Propranolol (Intravenous)

Propranolol is also known under US brand name Inderal and is a drug given via injection to control abnormal heart rhythms and fast heartbeats.

Overview

Propranolol injection is a drug used to control abnormal heart rhythms and fast heartbeats. This medication is a beta-blocker and works by affecting the response to the nerve impulses in various parts of the body, such as the heart. This results in the heart beating slower and at a regular rhythm. This medication is only available via prescription from your doctor and is available in the dosage form: solution.

Conditions Treated

  • Having a Rapid Heart Action - Supraventricular Tachycardia
  • Ventricular Rate Control in Atrial Fibrillation
  • Life-Threatening Rapid Ventricular Heartbeat
  • Irregular Heartbeat During Surgery

Type of Medicine

  • Solution

Side Effects

Along with its intended effects, the consumption of Propranolol can produce some unwanted side effects. Not all of these side effects may occur at the same time, but if they do, they may require medical attention.

Inform your doctor or a healthcare professional immediately if you suffer from any of the following side effects whilst taking propranolol:

More common side effects:

  • Blurred vision
  • Decreased urine output
  • Chest discomfort or pain
  • Dilated neck veins
  • Irregular breathing
  • Faintness, dizziness or lightheadedness when getting up from a sitting or lying position suddenly
  • Extreme fatigue
  • Fainting, lightheadedness, dizziness
  • Confusion
  • Slow or irregular heartbeat
  • Shortness of breath
  • Sweating
  • Tightness in chest
  • Swelling of face, fingers, feet, or lower legs
  • Troubled breathing
  • Wheezing
  • Unusual weakness or tiredness
  • Weight gain

Rare side effects:

Incidence not determined:

  • Abdominal pain, usually after eating a meal
  • Black, tarry stools
  • Abdominal tenderness
  • Bloody stools
  • Blood in urine
  • Bloody nose
  • Body aches or pain
  • Constipation
  • Crawling, burning, itching, numbness, prickling, "pins and needles", or tingling feelings
  • Congestion
  • Cough
  • Difficult or labored breathing
  • Decreased awareness or responsiveness
  • Diarrhea
  • Dryness or soreness of throat
  • Heavier menstrual periods
  • General feeling of tiredness or weakness
  • Hoarseness
  • Mimicry of speech or movements
  • Lower back or side pain
  • Mutism
  • Negativism
  • Nausea
  • No pulse or blood pressure
  • Painful or difficult urination
  • Noisy breathing
  • Paleness or cold feeling in fingertips and toes
  • Pinpoint red or purple spots on skin
  • Peculiar postures or movements, mannerisms, or grimacing
  • Rectal bleeding
  • Reddened skin
  • Severe sleepiness
  • Runny nose
  • Sores on the skin
  • Tender, swollen glands in neck
  • Ulcers, sores or white spots on lips or in mouth
  • Stopping by heart
  • Tingling or pain in fingers or toes when exposed to cold
  • Unconsciousness
  • Trouble in swallowing
  • Unusual bruising or bleeding
  • Vomiting
  • Voice changes

Some side effects of propranolol that may occur usually won't need medical attention. You usually find these side effects begin to disappear as your body starts adjusting to the medication. However, if they are bothering you, you should contact your local pharmacist or doctor for advice on ways to prevent or reduce these side effects. may occur that usually do not need medical attention.

Rare side effects:

  • Decreased interest in sexual intercourse
  • Loss of sexual ability, desire, drive, or performance
  • Dry eyes
  • Inability to have or keep an erection
  • Thinning of hair
  • Pain of penis on erection
  • Skin irritation or rash, including rash that looks like psoriasis

Incidence not determined:

  • Crying
  • Disturbed color perception
  • Depersonalization
  • Double vision
  • Euphoria
  • Confusion about time, identity, place
  • Dysphoria
  • Halos around lights
  • Loss of vision
  • Loss of energy or strength
  • Mental depression
  • Night blindness
  • Muscle weakness
  • Overbright appearance of lights
  • Quick to react or overreact emotionally
  • Paranoia
  • Rapidly changing moods
  • Short-term memory loss
  • Hearing, seeing or feeling things that are not there
  • Sleeplessness
  • Tunnel vision
  • Trouble sleeping
  • Unable to sleep
  • Vivid dreams
  • Unusual drowsiness, dullness, or feeling of sluggishness

Remember you can report all side effects to the FDA on 1-800-FDA-1088, regardless of severity.

Dosage

The final dosage of any medication will depend on a variety of different factors. This includes your weight, age and height, your past medical history, any medications you are currently taking, the severity of your condition and how you react to the first dose. A trained health professional or nurse will give you this medication. This drug is given through a needle placed in one of your veins.

