Propranolol dosage, forms, and strengths

Propranolol is a generic prescription for treating high blood pressure, heart problems, and other medical conditions. Belonging to a family of drugs called beta blockers, propranolol lowers blood pressure, slows heart rate, and reduces the force of heartbeats. Healthcare professionals use propranolol to treat high blood pressure, chest pain (angina), heart rhythm problems, and heart muscle enlargement, as well as to prevent heart or blood vessel problems right after a heart attack. Other FDA-approved uses include migraine headache prevention, adrenal gland mass (pheochromocytoma), and essential tremor. 

Propranolol forms and strengths

Most people take propranolol as a tablet or oral solution, but hospitalized patients with life-threatening heart rhythm problems may require intravenous injections. Extended-release propranolol is available as generic or several brand names, including Inderal LA, Inderal XL, or InnoPran XL.

• Tablets: 10 milligrams (mg), 20 mg, 40 mg, 60 mg, 80 m

• Extended-release capsules: 60 mg, 80 mg, 120 mg, 160 mg

• Oral solution: 20 mg per 5 mL, 40 mg per 5 mL

Propranolol dosage for adults

Healthcare professionals prescribe propranolol for several cardiovascular medical conditions: hypertension, heart rhythm problems, heart muscle enlargement, and right after a heart attack. It’s also used for a specific adrenal gland mass (pheochromocytoma), tremor, and preventing migraine episodes. In addition, healthcare professionals often prescribe propranolol off-label to treat the symptoms of anxiety and panic attacks. Other off-label uses for propranolol include treating agitation, aggressiveness, hyperthyroidism (thyrotoxicosis), thyroid storm, heart failure, hemangiomas, and controlling the body’s metabolism in severe burn patients.

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Propranolol dosage for hypertension

Propranolol reduces blood pressure by relaxing and widening blood vessels, slowing down the heart, and reducing the force of individual heartbeats. 

• Standard adult dosage for hypertension: 80–240 mg per day divided into two or three daily doses OR 120–160 mg extended-release capsule once per day

• Maximum adult dosage for hypertension: 640 mg per day

Propranolol dosage for angina

Propranolol reduces the incidence of chest pain and increases exercise tolerance. Angina results from oxygen deprivation of the heart’s muscles due to clogged arteries. By slowing the heart and reducing the strength of individual contractions, propranolol reduces the heart muscle’s oxygen needs.

• Standard adult dosage for hypertension: 80–320 mg per day divided into two, three, or four daily doses OR 80–320 mg extended-release capsule once per day

• Maximum adult dosage for hypertension: 320 mg per day

Propranolol dosage for heart attack

Immediate-release propranolol or a similar beta-blocker such as atenolol or metoprolol is given in the weeks and months after a heart attack (myocardial infarction) to reduce the likelihood of another heart attack or other cardiovascular events. 

• Standard adult dosage for heart attack: 180–240 mg per day divided into three daily doses

• Maximum adult dosage for hypertension: 240 mg per day

Propranolol dosage for migraine prevention

Many migraine symptoms, including headache pain, are caused by the sudden narrowing of blood vessels in the brain. Immediate-release propranolol helps to prevent migraines by widening blood vessels.

• Standard adult dosage for migraine prevention: 160–240 mg per day divided into two or three divided doses

• Maximum adult dosage for migraine prevention: 240 mg per day

Propranolol dosage for essential tremor

Propranolol helps reduce tremors in the hands and arms, but healthcare professionals do not know how it works. 

• Standard adult dosage for migraine prevention: 120 mg per day divided into two or three divided doses

• Maximum adult dosage for migraine prevention: 320 mg per day

Propranolol dosage for arrhythmias

When the heart beats abnormally or too quickly, healthcare professionals call this an arrhythmia. Propranolol is FDA-approved to treat atrial fibrillation (AFib), a condition in which the top chambers of the heart beat irregularly and not in combination with the other parts of the heart, and supraventricular tachycardia (SVT), a condition in which the bottom chambers of the heart beat too fast. Cardiologists and emergency room doctors use well-established guidelines for dosages and treatment duration. The first doses may be administered as intravenous injections to stabilize the heart. Some people with AFib may be prescribed immediate-release propranolol tablets.

Propranolol dosage for hypertrophic obstructive cardiomyopathy

Formerly called hypertrophic subaortic stenosis (IHSS), hypertrophic obstructive cardiomyopathy (HOCM) is a heart condition in which the wall that separates the two lower heart chambers (ventricles) grows too thick, and blocks blood flow out of the heart. HOCM is a common cause of unexpected and sudden death. The use of propranolol reduces the risk of HOCM complications such as fast heartbeats, heart failure, heart block, sudden heart attack, or sudden death.

