Propranolol (Inderal LA, Innopran XL, others) - Uses, Side Effects, and More

Medically Reviewed by Kimberly Rath, PharmD on Jun 13, 2024 | Written by Alex Poppen, PharmD

Uses

What is propranolol used for?

Propranolol is commonly used for the following conditions.

• To reduce the growth of birthmarks in people with infantile hemangioma
• High blood pressure (hypertension)
• To reduce chest pain in people with heart disease
• To help prevent migraine headaches 
• To help reduce heart failure symptoms in people with hypertrophic subaortic stenosis
• Life-threatening heart rhythms
• To help control heart rate in people with atrial fibrillation
• To lower the risk of death in people who have recently had a heart attack
• To help reduce involuntary movements in people with tremor 
• To help lower blood pressure in people with a certain type of adrenal gland tumor, called pheochromocytoma

Propranolol may also be used for other conditions as determined by your healthcare provider.

How does propranolol work (mechanism of action)?

Propranolol blocks beta receptors in your heart. These receptors normally bind to hormones called catecholamines. When catecholamines bind to these receptors, it causes your heart to beat harder and faster. Blocking these receptors helps your heart beat more slowly. These effects can help your heart work better, lower blood pressure, and may reduce your risk for heart attack and stroke. 

How is propranolol supplied (dosage forms)?

Propranolol is available as Hemangeol, Inderal LA, Innopran XL, and generic propranolol in the following dosage forms that are taken by mouth.

• 60 mg oral extended-release capsules
• 80 mg oral extended-release capsules
• 120 mg oral extended-release capsules
• 160 mg oral extended-release capsules
• 4.28 mg/mL oral solution
• 20 mg/5 mL oral solution
• 40 mg/5 mL oral solution
• 10 mg oral tablets
• 20 mg oral tablets
• 40 mg oral tablets
• 60 mg oral tablets
• 80 mg oral tablets

Propranolol is also available in injectable forms.

How should I store propranolol?

Oral solution. Propranolol oral solution should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place. Do not shake or freeze. Hemangeol should be thrown away 2 months after opening.

Extended-release capsules. Propranolol extended-release capsules should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place, in a tightly closed container. Protect from moisture and light. 

Tablets. Propranolol tablets should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place, in a tightly closed container. Protect from light. 

Side Effects

What are the most common side effects of propranolol?

The most common side effects of propranolol are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

• Feeling unusually weak or tired 
• Slow heartbeat
• Dizziness
• Diarrhea
• Vomiting
• Constipation

There may be other side effects of propranolol that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of propranolol?

While less common, the most serious side effects of propranolol are described below, along with what to do if they happen.

Heart Rate Changes. Propranolol can make your heart beat slower than normal (bradycardia). Call your healthcare provider right away if you have any of the following symptoms of bradycardia. 

• Feeling lightheaded, dizziness, or fainting
• Confusion
• Feeling weak or easily tired 
• Chest pain
• Shortness of breath

Decreased Blood Pressure (Hypotension). Propranolol may cause low blood pressure. If you feel faint or dizzy, lie down. Tell your healthcare provider right away if you have any of the following symptoms of low blood pressure.

• Dizziness, feeling lightheaded, or fainting
• Confusion
• Feeling weak or tired

New or Worsening Heart Failure. Propranolol may worsen existing heart failure or cause fluid buildup in your body. For individuals with underlying heart disease or heart damage, propranolol can potentially lead to heart failure over time. Tell your healthcare provider right away if you have any of the following symptoms.

• Shortness of breath or trouble breathing, especially while lying down
• Swelling in your feet, ankles, or legs
• Unusually fast weight gain
• Unusual tiredness

Breathing Problems. Propranolol may cause the muscles around the airways to tighten (bronchospasm) instead of relaxing, which can be serious. Stop using propranolol and contact your healthcare provider right away if you have trouble breathing.

Severe Allergic Reactions. Propranolol may cause allergic reactions, which can be serious. Stop using propranolol and get help right away if you have any of the following symptoms of a serious allergic reaction.