Adult dose for heart rate control those with atrial flutter and for atrial fibrillation

  • The usual dose is 1 - 3 mg IV, given at a rate no faster than one mg/minute. If needed, a second dose can be given after a two minute period with careful monitoring of heart rate and blood pressure. Thereafter, subsequent doses can be given every four hours as needed.

Adult dose for the treatment of paroxysmal supraventricular tachycardia (PSVT) prophylaxis or paroxysmal supraventricular tachycardia (PSVT)

  • 1 - 3 mg IV at a rate no faster than one mg/minute. This should be repeated if necessary every two minutes. Separate any subsequent doses by at least a four hour period.
  • In geriatric patients, begin with conservative initial doses and ensure you titrate carefully. Elderly patients typically have unpredictable responses to beta-blockers in general.

Adult dose for the treatment of an evolving acute myocardial infarction

  • 0.1 mg/kg IV, administered in three equally divided doses at two to three-minute intervals.

Interactions

Drug interactions can cause severe side effects or reduce the effectiveness of either drug. To limit these interactions, it's important that you give your doctor or a healthcare professional a full list of the medications you are currently taking and any past medications also. This should include all prescription, non-prescription drugs, vitamins, and herbal remedies. You should also let your doctor know of any current medical conditions you are suffering from, including any medical conditions that are hereditary or present in your family history.

The use of this medication is not recommended with the following drugs. Your doctor may decide to avoid treating you with this drug altogether or alter some of the other medications you take.

  • Thioridazine

The use of this medication alongside any of the following medications is not usually recommended. However, in some cases, it may be the best treatment option for you. If you are prescribed both medications together, your doctor may alter the dose or frequency in which you take one or both medications.

  • Bupivacaine Liposome
  • Clozapine
  • Bupivacaine
  • Bupropion
  • Clonidine
  • Crizotinib
  • Diatrizoate
  • Epinephrine
  • Dronedarone
  • Eslicarbazepine Acetate
  • Fenoldopam
  • Fingolimod
  • Fluoxetine
  • Haloperidol
  • Lidocaine
  • Lacosamide
  • Mefloquine
  • Oxymetazoline
  • Mepivacaine
  • Peginterferon Alfa-2b
  • Prilocaine
  • Pixantrone
  • Verapamil
  • Rivastigmine
  • Simeprevir

The use of this medication with any of the following drugs can cause an increase in some side effects, but in some cases, the use of both drugs may be necessary. If both medications are prescribed together, your doctor may alter the dose or frequency of how often you take one or both of the medications.

  • Acarbose
  • Acetyldigoxin
  • Acemetaci
  • Aceclofenac
  • Albiglutide
  • Alogliptin
  • Alfuzosin
  • Amiodarone
  • Bromfenac
  • Amtolmetin Guacil
  • Aspirin
  • Bufexamac
  • Arbutamine
  • Canagliflozin
  • Bunazosin
  • Celecoxib
  • Chlorpromazine
  • Choline Salicylate
  • Chlorpropamide
  • Cholestyramine
  • Cimetidine
  • Clonixin
  • Dapagliflozin
  • Dexibuprofen
  • Deslanoside
  • Dexketoprofen
  • Diflunisal
  • Diclofenac
  • Digitoxin
  • Dihydroergotamine
  • Digoxin
  • Dipyrone
  • Doxazosin
  • Disopyramide
  • Droxicam
  • Empagliflozin
  • Ergotamine
  • Dulaglutide
  • Etofenamate
  • Etodolac
  • Etoricoxib
  • Felbinac
  • Exenatide
  • Fenoprofen
  • Flecainide
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flurbiprofen
  • Flufenamic Acid
  • Fluvoxamine
  • Glipizide
  • Glimepiride
  • Glyburide
  • Ibuprofen
  • Guggul
  • Indomethacin
  • Insulin Degludec
  • Insulin Aspart, Recombinant
  • Insulin Detemir
  • Insulin Glulisine
  • Insulin Human Isophane (NPH)
  • Insulin Human Inhaled
  • Insulin Human Regular
  • Ketoprofen
  • Insulin Lispro, Recombinant
  • Linagliptin
  • Ketorolac
  • Liraglutide
  • Lornoxicam
  • Lixisenatide
  • Loxoprofen
  • Meclofenamate
  • Lumiracoxib
  • Mefenamic Acid
  • Metildigoxin
  • Meloxicam
  • Metformin
  • Miglitol
  • Mibefradil
  • Morniflumate
  • Nabumetone
  • Moxisylyte
  • Naproxen
  • Niflumic Acid
  • Nateglinide
  • Nepafenac
  • Nimesulide
  • Oxaprozin
  • Nimesulide Beta Cyclodextrin
  • Oxyphenbutazone
  • Phenoxybenzamine
  • Parecoxib
  • Phentolamine
  • Phenylephrine
  • Phenylbutazone
  • Piketoprofen
  • Piperine
  • Pioglitazone
  • Piroxicam
  • Pranoprofen
  • Pramlintide
  • Prazosin
  • Propoxyphene
  • Proglumetacin
  • Propyphenazone
  • Quinidine
  • Proquazone
  • Repaglinide
  • Rizatriptan
  • Rifapentine
  • Rofecoxib
  • Salicylic Acid
  • Rosiglitazone
  • Salsalate
  • Sertraline
  • Saxagliptin
  • Sitagliptin
  • St John's Wort
  • Sodium Salicylate
  • Sulindac
  • Tenoxicam
  • Tamsulosin
  • Terazosin
  • Tolbutamide
  • Tiaprofenic Acid
  • Tolazamide
  • Tolfenamic Acid
  • Trimazosin
  • Tolmetin
  • Tubocurarine
  • Valdecoxib
  • Urapidil
  • Zileuton
  • Vildagliptin

