propranolol (Rx)

Brand and Other Names:Inderal, Inderal LA, more...InnoPran XL, Hemangeol
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

oral solution

  • 20mg/5mL
  • 40mg/5mL

injectable solution

  • 1mg/mL

tablet

  • 10mg
  • 20mg
  • 40mg
  • 60mg
  • 80mg

capsule, extended-release

  • 60mg
  • 80mg
  • 120mg
  • 160mg

Hypertension

Immediate release

  • 40 mg PO q12hr initially, increasing every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day

Inderal LA

  • 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day

InnoPran XL

  • 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO

Migraine

Prophylaxis

80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr

Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day

Withdraw therapy if satisfactory response not seen after 6 weeks

Angina

80-320 mg/day PO divided q6-12hr

Inderal LA: 80 mg/day PO; not to exceed 320 mg/day

Pheochromocytoma

30-60 mg/day PO in divided doses

Hypertrophic Subaortic Stenosis

20-40 mg PO q6-8hr

Supraventricular Arrhythmia

PO: 10-30 mg q6-8hr

IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg

Once response or maximum dose achieved, do not give additional dose for at least 4 hours

Portal Hypertension

Prevention of variceal bleeding

10-60 mg PO q6-8hr; 10 mg PO q8hr initially; titrate dose to reduce resting heart rate by 25%

Essential Tremor

40 mg PO q12hr initially; maintenance: 120-320 mg/day PO divided q8-12hr

Antipsychotic-Induced Akathisia

30-120 mg PO q8-12hr

Malignant Glioma (Orphan)

Orphan designation for treatment of malignant glioma (plus etodolac)

Sponsor

  • Vicus Therapeutics, LLC; 55 Madison Avenue, Suite 400; Morristown, NJ 07960

Esophageal Variceal Bleeding (Off-label)

20-180 mg PO q12hr; adjust to maximum tolerated dose

Panic Disorder (Off-label)

40-320 mg/day PO

Aggressive Behavior (Off-label)

80-300 mg/day PO

Dosage Forms & Strengths

oral solution

  • 4.28mg/mL (Hemangeol)
  • 20mg/5mL
  • 40mg/5mL

injectable solution

  • 1mg/mL

tablet

  • 10mg
  • 20mg
  • 40mg
  • 60mg
  • 80mg

capsule, extended-release

  • 60mg
  • 80mg
  • 120mg
  • 160mg

Infantile Hemangiomas

Hemangeol: Indicated for treatment of proliferating hemangioma requiring systemic therapy

Initiate treatment at aged 5 weeks to 5 months

Starting dose: 0.6 mg/kg (0.15 mL/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 mL/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 mL/kg) BID  

Administration (infantile hemangiomas)

  • Use supplied oral dosing syringe for administration and give directly into the child’s mouth; if necessary, the product may be diluted in a small quantity of milk or fruit juice and given in a baby’s bottle
  • Administer doses at least 9 hr apart during or after feedings
  • To reduce the risk of hypoglycemia, administer during or right after a feeding; skip the dose if the child is not eating or is vomiting
  • Readjust dose periodically as the child's weight increases
  • Monitor HR and BP for 2 hr after initial dose and after increasing dose
  • If hemangiomas recur, treatment may be reinitiated

Hypertension (Off-label)

0.5-1 mg/kg/day PO divided q6-12hr initially; increase gradually every 5-7 days; usual range: 2-4 mg/kg/day PO divided q12hr  

Arrhythmias (Off-label)

PO: 0.5-1 mg/kg/day divided q6-8hr; may be increased every 3-7 days; usual range: 2-6 mg/kg/day; not to exceed 16 mg/kg/day or 60 mg/day  

IV: 0.01-0.1 mg/kg over 10 minutes; repeat q6-8hr PRN; not to exceed 1 mg for infants or 3 mg for children

Hypercyanotic Spells (Off-label)

PO: 1 mg/kg/day divided q6hr; after 1 week, may be increased by 1 mg/kg/day to maximum of 10-15 mg/kg/day if patient refractory; allow 24 hours between dosing changes  

IV: 0.01-0.2 mg/kg over 10 minutes; not to exceed 5 mg

Thyrotoxicosis (Off-label)

10-40 mg PO q6hr; adjust dose to effect  

Retinopathy of Prematurity (Orphan)

Orphan designation for treatment of retinopathy of prematurity

Orphan sponsor

  • Recordati Rare Diseases, SARL; Immeuble le "Wilson"; 70 Avenue du General de Gaulle; Puteaux, France

Hypertension

Immediate-release: 40 mg PO q12hr initially, increased every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day

Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day

InnoPran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO

Consider lower initial dose

Supraventricular Arrhythmia

PO: 10 mg q6-8hr; may be increased every 3-7 days

IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg

Once response or maximum dose achieved, do not give additional dose for at least 4 hours

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Interactions

Interaction Checker

and propranolol

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              Serious - Use Alternative (44)

              • abametapir

                abametapir will increase the level or effect of propranolol by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP1A2 substrates. If not feasible, avoid use of abametapir.