Propranolol dosage for pheochromocytoma

Pheochromocytoma is a mass on the adrenal gland that causes the adrenal gland to overproduce stress hormones. Beta blockers like propranolol are prescribed to decrease the adverse effects of elevated stress hormones such as fast heartbeats and high blood pressure. They are only prescribed along with alpha-blockers as a second-line treatment.

Propranolol dosage for children

Propranolol is not FDA-approved for use in children or teens. However, the FDA has approved the use of Hemangeol (propranolol oral solution) to treat infantile hemangioma in newborns and very young infants from the age of five weeks to five months. Hemangiomas are benign blood vessel tumors that cause raised red spots on the skin. Propranolol is the first-line treatment for this type of tumor. Doses will be based on the infant’s weight and are taken twice per day. Doses will increase between the first and second week and between the second and third week. After that, doses will change based on the baby’s body weight. 

Propranolol dosage restrictions

The FDA has not specified dosage restrictions for people with kidney problems, hepatic impairment, or age.

Propranolol dosage for pets 

Veterinarians use propranolol in both dogs and cats to treat many of the same conditions as humans: high blood pressure, fast heartbeats, irregular heartbeats, hyperthyroidism, and pheochromocytoma (adrenal gland cancer). The standard dosage in dogs is 0.2 to 1 mg per kilogram of body weight every eight hours. Cats will receive 0.4 to 1.2 mg/kg every eight hours.

How to take propranolol

People usually take propranolol orally as a tablet or extended-release capsule. People who cannot swallow a tablet or capsule will be given an oral solution for easier dosing.

• Take this medicine as directed. The dose may change several times during the course of therapy.

• Propranolol can be taken with or without food, but take it the same way each time.

• Swallow the extended-release capsule whole. Do not crush, break, or chew it.

• Take the extended-release capsule at bedtime.

• When taking the oral liquid, measure each dose with the oral syringe that comes with the package. Mix the liquid with water or juice to make it easier to swallow. 

• Only administer Hemangeol or propranolol oral solution to an infant during or after feeding. Do not administer a dose if the child is vomiting or unable to eat.

• This medicine should come with a Medication Guide. Ask your pharmacist for a copy if you do not have one.

• Missed dose: Take a dose as soon as you remember. If it is almost time for the next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose.

• Store the medicine in a closed, childproof container at room temperature, away from heat, moisture, freezing temperatures, and direct light. 

Propranolol dosage FAQs

How long can you take propranolol?

No limits have been placed on propranolol treatment duration. Healthcare professionals will prescribe the medicine for as long as it works and as long as side effects are tolerable.

How do I stop taking propranolol?

Do not stop taking propranolol abruptly unless instructed by a doctor. The sudden discontinuation of propranolol may worsen existing conditions such as chest pain, heart racing or blood pressure. Talk to a healthcare provider if there are problems with propranolol. The clinician may need to taper the dose to end treatment. 

Can you overdose on propranolol?

Do not take more propranolol than prescribed. A propranolol overdose can cause blood pressure to fall too low (hypotension) or the heart to slow down (bradycardia). Symptoms of an overdose or an overreaction include slow heartbeats, racing heartbeats, trouble breathing, lightheadedness, restlessness, and tremors. Call a poison helpline or get emergency care if you’ve taken too much propranolol or overreacted to a regular dose.

What interacts with propranolol?

Only a handful of drugs are contraindicated for use with propranolol. The others will require extra monitoring for side effects. At the top of the list are other drugs that reduce blood pressure, such as ACE inhibitors, calcium channel blockers, diuretics, and prazosin. The combination may cause dangerously low blood pressure. Your physician may ask that you take your blood pressure daily (or when you feel tired, weak, chest pain, or have shortness of breath), write these down, and submit the blood pressure log for review. 

Other drugs that might cause problems when taken with propranolol include heart rhythm drugs, epinephrine, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), asthma drugs, clonidine, the blood thinner warfarin, and illicit drugs such as cocaine. Some drugs, like theophylline or cimetidine, may increase the risk of serious side effects of propranolol.

The list of possible drug interactions is long. Make sure to tell the prescribing clinician about all drugs being taken. Ask the prescriber for medical advice about what vitamins or supplements are safe to take with propranolol. 

Is it safe to take propranolol during pregnancy?

There are no studies on the use of propranolol during pregnancy, so healthcare professionals are cautious about giving it to pregnant women. There’s no indication that it affects pregnancy or causes birth defects. However, there have been cases of infants born to women on propranolol who have had slow heart rates, slowed breathing, or low blood sugar. There are other pregnancy-safe medications to use. Let your physician know that you are anticipating an upcoming pregnancy and your medications can be changed before conception. 

Is it safe to take propranolol while breastfeeding?

When breastfeeding women take propranolol, studies have shown that only a small amount of propranolol is present in breast milk. No studies have identified adverse effects in a nursing baby.