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Medication Overview Propranolol

This medication overview reviews the risks and benefits of propranolol for treating performance-only social anxiety in individuals 18 years of age and older, including how the medication works, and how to effectively and safely use this medication. You will also receive a physical document called a medication guide or pharmacy information brochure in the package with your medication when it arrives from the pharmacy which contains full information about propranolol you should read all of the information that comes with your prescription shipment before taking your medication.

In this medication overview
  • 1

    Usage

    How to get the most out of your treatment

  • 2

    Side Effects

    What to look out for when using your treatment

Usage
How does propranolol works?

Propranolol is a beta adrenergic blocker that is FDA approved for the treatment of high blood pressure (hypertension), angina pectoris, and migraine headache. Propranolol is prescribed off-label for the treatment of performance-only social anxiety disorder.

How should I take propranolol?

  • To get started, review the directions on your prescription label and follow your provider's dosing instructions.

  • Propranolol comes in a tablet form. The amount you should take depends on your medical history. Never take more than what your healthcare provider prescribes.

  • You’ll likely notice results the first time you take beta-blockers for performance anxiety, but they can take an hour or two to reach their full effect. During this time, you’ll feel your heart rate decrease, which might make you feel more relaxed.

  • Propranolol is taken approximately 45-60 minutes prior to the stress inducing event. Do not take more than 2 doses in a 24 hour period. Do not take propranolol your pulse rate is below 60 beats per minute.

  • Since propranolol is used as needed rather than everyday, no taper is necessary if you decide to stop taking it.

What other information do I need to know about taking propranolol?

  • Do not drive or use machinery until you are sure you can perform activities safely.

  • People taking propranolol may be less responsive to epinephrine used to treat a severe anaphylactic reaction.

  • If you take too much propranolol seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

IMPORTANT SAFETY INFORMATION
Do not use propranolol if you have a history of:

  • Sudden and severe drop in blood pressure and blood flow through the body because the heart is not pumping normally

  • Any allergies to the active ingredient propranolol, or to any of the inactive ingredients.

  • Anaphylactic reaction/Anaphylaxis

  • Bradycardia (slow heartbeat), Heart block/heart rhythm disorder, Sick sinus syndrome (type of abnormal heart rhythm), Tachycardia (fast heartbeat)

  • Angina (severe chest pain)

  • Asthma, COPD, or bronchospasm

  • Recent heart attack

  • Glaucoma

  • Muscle problems (eg, myopathy, myotonia or myasthenia gravis)

  • Wolff-Parkinson-White syndrome (rare heart condition)

  • Heart failure

  • Tremors due to Parkinson's disease

  • Hypotension (low blood pressure)

  • Pheochromocytoma (an adrenal problem)

  • Diabetes

  • Hypoglycemia (low blood sugar)

  • Hyperthyroidism (overactive thyroid)

  • Kidney disease

  • Liver disease

  • Lung disease (eg, chronic bronchitis, emphysema, COPD)

  • Blood circulation problems (e.g., Raynaud's disease)

What should I tell my healthcare provider before taking propranolol?

Before starting propranolol, tell your healthcare provider about all of your medical conditions, including if you:

  • Have heart failure

  • Are scheduled for surgery and will be given anesthetic agents

  • Have diabetes and take medicine to control blood sugar

  • Have thyroid problems

  • Have irregular heartbeats

  • Have liver or kidney problems

  • Have had allergic reactions to medications or have allergies

  • Have asthma or other lung problems (such as bronchitis or emphysema)

  • Are pregnant or trying to become pregnant. It is not known if propranolol is safe for your unborn baby

  • Are breastfeeding or plan to breastfeed. Propranolol passes into your breastmilk

Tell your healthcare provider about all of the prescription or over-the-counter medications, vitamins, or herbal supplements you are taking including:

  • Warfarin

  • Propafenone

  • Dronedarone (Multaq)

  • Other beta blockers and alpha blockers such as: clonidine (Catapres, Kapvay, Nexiclon), carvedilol (Coreg), labetalol, prazosin (Minipress, Vasoflex, Lentopres and Hypovase)

  • The heart failure drug dobutamine

  • Antidepressants

  • Non-steroidal anti-inflammatory drugs (NSAIDS) for pain relief, fever reduction, and reducing inflammation including over-the-counter ibuprofen (e.g. Advil, Motrin)

  • Migraine drugs such as zolmitriptan (Zomig) or rizatriptan (Maxalt)

  • Bromperidol

  • Fexinidazole

  • Fezolinetant (Veozah)

  • Isocarboxazid (Marplan)

  • Mavorixafor (Xolremdi)

  • Rivastigmine (Exelon)

  • Thioridazine

  • Amifostine (Ethyol)

  • Ceritinib (Zykadia)

  • Fluvoxamine (Luvox)

  • Fingolimod (Gilenya)

  • Grass pollen extract (Oralair)

  • Obinutuzumab (Gazyva)

  • Ponesimod (Ponvory)

  • Siponimod (Mayzent)

  • Tizanidine (Zanaflex)

This list is not complete and not all possible interactions are listed. Other drugs may interact with propranolol, including prescription and over-the-counter medicines, vitamins, and herbal products. If you are not sure about taking propranolol with another medication be sure to discuss this with your healthcare provider.

Side effects
What are the possible side effects of propranolol?

The most common side effects people taking propranolol report are:

  • Slow heart rate (may affect 10-20% of those who take this medication)

  • Fatigue (10-15%)

  • Dizziness (5-10%)

  • Low blood pressure (5-10%)

  • Nausea (1-5%)

  • Diarrhea (1-5%)

  • Constripation (1-5%)

  • Depression (1-5%)

  • Weakness (1-5%)

  • Decreased interest in sex (1-5%)

Consult your doctor at once if you have any of these less common, but serious, side effects:

  • A light-headed feeling, like you might pass out

  • Wheezing or trouble breathing

  • Shortness of breath (even with mild exertion), swelling, rapid weight gain

  • Sudden weakness, vision problems, or loss of coordination Depression, confusion, hallucinations

  • Liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes)

  • Low blood sugar--headache, hunger, weakness, sweating, confusion, irritability, dizziness, fast heart rate, or feeling jittery

  • Severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling

This is not a complete list of side effects and others may occur. Please review the pharmacy information brochure that is supplied with the medication for more detailed information. Contact your healthcare provider for medical advice about side effects.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Medication disposal

If you no longer need your medication, the best way to dispose of most types of old, unused, unwanted, or expired medicines (both prescription and over the counter) is to drop off the medicine at a drug take back site, location, or program immediately. You can use the DEA DIVERSION CONTROL DIVISION LOOKUP to find your nearest drug disposal site.

If no drug take back sites, locations, or programs are available in your area, and there are no specific disposal instructions (such as flushing) in the medication guide or package insert, you can visit FDA- Disposal of Unused Medicines for more information or follow these simple steps to dispose of most medicines in your trash at home:

  • Mix medicines (liquid or pills; do not crush tablets or capsules) with an unappealing substance such as dirt, cat litter, or used coffee grounds;

  • Place the mixture in a container such as a sealed plastic bag;

  • Throw away the container in your trash at home; and

  • Delete all personal information on the prescription label of empty medicine bottles or medicine packaging, then trash or recycle the empty bottle or packaging.

The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The product information provided is intended only for residents of the United States. The products discussed herein may have different product labeling in different countries.