              • acebutolol

                acebutolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • afatinib

                propranolol increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

              • artemether/lumefantrine

                artemether/lumefantrine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • atenolol

                atenolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • betaxolol

                betaxolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • bisoprolol

                bisoprolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • bosutinib

                propranolol increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • carvedilol

                carvedilol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • celiprolol

                celiprolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • chlorpromazine

                propranolol, chlorpromazine. Either increases levels of the other by decreasing metabolism. Contraindicated. Not all beta blockers share this interaction (e.g., atenolol, nadolol, sotalol do not interact).

              • clonidine

                clonidine, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • dacomitinib

                dacomitinib will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

              • digoxin

                digoxin, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • diltiazem

                diltiazem, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • edoxaban

                propranolol will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

              • epinephrine

                propranolol increases effects of epinephrine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

              • epinephrine racemic

                propranolol increases effects of epinephrine racemic by pharmacodynamic synergism. Avoid or Use Alternate Drug. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

              • esmolol

                esmolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • fexinidazole

                fexinidazole, propranolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .

              • fluoxetine

                fluoxetine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • givosiran

                givosiran will increase the level or effect of propranolol by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP1A2 substrates with givosiran. If unavoidable, decrease the CYP1A2 substrate dosage in accordance with approved product labeling.

                givosiran will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

              • iobenguane I 131

                propranolol will decrease the level or effect of iobenguane I 131 by Other (see comment). Avoid or Use Alternate Drug. Based on the mechanism of action of iobenguane, drugs that reduce catecholamine uptake or that deplete catecholamine stores may interfere with iobenguane uptake into cells, and thus, reduce iobenguane efficacy. Discontinue interfering drugs for at least 5 half-lives before administration of either the dosimetry or an iobenguane dose. Do not administer these drugs until at least 7 days after each iobenguane dose.

              • labetalol

                labetalol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • lofexidine

                lofexidine, propranolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

              • lumefantrine

                lumefantrine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • metoprolol

                metoprolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • nadolol

                nadolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • nebivolol

                nebivolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • paroxetine

                paroxetine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

              • penbutolol

                penbutolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • pindolol

                pindolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • pomalidomide

                propranolol increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

              • quinidine

                quinidine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Monitor patients for hypotension, bradycardia, arrhythmias and heart failure.

              • riociguat

                propranolol will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

              • rivastigmine

                propranolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

              • sotalol

                propranolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • thioridazine

                thioridazine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Due to the potential for significant, possibly life-threatening, proarrhythmic effects, concurrent administration of thioridazine and propranolol is contraindicated.

                propranolol, thioridazine. Either increases levels of the other by decreasing metabolism. Contraindicated. Not all beta blockers share this interaction (e.g., atenolol, nadolol, sotalol do not interact).

              • thiothixene

                propranolol, thiothixene. Either increases levels of the other by decreasing metabolism. Contraindicated. Not all beta blockers share this interaction (e.g., atenolol, nadolol, sotalol do not interact).

              • timolol

                propranolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

              • umeclidinium bromide/vilanterol inhaled

                propranolol, umeclidinium bromide/vilanterol inhaled. pharmacodynamic synergism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

              • venetoclax

                propranolol will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

              • verapamil

                verapamil, propranolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

              • vilanterol/fluticasone furoate inhaled

                propranolol, vilanterol/fluticasone furoate inhaled. pharmacodynamic synergism. Avoid or Use Alternate Drug. If a beta-blocker must be used in patients with COPD taking a beta-agonist, consider using a beta-blocker that is beta-1 selective .

              Monitor Closely (249)

              • abiraterone

                abiraterone increases levels of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

              • acebutolol

                acebutolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • aceclofenac

                propranolol and aceclofenac both increase serum potassium. Use Caution/Monitor.

                aceclofenac decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • acemetacin

                propranolol and acemetacin both increase serum potassium. Use Caution/Monitor.

                acemetacin decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • albuterol

                propranolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • aldesleukin

                aldesleukin increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • alfuzosin

                alfuzosin and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of Alfuzosin may be enhanced.

              • aluminum hydroxide

                aluminum hydroxide decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • amifostine

                amifostine, propranolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

              • amiloride

                propranolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • amiodarone

                amiodarone will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Concomitant use may result in additive cardiac effects. Monitor cardiac function carefully and observe for signs of bradycardia or heart block when amiodarone and a beta adrenergic blocker are coadministered. Amiodarone should be used with caution in patients receiving a beta adrenergic blocker, particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.

                amiodarone, propranolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

              • amlodipine

                propranolol and amlodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • amobarbital

                amobarbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • antipyrine

                propranolol increases levels of antipyrine by decreasing metabolism. Use Caution/Monitor.

              • arformoterol

                propranolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • articaine

                propranolol, articaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

              • asenapine

                asenapine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                asenapine and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • aspirin

                propranolol and aspirin both increase serum potassium. Use Caution/Monitor.

                aspirin decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aspirin rectal

                propranolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

                aspirin rectal decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • aspirin/citric acid/sodium bicarbonate

                aspirin/citric acid/sodium bicarbonate decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                propranolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.

