Dosing & Uses
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
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.
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
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
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.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
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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| propranolol oral - | 80 mg capsule |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 10 mg tablet |  | |
| propranolol oral - | 10 mg tablet |  | |
| propranolol oral - | 80 mg capsule |  | |
| propranolol oral - | 60 mg capsule |  | |
| propranolol oral - | 120 mg capsule |  | |
| propranolol oral - | 10 mg tablet |  | |
| propranolol oral - | 80 mg capsule |  | |
| propranolol oral - | 60 mg capsule |  | |
| propranolol oral - | 120 mg capsule |  | |
| propranolol oral - | 80 mg tablet |  | |
| propranolol oral - | 60 mg tablet |  | |
| propranolol oral - | 80 mg tablet |  | |
| propranolol oral - | 80 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 60 mg tablet |  | |
| propranolol oral - | 10 mg tablet |  | |
| propranolol oral - | 160 mg capsule |  | |
| propranolol oral - | 60 mg capsule |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 160 mg capsule |  | |
| propranolol oral - | 80 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 10 mg tablet |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 80 mg capsule |  | |
| propranolol oral - | 60 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 10 mg tablet |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 60 mg tablet |  | |
| propranolol oral - | 80 mg tablet |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 160 mg capsule |  | |
| propranolol oral - | 20 mg tablet |  | |
| propranolol oral - | 20 mg/5 mL (4 mg/mL) solution |  | |
| propranolol oral - | 120 mg capsule |  | |
| propranolol oral - | 60 mg tablet |  | |
| propranolol oral - | 40 mg tablet |  | |
| propranolol oral - | 60 mg capsule |  | |
| propranolol oral - | 80 mg capsule |  | |
| propranolol oral - | 80 mg tablet |  | |
| Inderal LA oral - | 160 mg capsule | | |
| Inderal LA oral - | 120 mg capsule | | |
| Inderal LA oral - | 80 mg capsule | | |
| Inderal LA oral - | 60 mg capsule | | |
| Inderal XL oral - | 120 mg capsule |  | |
| Hemangeol oral - | 4.28 mg/mL solution |  | |
| propranolol intravenous - | 1 mg/mL vial |  | |
| propranolol intravenous - | 1 mg/mL vial |  | |
| propranolol intravenous - | 1 mg/mL vial |  | |
| propranolol intravenous - | 1 mg/mL vial |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
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.
Formulary
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- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
