Propranolol

Propranolol is a prescription nonselective beta-blocker used to treat high blood pressure (hypertension), angina (chest pain), irregular heart rhythms, tremors, and to reduce the risk of complications after a heart attack. It is also used to prevent migraine headaches and to manage symptoms of pheochromocytoma, a rare tumor that affects adrenaline production.

Propranolol may be prescribed off-label for anxiety, where it helps control physical anxiety symptoms such as a rapid heartbeat, shaking, and sweating.

Propranolol works by blocking beta-adrenergic receptors in the heart, blood vessels, and kidneys, which decreases heart rate and force of heart contractions, and lowers blood pressure. This reduces the heart's oxygen demand and helps control various cardiovascular conditions. Experts are not sure how propranolol works to prevent migraines or tremors.

Propranolol is available as a tablet, an extended-release (long-acting) capsule, and an oral solution.

Hemangeol (propranolol oral liquid 4.28 milligrams) is given to infants 5 weeks to 1 year old to treat a genetic condition called infantile hemangiomas.

Take propranolol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Adults may take propranolol with or without food, but take it the same way each time.

Give Hemangeol (propranolol hydrochloride oral solution) prescribed for an infant during or just after a feeding. If your child is not taking feedings, for example, due to an illness or vomiting, do not give Hemangeol until they are taking feedings normally again. Doses should be spaced at least 9 hours apart. Measure Hemangeol with the supplied measuring device (not a kitchen spoon). Do not shake.

Your heart function and blood pressure will need to be checked often.

Tell your doctor if you have a planned surgery.

Your condition may get worse if you stop using propranolol suddenly. Ask your doctor before stopping the medicine.

This medicine can affect the results of certain medical tests. Tell any doctor who treats you that you are using propranolol.

If you have high blood pressure, keep using this medicine even if you feel well. High blood pressure often has no symptoms.

Store at room temperature away from moisture and heat. Do not freeze Hemangeol. Throw away any unused Hemangeol 2 months after you first opened the bottle.

You should not use propranolol if you have asthma, chronic bronchitis, emphysema, very slow heartbeats, cardiogenic shock, or a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker).

Babies who weigh less than 4.5 pounds or were born prematurely and have not reached the corrected age of 5 weeks should not be given Hemangeol oral liquid.

You should not use propranolol if you are allergic to it, or if you have:

• asthma;
• history of slow heartbeats that have caused you to faint;
• severe heart failure (that required you to be in the hospital); or
• a serious heart condition such as "sick sinus syndrome", heart block (2nd or 3rd degree, unless you have a pacemaker), or cardiogenic shock.

You should not use Hemangeol if you have pheochromocytoma (tumor of the adrenal gland). Hemangeol also should not be used in babies who weigh less than 4.5 pounds or were born prematurely and have not reached the corrected age of 5 weeks.

To make sure propranolol is safe for you, tell your doctor if you have ever had:

• slow heartbeats, congestive heart failure;
• bronchitis, emphysema, or other breathing disorders;
• diabetes (propranolol can make it harder for you to tell when you have low blood sugar);
• liver or kidney disease;
• a thyroid disorder;
• pheochromocytoma (tumor of the adrenal gland);
• problems with circulation (such as Raynaud's syndrome); or
• if you smoke.

Tell your doctor if you are pregnant or breastfeeding.

Common propranolol side effects may include:

• dizziness, tiredness;
• nausea, vomiting, diarrhea, constipation, stomach cramps;
• sleep problems (insomnia); or
• runny or stuffy nose, cough, sore throat, hoarse voice.

Serious side effects

Get emergency medical help if you have signs of an allergic reaction to propranolol (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Call your doctor at once if you have:

• slow or uneven heartbeats;
• a light-headed feeling, like you might pass out;
• wheezing or trouble breathing;
• sudden weakness, vision problems, or loss of coordination (especially in a child with hemangioma that affects the face or head);
• cold feeling in your hands and feet;
• depression, confusion, hallucinations;
• heart problems - swelling, rapid weight gain, feeling short of breath;
• low blood sugar - headache, hunger, sweating, irritability, dizziness, fast heart rate, and feeling anxious or shaky; or
• low blood sugar in a baby - pale skin, blue or purple skin, sweating, fussiness, crying, not wanting to eat, feeling cold, drowsiness, weak or shallow breathing (breathing may stop for short periods), seizure (convulsions), or loss of consciousness.

This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

If your child spits up a dose of Hemangeol or if you are not sure they got all of the medicine, do not give another dose. Wait until the next scheduled dose.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include feeling light-headed or restless, tremors, fast or slow heartbeats, and trouble breathing.

Avoid drinking alcohol. It may increase your blood levels of propranolol.

Sometimes it is not safe to use certain medicines at the same time. Some drugs can affect your blood levels of other drugs you use, which may increase side effects or make the medicines less effective.

Tell your doctor about all your current medicines. Many drugs can affect propranolol, especially:

• cholestyramine or colestipol;
• warfarin (Coumadin, Jantoven);
• an antidepressant;
• heart or blood pressure medicine;
• medicine to treat an infection;
• medicine to treat a prostate disorder;
• steroid medicine; or
• NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.

This list is not complete and many other drugs may interact with propranolol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.