              • atenolol

                atenolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • avanafil

                avanafil increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • bendroflumethiazide

                propranolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • betaxolol

                betaxolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • betrixaban

                propranolol increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

              • bismuth subsalicylate

                bismuth subsalicylate, propranolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

              • bisoprolol

                bisoprolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • bretylium

                propranolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

              • bumetanide

                propranolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • bupivacaine

                propranolol, bupivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

              • bupropion

                bupropion will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • butabarbital

                butabarbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • butalbital

                butalbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • calcium acetate

                calcium acetate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium carbonate

                calcium carbonate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

                calcium carbonate decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • calcium chloride

                calcium chloride decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium citrate

                calcium citrate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

              • calcium gluconate

                calcium gluconate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

              • candesartan

                candesartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • cannabidiol

                cannabidiol, propranolol. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Owing to the potential for both CYP1A2 induction and inhibition with the coadministration of CYP1A2 substrates and cannabidiol, consider reducing dosage adjustment of CYP1A2 substrates as clinically appropriate.

              • carbenoxolone

                propranolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • carbidopa

                carbidopa increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

              • carvedilol

                carvedilol and propranolol both increase serum potassium. Use Caution/Monitor.

              • celecoxib

                celecoxib will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                propranolol and celecoxib both increase serum potassium. Use Caution/Monitor.

                celecoxib decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • celiprolol

                celiprolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • ceritinib

                propranolol increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • chloroprocaine

                propranolol, chloroprocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

              • chloroquine

                chloroquine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • chlorothiazide

                propranolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • chlorpropamide

                propranolol decreases effects of chlorpropamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • chlorthalidone

                propranolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • choline magnesium trisalicylate

                propranolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

                choline magnesium trisalicylate decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • cimetidine

                cimetidine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • citalopram

                citalopram increases levels of propranolol by decreasing metabolism. Use Caution/Monitor.

              • clevidipine

                propranolol and clevidipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • clonidine

                propranolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Non selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

              • cyclopenthiazide

                propranolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • dabigatran

                propranolol will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

              • darifenacin

                darifenacin will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • dasiglucagon

                propranolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

              • deferasirox

                deferasirox increases levels of propranolol by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • desflurane

                desflurane, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • desvenlafaxine

                desvenlafaxine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

              • diclofenac

                propranolol and diclofenac both increase serum potassium. Use Caution/Monitor.

                diclofenac decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • diflunisal

                propranolol and diflunisal both increase serum potassium. Use Caution/Monitor.

                diflunisal decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • digoxin

                propranolol and digoxin both increase serum potassium. Use Caution/Monitor.

                propranolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.

              • diltiazem

                propranolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • diphenhydramine

                diphenhydramine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • dobutamine

                propranolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

              • dopexamine

                propranolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.

              • doxazosin

                doxazosin and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of doxozosin may be enhanced.

              • dronedarone

                dronedarone will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • drospirenone

                propranolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

              • duloxetine

                duloxetine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • eliglustat

                eliglustat increases levels of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

              • elvitegravir/cobicistat/emtricitabine/tenofovir DF

                elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

              • ephedrine

                propranolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • epinephrine

                propranolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • epinephrine inhaled

                propranolol decreases effects of epinephrine inhaled by pharmacodynamic antagonism. Use Caution/Monitor. Beta2-adrenergic blockers may may inhibit bronchodilatory effects of epinephrine.

              • epinephrine racemic

                propranolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.

              • eprosartan

                eprosartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • esmolol

                esmolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • ethacrynic acid

                propranolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ethanol

                ethanol, propranolol. Other (see comment). Use Caution/Monitor. Comment: Propranolol plasma levels may increase with acute alcohol consumption, but decrease with chronic alcohol consumption.

              • ether

                propranolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

              • etodolac

                propranolol and etodolac both increase serum potassium. Use Caution/Monitor.

                etodolac decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • etomidate

                etomidate, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • fedratinib

                fedratinib will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

              • felodipine

                propranolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • fenbufen

                propranolol and fenbufen both increase serum potassium. Use Caution/Monitor.

              • fenoprofen

                propranolol and fenoprofen both increase serum potassium. Use Caution/Monitor.

                fenoprofen decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • fexinidazole

                fexinidazole will increase the level or effect of propranolol by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • fingolimod

                propranolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.

              • flecainide

                flecainide, propranolol. Either increases levels of the other by decreasing metabolism. Use Caution/Monitor. Increased serum levels of both agents; additive negative inotropic effects.

              • flurbiprofen

                propranolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.

                flurbiprofen decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • formoterol

                propranolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • furosemide

                propranolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • gentamicin

                propranolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • glecaprevir/pibrentasvir

                propranolol will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • glimepiride

                propranolol decreases effects of glimepiride by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • glipizide

                propranolol decreases effects of glipizide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • glucagon

                glucagon decreases toxicity of propranolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

              • glucagon intranasal

                glucagon intranasal decreases toxicity of propranolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

              • glyburide

                propranolol decreases effects of glyburide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • guanfacine

                propranolol, guanfacine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Non selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

              • guggul

                guggul decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              • haloperidol

                haloperidol will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised. Coadministration of beta-blockers and haloperidol may cause an unexpected severe hypotensive reaction.

              • hawthorn

                hawthorn increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor.

              • hydralazine

                hydralazine increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

              • hydrochlorothiazide

                propranolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • ibuprofen

                propranolol and ibuprofen both increase serum potassium. Use Caution/Monitor.

                ibuprofen decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ibuprofen IV

                ibuprofen IV decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                propranolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.