Other Interactions

Some medications can not be used at or around the time of eating food or eating certain types of food. This is due to the risk of interactions. Using tobacco or alcohol with certain medications can also cause interactions to occur.

The use of this medication with any of the following is not recommended. If used together, your doctor may alter the dose or frequency in which you take either substance or give you special instructions about the alcohol, food or tobacco.

  • Tobacco

Other Medical Problems

If you suffer from other medical conditions, this could affect the use of this medication. Ensure you inform your doctor or healthcare professional of any other medical issues you may suffer from, especially:

  • Asthma
  • Bradycardia (slow heartbeat)
  • Angina (severe chest pain) - This drug may provoke chest pain if it is stopped too quickly.
  • Heart block
  • Type 1 or Type 2 diabetes
  • Heart failure - This drug should not be used in those patients who suffer from heart failure.
  • Hyperthyroidism (overactive thyroid)
  • Kidney disease
  • Hypoglycemia (low blood sugar) - This drug may cover up some of the symptoms and signs of this disease, such as a fast heartbeat.
  • Liver disease - Caution should be exercised as the effects may be increased because due to a slower removal of the drug from the body.
  • Wolff-Parkinson-White syndrome (rare heart condition) - This drug may cause a very slow heartbeat in patients with this condition.
  • Lung disease (e.g., bronchitis, emphysema) - This drug may cause difficulty with breathing in patients who suffer from lung disease.

Warnings

Use in pediatric population

Studies have not been conducted on the relationship of age to the effects of propranolol injection in the younger population. Therefore efficacy and safety have not been established.

Use in geriatric population

Studies conducted to date have not indicated a geriatric-specific problem that could limit the effectiveness of propranolol injection in the older population. However, older patients are more likely to have age-related kidney, liver or heart problems, which may require a dosage adjustment in those patients receiving propranolol injection.

Use in pregnancy and breastfeeding

This drug is under FDA pregnancy category C. It is unknown whether propranolol will cause harm to an unborn baby. Inform your doctor if you are pregnant or intend on falling pregnant whilst you are using propranolol.

With regards to breastfeeding, this drug can pass into breast milk and could cause harm to a nursing infant. You should let your doctor know if you are breastfeeding an infant as you may need to stop.

Avoid drinking alcohol as it can increase your blood levels of propranolol.

Avoid jumping up too fast from a lying or sitting position, or you may experience dizziness. Get up steady and slowly to prevent falling.

Storage

This medication will be stored in a hospital setting. It should be stored in a Refridgerator before use in vials. It should be kept away from sunlight and moisture. Once opened, the medication should be used straight away. For advice on disposal of unused medication, you should contact your local pharmacist.

Summary

When used correctly, propranolol is successful in the treatment of fast heartbeats and abnormal heart rhythms. You will be given this injection for only a few doses until your condition improves and then you will be switched to an oral medication which works in the same way. If you have concerns or worries about this, you should speak with your doctor. Due to the high amount of interactions possible with this drug, it's important that you let your doctor or healthcare professional know about all the drugs you are currently taking. This drug isn't recommended during pregnancy or breastfeeding. Let your doctor know if you intended on becoming pregnant whilst using this medication. You should weigh up the benefits against the risks alongside your doctor. You will receive this drug in a clinical setting by a trained professional. This drug will be given via injection placed in your vein.

 

Resources
Last Reviewed:
January 28, 2018
Last Updated:
April 26, 2018