolol is not recommended for use with any stimulants, such as epinephrine, isoproterenol or dobutamine. 

Propranolol can also interact with some blood thinners, such as warfarin, causing an increase in warfarin concentration, and with antidepressants such as sertraline.

Your healthcare provider might also recommend avoiding common stimulants such as caffeine, as these can affect the effectiveness of propranolol. 

Propranolol can also affect your body’s ability to process high-potassium foods.

Since propranolol is a prescription drug, you’ll need to talk to your healthcare provider before you’re able to use it. 

Make sure you inform your healthcare provider of all medications you use on a regular basis to avoid any potential drug interactions.

Propranolol Warnings

You should not stop taking propranolol without first discussing it with your healthcare provider. 

Abruptly stopping propranolol could cause your health conditions to worsen. If your healthcare provider decides to wean you off of propranolol gradually, it is important to avoid strenuous exercise to reduce stress on your heart. 

Seek immediate medical attention if you experience serious withdrawal effects such as chest pain that worsens or spreads to the neck, jaw or arm, difficulty breathing or tightness in your chest or irregular heartbeat. 

Before taking propranolol, be sure to discuss any other existing medical conditions with your healthcare provider. Patients with diabetes may be at risk for low blood sugar due to propranolol. 

Additionally, patients with asthma may experience worsened breathing problems. Propranolol may also cause drowsiness, so it is important to not drive or operate heavy machinery until you know how this drug affects you. 

FAQs About Propranolol

How Long Does Propranolol Last?

Propranolol has a half-life of about three to six hours, so its effects will be most noticeable for about three to four hours after taking the drug.  

How Long Does it Take For Propranolol to Work?

It will take about 30 to 60 minutes for you to notice the effects of propranolol. Those using propranolol for anxiety should plan to take their dose an hour or so before they wish to feel the desired effect. 

Does Propranolol Cause Weight Gain?

As your body adjusts to taking a new beta-blocker, you may notice some weight gain. 

This is because during the first few months, a beta-blocker will slightly alter your body’s ability to metabolize fat. After that, the typical user will see a plateau in weight gain. 

Can You Overdose on Propranolol?

Yes. If you take too much propranolol, your heart rate can slow so much that it will be difficult to breathe. 

Always take propranolol exactly as prescribed and if an overdose is suspected, seek emergency medical care. 

How Long Does Propranolol Stay in Your System?

Propranolol can stay in your system for about 1-2 days. However, the effects of the drug, if taken regularly, can last for up to a week. 

Does Propranolol Cause Hair Loss?

Yes, propranolol may  cause hair loss. However, this hair loss is only temporary and is typically due to hair follicles shedding too early. 

Is it Safe to Take Propranolol With Alcohol?

Propranolol should not be used with alcohol. One study found that consuming alcohol while you’re under the effects of propranolol can increase the chance of low blood pressure, causing you to feel lightheaded and sleepy.

Is it Safe to Exercise After Taking Propranolol?

Like other beta blockers, propranolol can reduce your heart rate. This means that you may have a lower-than-normal heart rate while exercising and this can make it harder to exert yourself. 

Most of the time, it’s okay to exercise at a mild to moderate intensity level while on propranolol.

However, if you engage in strenuous exercise, or frequently work out until you’re exhausted, you should talk to your healthcare provider before using propranolol or any other beta blockers.

Additionally, if you have a chronic lung disease, such as emphysema or COPD, it is important to talk with your healthcare provider before taking propranolol in order to be properly monitored during your use. 

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Learn More About Beta Blockers

Propranolol is one of several beta blocker medications used to treat heart conditions, anxiety, migraines and other conditions. 

Our guide to beta blockers goes into more detail on how beta blockers like propranolol work.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

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