              • imatinib

                imatinib will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • indacaterol, inhaled

                indacaterol, inhaled, propranolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

              • indapamide

                propranolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • indomethacin

                propranolol and indomethacin both increase serum potassium. Use Caution/Monitor.

                indomethacin decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • insulin aspart

                propranolol, insulin aspart. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • insulin degludec

                propranolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin degludec/insulin aspart

                propranolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin detemir

                propranolol, insulin detemir. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • insulin glargine

                propranolol, insulin glargine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • insulin glulisine

                propranolol, insulin glulisine. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • insulin inhaled

                propranolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

              • insulin lispro

                propranolol, insulin lispro. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • insulin NPH

                propranolol, insulin NPH. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • insulin regular human

                propranolol, insulin regular human. Mechanism: pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers delay recovery of normoglycemia after insulin induced hypoglycemia; however, they also inhibit insulin secretion, so long term beta blocker Tx may result in reduced glucose tolerance. Insulin induced hypoglycemia may induce hypertension during non selective beta blocker Tx.

              • irbesartan

                irbesartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • isoproterenol

                propranolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

              • isradipine

                propranolol and isradipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • ivabradine

                ivabradine, propranolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

              • ketamine

                ketamine, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • ketoprofen

                propranolol and ketoprofen both increase serum potassium. Use Caution/Monitor.

                ketoprofen decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ketorolac

                propranolol and ketorolac both increase serum potassium. Use Caution/Monitor.

                ketorolac decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ketorolac intranasal

                propranolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.

                ketorolac intranasal decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • labetalol

                labetalol and propranolol both increase serum potassium. Use Caution/Monitor.

              • lasmiditan

                propranolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

              • letermovir

                letermovir increases effects of propranolol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              • levalbuterol

                propranolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • levodopa

                levodopa increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

              • lidocaine

                propranolol, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Increased effects of epinephrine in anesthetic; risk of hypertension and bradycardia. Do NOT D/C chronic beta blocker Tx prior to anesthetic administration. Consider selective beta 1 blocker (e.g., metoprolol).

                propranolol increases levels of lidocaine by decreasing elimination. Use Caution/Monitor. Risk of hypertension and bradycardia. Consider selective beta 1 blocker (e.g., metoprolol).

              • lorcaserin

                lorcaserin will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • lornoxicam

                propranolol and lornoxicam both increase serum potassium. Use Caution/Monitor.

                lornoxicam decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • losartan

                losartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • lurasidone

                lurasidone increases effects of propranolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

              • maraviroc

                maraviroc will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • marijuana

                marijuana will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • meclofenamate

                meclofenamate decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

                propranolol and meclofenamate both increase serum potassium. Use Caution/Monitor.

              • mefenamic acid

                propranolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.

                mefenamic acid decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • mefloquine

                mefloquine increases levels of propranolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

              • meloxicam

                propranolol and meloxicam both increase serum potassium. Use Caution/Monitor.

                meloxicam decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • mepivacaine

                propranolol, mepivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

              • metaproterenol

                propranolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

              • methyclothiazide

                propranolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

              • methyldopa

                propranolol, methyldopa. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Non selective beta blocker administration during withdrawal from methyldopa may result in rebound hypertension.

              • methylphenidate

                methylphenidate will decrease the level or effect of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

              • metolazone

                propranolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • metoprolol

                metoprolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • mirabegron

                mirabegron will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • moxisylyte

                moxisylyte and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • nabumetone

                propranolol and nabumetone both increase serum potassium. Use Caution/Monitor.

                nabumetone decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nadolol

                nadolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • naldemedine

                propranolol increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

              • naproxen

                propranolol and naproxen both increase serum potassium. Use Caution/Monitor.

                naproxen decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • nebivolol

                nebivolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • nicardipine

                propranolol and nicardipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

                nicardipine increases levels of propranolol by decreasing elimination. Use Caution/Monitor.

              • nifedipine

                propranolol and nifedipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

                nifedipine increases levels of propranolol by decreasing elimination. Use Caution/Monitor.

              • nilotinib

                nilotinib will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • nintedanib

                propranolol increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .

              • nisoldipine

                propranolol and nisoldipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

                nisoldipine increases levels of propranolol by decreasing elimination. Use Caution/Monitor.

              • nitroglycerin rectal

                nitroglycerin rectal, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

              • norepinephrine

                propranolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

              • olmesartan

                olmesartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • olodaterol inhaled

                propranolol, olodaterol inhaled. Either decreases effects of the other by pharmacodynamic antagonism. Use Caution/Monitor. Beta-blockers and olodaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

              • oxaprozin

                propranolol and oxaprozin both increase serum potassium. Use Caution/Monitor.

                oxaprozin decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • oxymetazoline intranasal

                propranolol increases effects of oxymetazoline intranasal by pharmacodynamic synergism. Use Caution/Monitor. When beta-2 receptors are antagonized by nonselective beta blockers, alpha1 vasoconstriction may be unopposed, thus increasing hypertensive effect. When oxymetazoline is combined with intranasal tetracaine for dental anesthesia, avoid or use an alternant anesthetic in patients taking nonselective beta blockers.

              • oxymetazoline topical

                oxymetazoline topical increases and propranolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • parecoxib

                parecoxib will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

                propranolol and parecoxib both increase serum potassium. Use Caution/Monitor.

                parecoxib decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • peginterferon alfa 2b

                peginterferon alfa 2b, propranolol. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.

