Propranolol

Propranolol, which treats high blood pressure, irregular heart rhythms, chest pain, and other heart symptoms, is also approved by the U.S. Food and Drug Administration (FDA) for preventing migraine attacks.

Propranolol falls into the beta-blocker class of medications. Beta blockers reduce the frequency of migraine attacks in 60 to 80 percent of people.1 It is not clear, however, if propranolol affects active migraine, so it should not be taken to stop migraine attacks already in progress.

Propranolol is available in multiple formulations, including tablets, liquid, and a long-acting time-release capsule.2 Not all formulations of propranolol are approved for preventing migraine.

This medication is sold under the brand names:

  • Inderal®
  • Inderal® LA
  • Inderal® XL
  • InnoPran® XL

What are the ingredients in propranolol?

Propranolol is the active ingredient in Inderal LA, Inderal XL, and InnoPran XL.

How does propranolol work?

Propranolol works by blocking certain receptors, known as beta receptors, in blood vessels. This causes the vessels to relax and improve blood flow. It also slows down the heart rate. Researchers do not fully understand how Inderal works to prevent migraine.3 But since migraine are thought to result from changes to blood flow in the brain, it is possible that opening the vessels can serve as a mode of prevention.

What are the possible side effects of propranolol?

Many clinical trials evaluated the safety and efficacy of propranolol. The most common side effects experienced by those taking propranolol include:

  • Tiredness or depression
  • Dizziness or lightheaded feeling
  • Diarrhea
  • Constipation
  • Difficulty breathing
  • Tightness in chest
  • Inderal can also mask the effect of low blood sugar in people with diabetes
  • Heart failure

This is not an exhaustive list of all potential side effects of propranolol. For more information, consult your doctor or healthcare provider. If you notice any new or worsening side effects, contact your doctor or healthcare provider immediately.

Things to note about propranolol

Propranolol should NOT be stopped suddenly. When patients abruptly stop taking this medication, it can sometimes lead to chest pains or even heart attacks.

You should not use this medication if you are allergic to it, have asthma, a slow heart rate, abnormal heart rhythms, uncontrolled heart failure, or serious heart conditions called “sick sinus syndrome” or “AV block”.3

Seek immediate medical attention if you experience problems breathing, blistering or peeling skin, itching or hives, swelling in the face, throat, lips, or tongue, sore throat, unusual bleeding, swelling in your feet or hands, unusual weight gain, chest pain or a slow or irregular heartbeat.

Before starting propranolol, talk with your healthcare provider if you:

  • Have heart failure
  • Are scheduled for surgery and will be given anesthesia
  • Have diabetes and take medicine to control blood sugar
  • Have thyroid problems
  • Have irregular heartbeats
  • Have liver or kidney problems
  • Have had allergic reactions to medications or have allergies
  • Have asthma or other lung problems (such as bronchitis or emphysema)
  • Are pregnant or trying to become pregnant
  • Are breastfeeding, as the drug is excreted in breast milk
  • Are taking any other medications, vitamins, or dietary supplements3

Dosing information

It is important to take this medicine exactly as your healthcare provider prescribes. Providers usually recommend taking a small dose to start (beginning with an 80 mg oral tablet or 80 mg oral solution once daily), and then gradually increasing until the patient experiences relief from chronic migraine symptoms. Usually the effective dose is between 160-240 mg taken once per day.4,5

This medicine can be taken with or without food, but it works best when it is always taken the same way and around the same time of day.

For more information, read the full prescribing information of Inderal, Inderal LA, Inderal XL, or InnoPran XL.

Written by: Sara Finkelstein | Last reviewed: June 2018.
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