propranolol (Rx)

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

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

Indicated for management of 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

Indicated for prophylaxis of common migraine headache

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

Indicated to decrease angina frequency and increase exercise tolerance in patients with chronic stable angina

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

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

Pheochromocytoma

Indiated as adjunct to alpha-adrenergic blockers to control blood pressure and symptoms of catecholamine-secreting tumors

30-60 mg/day PO in divided doses

Hypertrophic Subaortic Stenosis

Indicated for symptomatic treatment of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction

20-40 mg PO q6-8hr

Myocardial Infarction

Indicated to reduce cardiovascular mortality in patients who have survived the acute phase of myocardial infarction (MI) and are clinically stable

Initiate within 24 hr of MI and reevaluate for secondary prevention at later date

Immediate-release: 60-120 mg/day divided BID/TID; titrate dose based on heart rate and blood pressure as tolerated up to 240 mg/day

Supraventricular Arrhythmia

Indicated for control of supraventricular arrhythmias (eg, atrial fibrillation and flutter, atrioventricular nodal reentrant tachycardia) and ventricular tachycardias (eg, catecholamine-induced arrhythmias, digoxin toxicity)

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 hr

Essential Tremor

Indicated for management of familial or hereditary essential tremor

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

Portal Hypertension (Off-label)

Prevention of variceal bleeding

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

Antipsychotic-Induced Akathisia (Off-label)

30-120 mg PO q8-12hr

Esophageal 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

Malignant Glioma (Orphan)

Orphan designation for treatment of malignant glioma (plus etodolac)

Sponsor

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

Dosing Considerations

Innopran XL

  • Drug should be administered once daily at bedtime and should be taken consistently either on an empty stomach or with food
  • Initiate dosing at 80 mg and titrate to 120 mg daily as needed for blood pressure control. Doses above 120 mg have no additional effects on blood pressure

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

Next:

Interactions

Interaction Checker

and propranolol

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      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • fezolinetant

              propranolol will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors

            Serious - Use Alternative (44)

            • 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.

            • mavacamten

              propranolol, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.

            • 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.

            • methylphenidate transdermal

              methylphenidate transdermal decreases effects of propranolol by anti-hypertensive channel blocking. Use Caution/Monitor.

            • 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.

            • xipamide

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

            Minor (32)

            • 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 topical

              propranolol increases effects of cocaine topical 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.

            • 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

            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

            Prolonged experience with propranolol in pregnant women over several decades, based on published interventional and observational studies, has not identified a drug-associated risk of major birth defects, miscarriage, or other adverse maternal outcomes

            Bradycardia, hypoglycemia, and respiratory depression have been observed with use of beta-blockers, including propranolol, in utero near the time of delivery

            There are inconsistent reports of intrauterine growth restriction with beta-blocker use, including propranolol, during pregnancy

            Untreated hypertension during pregnancy can lead to serious adverse outcomes for the mother and the fetus

            Hypertension in pregnancy increases maternal risk for pre-eclampsia, gestational diabetes, premature delivery, and delivery complications (eg, need for cesarean section, and post-partum hemorrhage)

            Hypertension increases the fetal risk f or intrauterine growth restriction and intrauterine death; pregnant women with hypertension should be carefully monitored and managed accordingly

            The drug crosses placenta; neonates born to mothers who are receiving propranolol during pregnancy, may be at risk for bradycardia, hypoglycemia, and respiratory depression

            Monitor neonates exposed to propranolol during pregnancy and manage accordingly

            Infertility

            • Males: Based on published literature, beta-blockers, including propranolol, may cause erectile dysfunction; in rats, propranolol inhibits spermatogenesis

            Lactation

            The drug is present in human milk at low levels, but related risk to a breastfed infant is unknown; there are no data on effects on milk production

            Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from the drug or from underlying maternal condition

            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
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            propranolol oral
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            propranolol oral
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            propranolol oral
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            20 mg/5 mL (4 mg/mL) solution
            propranolol oral
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            160 mg capsule
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            120 mg capsule
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            60 mg capsule
            Inderal XL oral
            -
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            Hemangeol oral
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            4.28 mg/mL solution
            propranolol intravenous
            -
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            propranolol intravenous
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            Patient Handout

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            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 last or get worse, 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 this medication has been prescribed because the doctor 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 sore throat that doesn't go away, fever, cough), mental/mood changes (such as agitation).This product may cause low blood sugar (hypoglycemia), especially if your child is sick, not eating regularly, or is vomiting. Symptoms of low blood sugar include sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, seizures, or weakness. This product may prevent some of the symptoms of hypoglycemia (such as fast/pounding heartbeat). Other symptoms of low blood sugar, such as dizziness and sweating, are not affected by this drug. If your child has symptoms of hypoglycemia, 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. 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, fezolinetant, 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 May 2023. Copyright(c) 2023 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.

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            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
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            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.