              • penbutolol

                penbutolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • pentobarbital

                pentobarbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • perphenazine

                perphenazine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • phenobarbital

                phenobarbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • phenoxybenzamine

                phenoxybenzamine and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • phentolamine

                phentolamine and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • phenylephrine

                propranolol increases effects of phenylephrine by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode (rare).

              • phenylephrine PO

                propranolol increases effects of phenylephrine PO by pharmacodynamic synergism. Use Caution/Monitor. Risk of acute hypertensive episode (rare).

              • pindolol

                pindolol and propranolol both increase serum potassium. Use Caution/Monitor.

              • pirbuterol

                propranolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • piroxicam

                propranolol and piroxicam both increase serum potassium. Use Caution/Monitor.

                piroxicam decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • ponesimod

                ponesimod and propranolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

              • potassium acid phosphate

                propranolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium chloride

                propranolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.

              • potassium citrate

                propranolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.

              • prazosin

                prazosin and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. The severity and duration of hypotension following the first dose of prazosin may be enhanced.

              • prilocaine

                propranolol, prilocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

              • primidone

                primidone decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • propafenone

                propafenone will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. If concurrent therapy is required, monitor cardiac function carefully, particularly blood pressure. A dosage adjustment for the beta blocker may be required.

              • propofol

                propofol, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • quinacrine

                quinacrine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • ranolazine

                ranolazine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • rifabutin

                rifabutin decreases levels of propranolol by increasing metabolism. Use Caution/Monitor.

              • rifampin

                rifampin decreases levels of propranolol by increasing metabolism. Use Caution/Monitor.

              • rifapentine

                rifapentine decreases levels of propranolol by increasing metabolism. Use Caution/Monitor.

              • rifaximin

                propranolol increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

              • ritonavir

                ritonavir will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • rizatriptan

                propranolol increases levels of rizatriptan by unknown mechanism. Use Caution/Monitor. Do not exceed rizatriptan 5 mg/dose, up to a maximum of 3 doses in 24 hr .

              • rolapitant

                rolapitant will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

              • ropivacaine

                propranolol, ropivacaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Use extreme caution during concomitant use of bupivacaine and antihypertensive agents.

              • rucaparib

                rucaparib will increase the level or effect of propranolol by affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP1A2 substrates, if clinically indicated.

              • sacubitril/valsartan

                sacubitril/valsartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • salicylates (non-asa)

                propranolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

                salicylates (non-asa) decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • salmeterol

                propranolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

              • salsalate

                propranolol and salsalate both increase serum potassium. Use Caution/Monitor.

                salsalate decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • secobarbital

                secobarbital decreases levels of propranolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

              • sertraline

                sertraline will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Sertraline is a moderate to weak inhibitor of the hepatic (CYP2D6) which may be involved in the metabolism of propranolol. Monitor patients receiving propranolol and sertraline cotherapy for an increased incidence of chest pain. This effect may be more pronounced in patients with preexisting coronary artery disease.

              • sevelamer

                sevelamer decreases levels of propranolol by increasing elimination. Use Caution/Monitor.

              • sevoflurane

                sevoflurane, propranolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • sildenafil

                propranolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

              • silodosin

                silodosin and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Increased risk of dizziness and orthostatic hypotension when silodosin is administered concurrently with antihypertensives.

              • siponimod

                siponimod, propranolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

              • sodium bicarbonate

                sodium bicarbonate decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sodium citrate/citric acid

                sodium citrate/citric acid decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

              • sotalol

                propranolol and sotalol both increase serum potassium. Use Caution/Monitor.

              • spironolactone

                propranolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

              • stiripentol

                stiripentol, propranolol. affecting hepatic enzyme CYP1A2 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP1A2 inhibitor and inducer. Monitor CYP1A2 substrates coadministered with stiripentol for increased or decreased effects. CYP1A2 substrates may require dosage adjustment.

              • succinylcholine

                propranolol and succinylcholine both increase serum potassium. Use Caution/Monitor.

              • sulfasalazine

                propranolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.

                sulfasalazine decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • sulindac

                propranolol and sulindac both increase serum potassium. Use Caution/Monitor.

                sulindac decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tadalafil

                tadalafil increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

              • telmisartan

                telmisartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • terazosin

                terazosin and propranolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely. Additive hypotensive effects may occur when terazosin is used in combination with propranolol.

              • terbinafine

                terbinafine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

              • terbutaline

                propranolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

                propranolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor.

              • teriflunomide

                teriflunomide decreases levels of propranolol by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

              • theophylline

                propranolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.

              • timolol

                propranolol and timolol both increase serum potassium. Use Caution/Monitor.

              • tipranavir

                tipranavir will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • tolazamide

                propranolol decreases effects of tolazamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • tolbutamide

                propranolol decreases effects of tolbutamide by pharmacodynamic antagonism. Use Caution/Monitor. Non selective beta blockers may also mask the symptoms of hypoglycemia.

              • tolfenamic acid

                propranolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.

                tolfenamic acid decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolmetin

                propranolol and tolmetin both increase serum potassium. Use Caution/Monitor.

                tolmetin decreases effects of propranolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

              • tolvaptan

                propranolol and tolvaptan both increase serum potassium. Use Caution/Monitor.

