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Key takeaways
Propranolol, a beta blocker, is prescribed for various heart-related conditions but can cause side effects like dizziness, fatigue, gastrointestinal issues, and more severe effects, such as hallucinations, mood changes, and even mask symptoms of low blood sugar in people with diabetes.
Propranolol may not be suitable for those with pre-existing conditions, including those with asthma, uncontrolled heart failure, and certain blood pressure conditions.
To minimize side effects, it’s crucial to follow prescribed dosages, consider opting for extended-release versions, and consult a doctor when side effects are severe.
Propranolol (generic for brand-name Inderal) is a prescription drug that is approved by the U.S. Food and Drug Administration (FDA) to treat or prevent a number of cardiovascular problems, including high blood pressure, chest pain (angina), heart rhythm problems, heart attack, and an enlarged heart. It is also approved to prevent migraine headaches, reduce tremors, and control some of the effects of adrenal gland cancer. Before taking this medication, patients should be aware of propranolol side effects, warnings, and interactions. Learn how to avoid these side effects below.
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Common side effects of propranolol
As with any medication, there’s always the potential for side effects. Here are some common side effects of propranolol:
- Dizziness
- Lightheadedness
- Tiredness
- Nausea
- Stomach pain
- Decreased sex drive
- Diarrhea
- Constipation
Because propranolol slows down the heart rate, it may cause symptoms of a heart rate that is too slow (bradycardia), which can include chest pain, dizziness, fatigue, and fainting.
Propranolol is often prescribed for treating high blood pressure, and it may lower blood pressure too far, a condition known as hypotension. Symptoms of hypotension may include blurred vision, confusion, dizziness, fatigue, and shallow breathing.
Serious side effects of propranolol
While rare, serious side effects can happen and may require medical attention. These may include:
- Shortness of breath or wheezing
- Swelling of hands, feet, or face
- Rash or hives
- Hallucinations or confusion
- Depression or mood changes
- Memory problems
- Muscle cramps or weakness
- Cold hands or feet
- Insomnia or nightmares
Seek immediate help if you experience:
- Trouble breathing
- Rapid weight gain
- Severe dizziness
- Swelling or rash that worsens
“You should stop taking propranolol if serious side effects occur, but only under the guidance of a physician,” says Reuben Elovitz, MD, founder and CEO of Private Health Dallas.
Propranolol and weight gain
Propranolol may cause weight gain in some individuals, typically seen within the first few months of treatment and sustained with long-term use. In one clinical study, patients given propranolol gained more weight than those taking a placebo. The average weight gain was about five pounds.
Not everyone taking propranolol will experience weight gain, and in most cases, the weight gain is modest and can be managed through exercise and a balanced diet. Rapid weight gain, particularly if accompanied by swelling in the feet or difficulty breathing, may indicate a more serious problem and should be reported to a healthcare professional immediately.
How long do propranolol side effects last?
Side effects of propranolol can last anywhere from days to weeks. Most side effects will go away within a few days as the body adjusts to the medication. For others, this adjustment period may take longer. Side effects can worsen or improve as dosages increase or decrease. Long-term side effects of propranolol are possible, but this doesn’t happen for everyone.
Does dose affect the prevalence of side effects?
Because propranolol is used to treat a variety of conditions, the typical dosage amount can range from 10 mg to 40 mg, taken three or four times daily. There may also be variation in the dosage amount depending on whether an immediate-release or extended-release dosage form is taken. Higher doses of propranolol may increase the likelihood of experiencing side effects or worsening existing side effects.
What are the long-term side effects of propranolol?
Long-term propranolol use can help manage blood pressure and prevent heart attacks, but extended use may worsen side effects. In diabetics, it can mask symptoms of low blood sugar. High doses over time may lead to irregular heartbeats or exacerbate existing heart issues.
Never stop propranolol suddenly; doing so may cause chest pain or a heart attack. Always consult your doctor before adjusting your dose.
Propranolol warnings
Propranolol isn’t suitable for everyone. Avoid propranolol if you have:
- Bradycardia (slow heart rate)
- Asthma or breathing issues
- Uncontrolled heart failure
- Peripheral vascular disease
- Diabetes
- Pheochromocytoma
- Myasthenia gravis
- Hypotension or orthostatic hypotension
If you have hyperthyroidism, Raynaud’s disease, or liver, kidney, lung, or heart conditions, consult your doctor before use. These may cause adverse reactions or serious complications.
Pregnancy and breastfeeding
Propranolol during pregnancy should only be taken if the benefits outweigh the risks, as research on safety is limited. The drug passes into breast milk, so nursing mothers should use caution. Always speak with your healthcare provider before starting or stopping propranolol if pregnant, planning pregnancy, or breastfeeding.
Age restrictions
Propranolol may be prescribed for children (e.g., infantile hemangioma) only when necessary. For older adults, especially those with liver, kidney, or heart issues, doctors prescribe with caution. In some people over 60 with hypertension, propranolol may not be appropriate.
RELATED: How to lower blood pressure quickly and naturally
Propranolol interactions
Propranolol can interact with certain medications, including:
- Alpha blockers: Prazosin
- Anticholinergics: Scopolamine
- Other high blood pressure medications: Clonidine, acebutolol, nebivolol, digoxin, metoprolol
- Other heart medications: Quinidine, digoxin, verapamil
- Steroid medications: Prednisone
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Aspirin, ibuprofen
- Certain antidepressants: Fluoxetine, fluvoxamine
Avoid alcohol and limit caffeine, as both can intensify side effects or raise blood pressure. Always review all medications, vitamins, and supplements with your healthcare provider before starting propranolol.
Propranolol vs. propranolol ER side effects
Both forms of propranolol share similar side effects. The key difference is dosing:
- Regular (immediate-release): Taken multiple times daily
- ER (extended-release): Taken once daily
Some people prefer propranolol ER for convenience, but your provider will determine which version is best for you.
How to avoid propranolol side effects
To lower your risk of side effects:
- Follow the dosing instructions carefully
- Take immediate-release tablets on an empty stomach
- Take extended-release capsules consistently with or without food
- Avoid alcohol and limit caffeine
- Store at room temperature away from heat or light
- Don’t skip or double doses
If side effects become too severe, your provider may adjust your dose or suggest a different medication.
Other medications that treat similar conditions include:
Frequently asked questions about propranolol
Why should you not take propranolol?
It can be dangerous for people with asthma, a very slow heart rate, or certain heart conditions.
Does propranolol help with anxiety?
It’s often prescribed off-label to relieve physical symptoms of anxiety, like a racing heart or shaky hands.
Does propranolol cause weight gain?
It can, especially with long-term use, possibly due to fluid retention or a slower metabolism.
Will propranolol help me sleep?
Yes, it may cause insomnia or vivid dreams in some people.
Does propranolol cause hair loss?
Hair thinning is a possible side effect, but it typically reverses after discontinuation of the medication.
- Inderal (propranolol hydrochloride), FDA label
- Innopran XL (propranolol hydrochloride), FDA label
- Propranolol hydrochloride extended-release, FDA label
- Long term propranolol treatment and changes in body weight after myocardial infarction, British Medical Journal (1990)
- New thinking about beta blockers, Harvard Health Online (2015)
- When not to use beta blockers in seniors with hypertension, The Journal of Family Practice (2008)