Propranolol

Propranolol has a lot of actions on the body and can be used for lots of conditions like high blood pressure, prevention of heart attacks, and preventing migraine headaches.

In the mental health field, propranolol is used to manage the symptoms of anxiety (shaking, sweating, fast heartbeat).
Propranolol has also been used to treat movement problems called akathisia and tardive dyskinesia, which can be side-effects of other mental health medicines (like antipsychotic medicines).

How does propranolol work?

• When you are anxious your brain makes more of the chemicals noradrenaline and adrenaline.
• Adrenaline and noradrenaline make your heart beat faster and can make you shake and sweat.
• Propranolol blocks the effects of these chemicals and decreases these symptoms of anxiety.
• Propranolol only reduces these physical symptoms – it doesn’t make the anxiety go away.

You should take propranolol as agreed with your doctor

• Make sure that you know your dose. If it is not written on the label, check it with your pharmacist or doctor.
• Your doctor might change your dose at the beginning to find the right level for you.
• You may have to take it up to three times a day.
• It doesn’t matter what time you take it each day - choose a time that you can always remember. This could be a mealtime, or when you brush your teeth. If you take propranolol more than once a day, spread the doses as evenly as possible throughout the day.
• If you can, take it before a meal or some food.
• Swallow the tablet with a drink of water - if you chew it, it tastes bitter.
• If you find it difficult to take it more than once a day, ask your doctor about the long-acting capsules because they only have to be taken once a day.
• Swallow the capsules whole with a drink of water - they are specially made to release the medicine over a few hours into your body and should not be crushed or chewed.

What should I do if I forget to take a dose?

What to do if you miss a dose:

• If you remember later, take it as soon as possible.
• If you forget to take it until just before your next dose, just start again with the next dose.
• Do not take a double dose.

What might happen?

• If you forget to take your tablets for a few days, you may start getting withdrawal symptoms, some of which can be dangerous to your heart.
• Please talk to your doctor or pharmacist, and look out for any uncomfortable symptoms.

You must go to A&E if you take too much 

What to do if you take too much:

• If you have taken more propranolol than it said on the label, you must get help quickly – even if you do not feel any different.
• Go to A&E. Take your medicine with you, to show to the doctors. Tell them how much you have taken.
• Get a friend or family member to go with you, if you can, just in case you feel ill on the way.

 You might get any of the following signs:

• slow heartbeat
• dizziness
• sickness
• confusion
• hallucinations (seeing, hearing or sensing things that are not really there)
• body spasms
• breathlessness when you try to get up and do something
• fainting or coma
• You could also be in danger of a heart attack.

How long does it take to work?

• You will get the effect of propranolol quickly - usually within a few hours
• You should talk to your doctor about how long you will need to take propranolol for.
• Some people only need to take propranolol for a few days.
• Other people will take it regularly for months or even years.
• If you are taking it for a long time, make sure that you see your doctor for a review every six months.

Tell your doctor or pharmacist before you take propranolol if you have any of these conditions

You need to talk to your doctor or pharmacist before you take propranolol if any of the following apply to you:

• you are allergic (hypersensitive) to propranolol tablets or any of the other ingredients, or have a history of allergic reactions to medicines
• you have asthma or any other breathing difficulties
• you have any heart problems
• you have low blood pressure
• you have serious blood circulation problems (which may cause your fingers and toes to tingle or turn pale or blue)
• you have diabetes mellitus (low blood sugar levels may be hidden by this medicine) and increased acidity of the blood (metabolic acidosis)
• you are on a strict fasting diet
• you have a tight, painful feeling in the chest even when you rest (Prinzmetal’s angina)
• you have untreated high blood pressure due to a tumour near the kidney (phaeochromocytoma)
• you have muscle weakness (myasthenia gravis)
• you have kidney or liver disease
• you have symptoms of hyperthyroidism (increased appetite, weight loss, sweating)
• you have, or have ever had, psoriasis
• you have Raynaud’s disease (cold sensations in fingers and toes) or intermittent claudication (narrowing of arteries in the legs causing pain on walking)
• you smoke

Propranolol has possible side effects, and some of these are rare but serious

Stop taking propranolol and go to a doctor or hospital straight away if you get any of the following symptoms:

• slow heartbeat and low blood pressure causing dizziness, light-headedness, fainting or blurred eyesight.
• itching, difficulty breathing or swelling of the face, lips, throat or tongue – this could be an allergic reaction.

Some side-effects that do appear should get better after a few days.

Not everyone will experience side effects with propranolol. Some of the more common side effects are listed at the bottom of this page. If you are experiencing a problem that might be a side effect, but that is not listed here, please take a look at the patient information leaflet that was in the medicine packet or speak to your pharmacist or doctor. If you think you have a side effect that has not got better within a few days go back to your doctor.

If you have food allergies, and sometimes need an adrenaline injection (epi-pen), talk to your doctor as propranolol could reduce the effect of the injection.

• If you have food allergies, and you carry an epi-pen to treat any serious reactions, you need to tell your doctor.
• This is because propranolol can reduce the effectiveness of the injection.

Propranolol does not mix well with some other medicines and drugs

Before you take propranolol, tell your doctor or pharmacist if you take:

• verapamil or diltiazem (to treat heart problems)
• disopyramide, quinidine or amiodarone (to treat an irregular heartbeat)
• ergotamine or similar medicines (to treat migraine)
• adrenaline (epinephrine, used in anaphylactic shock)
• medicines to treat diabetes including insulin
• lidocaine, propafenine or flecanide (to treat irregular heartbeat (arrhythmia) or as a local anasethetic)
• indometacin (Non-Steroidal Anti-Inflammatory Drug (NSAID) for muscle pain)
• digoxin (to treat heart conditions)
• chlorpromazine (for mental health conditions)
• cimetidine (to treat stomach ulcers)
• medicines to treat high blood pressure (like alpha blockers, clonidine, moxonidine, methyldopa or hydralazine)
• antidepressant tablets like monoamine oxidase inhibitors (MAOIs), imipramine or fluvoxamine
• warfarin (to prevent clotting)
• rizatriptan (to treat migraine)
• rifampicin (to treat infections)
• barbiturates (to help with sleep problems)
• theophylline (treating asthma and other breathing problems)
• diuretics (‘water tablets’ to clear extra water from your body)

If you have any further questions about this you should speak to your doctor or pharmacist.

Tell the pharmacist you are taking propranolol if you buy medicines (including things you put on your skin) for common illnesses.

Tell the doctor if you are going to have an operation – you may need to stop propranolol before the operation

Propranolol can affect some blood & urine tests.

• The effects of propranolol on your heart mean a risk of effects on your heartbeat while you are under a general anaesthetic.
• You need to tell the people who are going to do your operation, before the day it takes place.
• They may ask you not to take your propranolol for a day before your operation.
• Tell your doctor you are taking propranolol if you are having any blood or urine tests.
• Propranolol can change the results of some lab tests.

Stopping this medicine quickly, or reducing the dose too much at once, may cause withdrawal symptoms that are dangerous to your heart

You can stop taking it safely with your doctor’s help.

If you want to stop taking propranolol, you should ask your doctor for help. If you stop too quickly, you could get withdrawal symptoms and they could be dangerous for your heart.

These symptoms include:

• sweating
• shaking
• irregular heartbeat
• chest pain, which may be angina or a heart attack.
• You will need to go to hospital if you get these symptoms, as your life might be in danger.

If you go to your doctor for help to stop, they will reduce your dose slowly and safely over about 2 weeks.