              • torsemide

                propranolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

              • triamterene

                propranolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

              • valsartan

                valsartan and propranolol both increase serum potassium. Use Caution/Monitor.

                propranolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

              • venlafaxine

                venlafaxine will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

              • verapamil

                propranolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

              • warfarin

                propranolol increases levels of warfarin by decreasing metabolism. Use Caution/Monitor. The anticoagulant effect of warfarin may be increased.

              • xipamide

                xipamide increases effects of propranolol by pharmacodynamic synergism. Use Caution/Monitor.

              Minor (33)

              • adenosine

                propranolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

              • agrimony

                agrimony increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • brimonidine

                brimonidine increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • cevimeline

                cevimeline increases effects of propranolol by unspecified interaction mechanism. Minor/Significance Unknown.

              • ciprofloxacin

                ciprofloxacin increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

              • cocaine

                propranolol increases effects of cocaine by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

              • cornsilk

                cornsilk increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • diazepam

                propranolol increases effects of diazepam by decreasing metabolism. Minor/Significance Unknown.

              • dihydroergotamine

                dihydroergotamine, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dihydroergotamine intranasal

                dihydroergotamine intranasal, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

              • dipyridamole

                dipyridamole, propranolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

              • escitalopram

                escitalopram increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

              • fenoldopam

                fenoldopam increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

              • forskolin

                forskolin increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • imaging agents (gadolinium)

                propranolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

              • levobetaxolol

                levobetaxolol increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • lily of the valley

                propranolol, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.

              • maitake

                maitake increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • melatonin

                melatonin decreases toxicity of propranolol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

              • metipranolol ophthalmic

                metipranolol ophthalmic increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • miglitol

                miglitol decreases levels of propranolol by unspecified interaction mechanism. Minor/Significance Unknown.

              • neostigmine

                propranolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • noni juice

                propranolol and noni juice both increase serum potassium. Minor/Significance Unknown.

              • octacosanol

                octacosanol increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • oxazepam

                propranolol increases effects of oxazepam by decreasing metabolism. Minor/Significance Unknown.

              • physostigmine

                propranolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

              • pilocarpine

                pilocarpine increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • reishi

                reishi increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • shepherd's purse

                shepherd's purse, propranolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

              • ticlopidine

                ticlopidine increases levels of propranolol by decreasing metabolism. Minor/Significance Unknown.

              • tizanidine

                tizanidine increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

              • treprostinil

                treprostinil increases effects of propranolol by pharmacodynamic synergism. Minor/Significance Unknown.

              • yohimbe

                propranolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.

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              Adverse Effects

              Frequency Not Defined

              Aggravated congestive heart failure

              Bradycardia

              Hypotension

              Arthropathy

              Raynaud phenomenon

              Hyper/hypoglycemia

              Depression

              Fatigue

              Insomnia

              Paresthesia

              Psychotic disorder

              Pruritus

              Nausea

              Vomiting

              Hyperlipidemia

              Hyperkalemia

              Cramping

              Bronchospasm

              Dyspnea

              Pulmonary edema

              Respiratory distress

              Wheezing

              Postmarketing Reports

              Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid; agranulocytosis, erythematous rash, fever with sore throat

              Psychiatric disorders: Hallucination

              Skin and subcutaneous tissues disorders: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria, purpura, dermatitis psoriasiform

              Musculoskeletal: Myopathy, myotonia

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              Warnings

              Black Box Warnings

              May exacerbate ischemic heart disease after abrupt withdrawal

              Hypersensitivity to catecholamines has been observed during withdrawal

              Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuance

              When discontinuing long-term administration of beta blockers (particularly with ischemic heart disease), gradually reduce dose over 1-2 weeks and carefully monitor

              If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina)

              Warn patients against interruption or discontinuance of beta-blocker therapy without physician advice

              Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension

              Contraindications

              Asthma, COPD

              Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker)

              Cardiogenic shock

              Uncompensated congestive heart failure

              Hypersensitivity

              Overt heart failure

              Sick sinus syndrome without permanent pacemaker

              Infantile hemangioma

              • Premature infants with corrected age <5 weeks
              • Infants weighing <2 kg
              • Hypersensitivity
              • Asthma or history of bronchospasm
              • Heart rate <80 bpm
              • Greater than first-degree heart block
              • Decompensated heart failure
              • Blood pressure <50/30 mm Hg
              • Pheochromocytoma

              Cautions

              Do not use InnoPran XL in pediatric patients

              Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

              Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions

              Sudden discontinuance can exacerbate angina and lead to myocardial infarction

              Use in pheochromocytoma

              Increased risk of stroke after surgery

              Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported

              Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported

              Exacerbation of myopathy and myotonia has been reported

              Less effective than thiazide diuretics in black and geriatric patients

              May worsen bradycardia or hypotension; monitor HR and BP

              Avoid beta-blockers without alpha1-adrenergic receptor blocking activity in patients with prinzmetal variant angina; unopposed alpha-1 adrenergic receptors may worsen anginal symptoms

              May induce or exacerbate psoriasis; cause and effect not established

              Prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations, and sweating May cause or worsen bradycardia or hypotension

