Non-selective beta blocker
ATC code: C07AA05 (Propranolol)
Brand names
Inderal, Inderal LA, InnoPran XL, Hemangeol
Blocks β1 and β2 adrenoreceptors. Reduces heart rate, blood pressure, contractility. Used for thyrotoxicosis, essential tremor, migraine prophylaxis, infantile hemangiomas. Contraindicated in asthma due to β2 blockade.
First line
Propranolol reduces hand essential tremor amplitude by 50–60 percent in most patients. 2022 classifies it at level A: first-line therapy alongside primidone. Effect develops over 1–2 weeks of titration at 80–320 mg/day. In patients with borderline airway obstruction, selective β1-blockers (metoprolol) are preferred, although their efficacy in tremor is lower.
First line
Oral propranolol is first-line systemic therapy for complicated infantile hemangiomas: function-threatening (periorbital, perinasal), ulcerated, large facial lesions. 2019 recommends starting at 5 weeks of age at 1–3 mg/kg/day in 2–3 divided doses. Treatment continues for up to 12 months. Regression efficacy exceeds 95 percent in large case series. Before the propranolol era, systemic glucocorticoids were standard with a worse side-effect profile.
Before initiation, PHACE syndrome is excluded (brain MRI in segmental facial hemangiomas): propranolol can worsen cerebral ischemia in children with vascular anomalies. Inpatient initiation is recommended in infants under 8 weeks and with comorbidities.
First line
Propranolol reduces migraine attack frequency by at least 50 percent in half of patients at 80–240 mg/day. 2019 classifies it at level A: first-line prevention alongside topiramate, metoprolol, and timolol. Effect develops over 4–8 weeks. Preferred in patients with co-existing hypertension or anxiety; avoided in asthma, symptomatic bradycardia, and depression.
First line
Propranolol controls adrenergic symptoms of thyrotoxicosis (tachycardia, tremor, anxiety) until euthyroidism is achieved with antithyroid drugs or radioactive iodine. 2016 recommends non-selective beta-blockers as the standard; propranolol additionally inhibits peripheral T4-to-T3 conversion, reinforcing the therapeutic effect. Doses 40–160 mg/day in 3–4 divided doses. Selective alternatives – metoprolol, atenolol – are used in patients with bronchial obstruction.
Not recommended
Propranolol is not chosen as first-line therapy for essential hypertension. 2024 and NG136 place beta-blockers in the fourth line after ACE inhibitors/ARBs, CCBs, and thiazide diuretics. Propranolol specifically loses to cardioselective bisoprolol and metoprolol on the side-effect profile and on the ASCOT-BPLA outcome data (Lancet 2005). Used only when other indications are present (migraine, thyrotoxicosis, tremor).
1 pair found. Sorted from critical to minor.
Mechanism
Бета-блокаторы маскируют адренергические симптомы гипогликемии (тахикардия, тремор), оставляя только потливость. Риск тяжелой гипогликемии без предупреждения.
Management
Информировать пациента о подмене симптомов. По возможности – кардиоселективные бета-блокаторы (бисопролол, метопролол) в минимальных дозах.
FDA category C. In pregnancy, propranolol is used for thyrotoxicosis, tachycardia in hypertrophic cardiomyopathy, and severe migraine. Newborns of mothers on beta-blockers in the third trimester may have symptomatic bradycardia, hypoglycemia, and reduced birth weight. The decision is shared with the obstetrician and the relevant specialist.
propranolol is evaluated for the following indications with varying evidence strength: Essential tremor (evidence tier A), Migraine prophylaxis (evidence tier A), Infantile hemangioma (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of propranolol (≥ 1 in 100): Bradycardia, hypotension, Fatigue, reduced exercise tolerance, Cold extremities, Sleep disturbance, nightmares (lipophilic – crosses the blood-brain barrier), Bronchospasm in predisposed patients. See the Safety section for uncommon and serious reactions.
FDA category C. FDA category C. In pregnancy, propranolol is used for thyrotoxicosis, tachycardia in hypertrophic cardiomyopathy, and severe migraine. Newborns of mothers on beta-blockers in the third trimester may have symptomatic bradycardia, hypoglycemia, and reduced birth weight. The decision is shared with the obstetrician and the relevant specialist.
Propranolol passes into breast milk at about 0.5 percent of the maternal dose. LactMed lists it as compatible with breastfeeding. Monitor the infant: symptomatic bradycardia, lethargy, or poor feeding warrant evaluation.
propranolol is contraindicated in: Asthma and severe COPD (bronchospasm risk); Second- and third-degree AV block without a pacemaker; Sick sinus syndrome; Decompensated heart failure; Cardiogenic shock. Full list in the Safety section.
Propranolol passes into breast milk at about 0.5 percent of the maternal dose. LactMed lists it as compatible with breastfeeding. Monitor the infant: symptomatic bradycardia, lethargy, or poor feeding warrant evaluation.
bronchospasm develops in patients with pre-existing airway hyperreactivity. In healthy people propranolol does not induce asthma. Cardioselective β1-blockers (metoprolol, bisoprolol) are safer in borderline obstruction.
beta-blockers remove peripheral symptoms (tachycardia, tremor) but do not treat the underlying anxiety disorder. Standard treatment is SSRIs and psychotherapy; propranolol acts as a situational drug for stage fright.
anaprilin and obzidan are trade names for the same propranolol from different manufacturers. Efficacy is identical, only price and the tablet differ.