• Breathing problems or wheezing
• Racing heart
• Fever or general ill feeling
• Swollen lymph nodes
• Swelling of the face, lips, mouth, tongue, or throat
• Trouble swallowing or throat tightness
• Itching, skin rash, or pale red bumps on the skin called hives
• Nausea or vomiting
• Dizziness, feeling lightheaded, or fainting
• Stomach cramps
• Joint pain

Warnings & Precautions

Who should not use propranolol?

Allergies to Ingredients. People who are allergic to any of the following should not use propranolol.

• Hemangeol
• Inderal LA
• Innopran XL 
• Propranolol
• Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in Hemangeol, Inderal LA, Innopran XL and the specific propranolol products they stock.

Bradycardia. Propranolol should not be used if your heart is beating too slow (bradycardia).

Hypotension. Propranolol should not be used if your blood pressure is too low (hypotension).

Heart Block. Propranolol should not be used if the electrical signals in your heart move too slow (heart block).

Severe or Worsening Heart Failure. Propranolol should not be used if your heart failure is severe or getting worse, causing you to feel very tired, have trouble breathing, or swelling in your legs. 

Cardiogenic Shock. Propranolol should not be used if you have a life-threatening condition called cardiogenic shock where your heart cannot pump enough blood to the rest of your body.

What should I know about propranolol before using it?

Do not take propranolol unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

If using propranolol oral solution for infantile hemangioma, give it with food or right after food. Otherwise, take propranolol with or without food.

If using propranolol oral solution, use an accurate measuring device to measure your dose. A household spoon is not an accurate measuring device and may cause you to take the wrong dose. Ask your pharmacist to recommend an appropriate measuring device.

Do not share propranolol with other people, even if they have the same condition as you. It may harm them.

Keep propranolol out of the reach of children.

Propranolol can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how propranolol affects you.

Stopping propranolol suddenly may lead to chest pain or heart attack in people with heart disease. Do not stop taking this medication without talking to your healthcare provider first. 

What should I tell my healthcare provider before using propranolol?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if propranolol is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

• Heart or circulation problems
• Breathing problems
• Kidney problems
• Liver problems
• Pheochromocytoma
• Thyroid problems

Diabetes. Propranolol can decrease early signs of low blood sugar, such as fast heartbeat, and make it more likely for the low blood sugar to be serious, especially for people with diabetes.

PHACE Syndrome. Propranolol can lower blood pressure and may increase the risk for stroke in people with PHACE syndrome that have abnormal blood vessels in the brain.

Wolff-Parkinson-White Syndrome. Propranolol may cause seriously low heart rate in people with Wolff-Parkinson-White Syndrome, a genetic condition where the heart beats too fast sometimes. 

Pregnancy. Available data does not show that propranolol would negatively affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant.

Breastfeeding. Propranolol passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed.

Interactions

Does propranolol interact with foods or drinks?

There are no known interactions between propranolol and foods or drinks.

Drinking alcohol may increase the drug levels of propranolol and may increase risk of side effects.

Does propranolol interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before taking propranolol.

• Diltiazem and verapamil, which are medicines used to treat chest pain and high blood pressure
• Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
• A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
• Clonidine, which is a medicine used to treat high blood pressure and attention deficit hyperactivity disorder (ADHD)
• Warfarin (Coumadin, Jantoven), which is a blood thinner
• Alpha-blockers, such as terazosin or doxazosin, which are medicine for high blood pressure or prostate problems
• Any corticosteroid, which are medicine for certain inflammatory conditions
• Cimetidine (Tagamet HB), which is a medicine used for heartburn
• A thyroid medicine, such as levothyroxine, which is used to raise thyroid hormone levels
• Colesevelam (Welchol) or colestipol (Colestid), which are medicine for high cholesterol
• Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety 
• A type of medicine called a triptan, such as sumatriptan (Imitrex and others), eletriptan (Relpax), and others, which is commonly used to treat migraines
• Theophylline, which is a medicine for certain breathing problems
• Any medicine for irregular heart rate or rhythm
• Any medicine for high blood pressure 
• Any medicine for diabetes
• Any medicine for depression or schizophrenia

Many other medicines may alter the blood levels of propranolol, and vice versa. Tell your healthcare provider about all medicines that you take or have recently taken.

Overdose/Missed Dose

What should I do if I accidentally use too much propranolol?

If you or someone else has used too much propranolol, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of propranolol?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.

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