              Therapy can cause hypoglycemia, at any time during treatment; risk is increased during a fasting period (eg, poor oral food intake, infection, vomiting) or when glucose demands are increased (eg, cold, stress, infections); withhold dose under these conditions; hypoglycemia may present in the form of seizures, lethargy, or coma; discontinue therapy if hypoglycemia develops and treat appropriately

              Concomitant treatment with corticosteroids may increase the risk of hypoglycemia

              Infantile hemangiomas and PHACE syndrome

              • By dropping blood pressure, propranolol may increase the risk of stroke in patients with PHACE syndrome who have severe cerebrovascular anomalies
              • Investigate infants with large facial infantile hemangioma for potential arteriopathy associated with PHACE syndrome before therapy
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              Pregnancy & Lactation

              Pregnancy category: C; intrauterine growth retardation, small placentas, and congenital abnormalities reported, but no adequate and well-controlled studies conducted

              Lactation: Use is controversial; an insignificant amount is excreted in breast milk

              Pregnancy Categories

              A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

              B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

              C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

              D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

              X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

              NA: Information not available.

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              Pharmacology

              Mechanism of Action

              Nonselective beta adrenergic receptor blocker; competitive beta1 and beta2 receptor inhibition results in decreases in heart rate, myocardial contractility, myocardial oxygen demand, and blood pressure

              Class 2 antidysrhythmic

              Absorption

              Bioavailability: 30-70% (food increases bioavailability)

              Onset: Hypertension, 2-3 wk; beta blockade, 2-10 min (IV) or 1-2 hr (PO)

              Duration: 6-12 hr (immediate release); 24-27 hr (extended release)

              Peak plasma time: 1-4 hr (immediate release); 6-14 hr (extended release)

              Distribution

              Protein bound: 68% (newborns); 90% (adults)

              Vd: 4 L/kg in adults

              Metabolism

              Metabolized by hepatic P450 enzymes CYP2D6 and CYP1A2

              Metabolites: 4-hydroxypropranolol (active)

              Elimination

              Half-life: Children, 3.9-6.4 hr; adults, 3.9-6.4 hr (immediate release) or 8-10 hr (extended release)

              Excretion: Urine (96-99%)

              Dialyzable: HD: No

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              Administration

              IV Incompatibilities

              Additive: Bicarbonate

              Syringe: Bicarbonate

              Y-site: Amphotericin B cholesteryl sulfate, diazoxide

              IV Compatibilities

              Solution: Most common solvents

              Additive: Dobutamine, verapamil

              Syringe: Inamrinone, milrinone

              Y-site: Alteplase, fenoldopam, gatifloxacin, heparin, hydrocortisone, sodium succinate, inamrinone, linezolid, meperidine, milrinone, morphine, potassium chloride, propofol, tacrolimus, tirofiban, vitamins B and C

              IV Administration

              IV administration rate should not exceed 1 mg/min

              IV dose is much smaller than oral dose

              Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution

              Continuous IV infusion generally is not recommended

              Storage

              Protect injection from light

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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              propranolol oral
              -
              20 mg/5 mL (4 mg/mL) solution
              propranolol oral
              -
              40 mg/5 mL (8 mg/mL) solution
              propranolol oral
              -
              10 mg tablet
              propranolol oral
              -
              60 mg capsule
              propranolol oral
              -
              20 mg tablet
              propranolol oral
              -
              80 mg capsule
              propranolol oral
              -
              10 mg tablet
              propranolol oral
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              20 mg tablet
              propranolol oral
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              40 mg tablet
              propranolol oral
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              80 mg tablet
              propranolol oral
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              60 mg tablet
              propranolol oral
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              10 mg tablet
              propranolol oral
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              80 mg tablet
              propranolol oral
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              40 mg tablet
              propranolol oral
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              20 mg tablet
              propranolol oral
              -
              60 mg tablet
              propranolol oral
              -
              10 mg tablet
              propranolol oral
              -
              20 mg tablet
              propranolol oral
              -
              40 mg tablet
              propranolol oral
              -
              80 mg capsule
              propranolol oral
              -
              40 mg tablet
              propranolol oral
              -
              20 mg tablet
              propranolol oral
              -
              10 mg tablet
              propranolol oral
              -
              60 mg capsule
              propranolol oral
              -
              80 mg tablet
              propranolol oral
              -
              60 mg tablet
              propranolol oral
              -
              40 mg tablet
              propranolol oral
              -
              160 mg capsule
              propranolol oral
              -
              80 mg tablet
              propranolol oral
              -
              80 mg capsule
              propranolol oral
              -
              60 mg tablet
              propranolol oral
              -
              40 mg tablet
              propranolol oral
              -
              20 mg tablet
              propranolol oral
              -
              60 mg capsule
              propranolol oral
              -
              80 mg capsule
              propranolol oral
              -
              120 mg capsule
              propranolol oral
              -
              160 mg capsule
              propranolol oral
              -
              120 mg capsule
              propranolol oral
              -
              160 mg capsule
              propranolol oral
              -
              80 mg tablet
              propranolol oral
              -
              40 mg tablet
              propranolol oral
              -
              120 mg capsule
              propranolol oral
              -
              120 mg capsule
              propranolol oral
              -
              160 mg capsule
              propranolol oral
              -
              60 mg capsule
              propranolol oral
              -
              60 mg tablet
              Inderal LA oral
              -
              80 mg capsule
              Inderal LA oral
              -
              60 mg capsule
              Inderal LA oral
              -
              160 mg capsule
              Inderal LA oral
              -
              120 mg capsule
              propranolol intravenous
              -
              1 mg/mL vial
              propranolol intravenous
              -
              1 mg/mL vial
              propranolol intravenous
              -
              1 mg/mL vial
              propranolol intravenous
              -
              1 mg/mL vial
              InnoPran XL oral
              -
              120 mg capsule

