Propranolol: clinical use

Prescribing considerations

• Confirm the indication, cardiovascular status and history of asthma, wheeze, hypoglycaemia or peripheral vascular disease.
• Avoid abrupt withdrawal, particularly in ischaemic heart disease; discontinuation should be supervised.
• Account for increased exposure and sensitivity in significant hepatic or renal impairment and in older people.
• Propranolol can mask tachycardia from hypoglycaemia and clinical signs of thyrotoxicosis.
• Review peri-operative management and inform the anaesthetist.

Contraindications and cautions

• History of bronchial asthma or bronchospasm.
• Bradycardia, hypotension, cardiogenic shock, sick sinus syndrome or second- or third-degree heart block.
• Uncontrolled heart failure or Prinzmetal angina.
• Severe peripheral arterial circulatory disturbance.
• Metabolic acidosis, prolonged fasting or other states with inadequate counter-regulation of hypoglycaemia.
• Untreated phaeochromocytoma; appropriate alpha-blockade is required when propranolol is used for this condition.

Monitoring

• Heart rate, blood pressure and symptoms of hypotension or conduction disturbance.
• Clinical response for the treated indication.
• Blood glucose and hypoglycaemia awareness in susceptible patients, especially those using insulin.
• Breathing symptoms if wheeze or breathlessness develops.
• Cardiac status where heart failure or poor cardiac reserve is relevant.
• Liver function and signs of hepatic encephalopathy in portal hypertension or decompensated cirrhosis.

Clinical pharmacology

Propranolol is a non-selective competitive beta-1 and beta-2 adrenoceptor antagonist with negative chronotropic and inotropic effects. It undergoes substantial hepatic first-pass metabolism, is widely distributed, including into the central nervous system, and is highly protein bound.

Formulation and product differences

• Selected Rosemont products are immediate-release oral solutions containing maltitol, propylene glycol and parabens; some also contain sunset yellow and small amounts of ethanol.
• The selected film-coated tablet contains lactose, and its score line is not intended for division.
• Xytencorg is an aspartame-containing orodispersible tablet that disperses on the tongue and may be swallowed with or without water; its score line is not intended for division.
• Do not assume formulations are interchangeable by volume, appearance or brand name. Verify the product and concentration before prescribing, dispensing or administering.

Capsule

Route: Oral

Strengths: 80 mg, 160 mg

Dispersible tablet

Route: Oral

Strengths: 10 mg, 40 mg