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Select a drug:
              Patient Education
              propranolol oral

              PROPRANOLOL SOLUTION PEDIATRIC - ORAL

              (proe-PRAN-oh-lol)

              COMMON BRAND NAME(S): Hemangeol

              USES: This formulation of propranolol is used for infants and children to treat a certain benign tumor (proliferating infantile hemangioma). It helps to shrink the tumor. Propranolol belongs to a class of drugs known as beta blockers.

              HOW TO USE: Read the Medication Guide and Instructions for Use Leaflet provided by your pharmacist before you start giving propranolol to your child and each time you get a refill. If you have any questions, ask the doctor or pharmacist.Give this medication to your child by mouth as directed by the doctor, usually 2 times daily (at least 9 hours apart). This medication should be given during or right after a meal/feeding. Skip the dose of the medication if your child is not eating or is vomiting.Do not shake the bottle before use. Carefully measure the dose using a special measuring device/oral syringe. Do not use a household spoon because you may not get the correct dose. You may give this medication directly into the child's mouth with the oral syringe or the medication can be mixed in a small amount of milk or fruit juice and then given to the child. If you are unsure if your child swallowed the full dose of the medication or if your child spits up the dose, do not give another dose, but wait for the next scheduled dose.The dosage is based on your child's medical condition, weight, and response to treatment. To reduce the risk of side effects, the doctor may direct your child to start this medication at a low dose and gradually increase the dose. The dosage may be increased by the doctor as your child gains weight. Follow the doctor's instructions carefully. The blood pressure and heart rate should be monitored for 2 hours when the medication is first started and after each dose increase.Use this medication regularly to get the most benefit from it. To help you remember, give it at the same times each day.Tell the doctor if your child's condition does not improve or if it worsens.

              SIDE EFFECTS: Dizziness, lightheadedness, or tiredness may occur as the body adjusts to the medication. Diarrhea, stomach/abdominal pain, decreased appetite, vomiting, trouble sleeping, and unusual dreams may also occur. If any of these effects persist or worsen, tell the doctor or pharmacist promptly.This drug may reduce blood flow to the hands and feet, causing them to feel cold. Tell the doctor if this occurs. Dress your child warmly.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to your child is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell the doctor right away if your child has any serious side effects, including: fainting, pale/blue/purple skin, new or worsening symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), very slow heartbeat, irregular heartbeat, signs of infection (such as fever, persistent sore throat, cough), mental/mood changes (such as agitation).This product may cause low blood sugar (hypoglycemia), especially if your child is not eating regularly or is vomiting. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, seizures, weakness, or tingling hands/feet. This product may prevent some of the symptoms of hypoglycemia (such as the fast/pounding heartbeat, sweating). Other symptoms of low blood sugar, such as dizziness, are unaffected by this drug. If your child has symptoms of hypoglycemia, stop giving the medication to your child and tell the doctor right away.This medication may increase the risk of stroke in certain children with a large hemangioma on their face or head. Get medical help right away if your child has symptoms of a stroke, including: trouble speaking, weakness on one side of the body, sudden vision changes, confusion.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: See also Side Effects section.Before using propranolol, tell the doctor or pharmacist if your child is allergic to it; or if your child has had a serious reaction to other beta blockers (such as metoprolol); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell the doctor or pharmacist your child's medical history, especially of: breathing problems (such as asthma), certain heart problems (such as heart failure, slow heart rate, second- or third-degree atrioventricular block), severe allergic reactions, a certain type of tumor (pheochromocytoma), very low blood pressure.Before having surgery, tell the doctor or dentist about all the products your child uses (including prescription drugs, nonprescription drugs, and herbal products).This drug may make your child dizzy. Do not let your child do any activity that requires alertness until you are sure your child can perform such activities safely.This formulation of propranolol is not usually used by adults. Therefore, it is unlikely to be used during pregnancy or breast-feeding. Consult your doctor if you have any questions about this medication.

              DRUG INTERACTIONS: Drug interactions may change how medications work or increase the risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products your child uses (including prescription/nonprescription drugs and herbal products) and share it with the doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without the doctor's approval.Some products that may interact with this drug include: bile acid-binding resins (such as cholestyramine), epinephrine, thioridazine.If you are breast-feeding your child, ask the doctor if any medications that you are using may pass into the breast milk and interact with this medication.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: very slow heartbeat, severe dizziness, fainting, mental/mood changes (such as restlessness), seizure.

              NOTES: Do not share this medication with others.Have your child's blood pressure and pulse (heart rate) checked regularly while taking this medication, especially when this medication is first started or after a dose increase. If directed by the doctor, learn how to monitor your child's blood pressure and pulse at home, and share the results with the doctor.

              MISSED DOSE: If you miss a dose, give it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Give the next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature. Do not freeze. Do not store in the bathroom. Keep all medications away from children and pets. Discard the medication 2 months after the bottle is opened.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

              Information last revised June 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.