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Inderal (Propranolol)

Inderal (Propranolol)


Propranolol is a beta blocker used to treat high blood pressure, irregular heartbeats, shaking (tremors), and other conditions. It is used after a heart attack to improve the chance of survival. It is also used to prevent migraine headaches and chest pain (angina).


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Propranolol came on the market as Inderal – that was an immediate release Propranolol form, then it came on as a delayed release Propranolol form – Inopran. It is a beta blocker, a beta blocker used for a variety of heart related issues – Propranolol for blood pressure control. It was patented in 1962 and approved in 1964 by Food and Drug Administration and even though it is an old drug – it is still among the forty four most commonly prescribed drugs in America with more than eighteen million prescriptions written each year. Inderal comes in a variety of different dosages, so you can take the appropriate amount of Propranolol.

Since it came on the market, a variety of other beta-blockers came on the market as well, and have stolen its thunder. Now we have low-pressor – Metaprolol, we have Atenolol or Tenormin, we have bata pase, Quarguard and many others. Some of those are better sellers. If we look at the most popular drugs in America – the sixths most frequently prescribed drug is Metoprolol – to eight millions prescriptions each year, and Carvedilol and Atenolol all have more prescriptions than the Propranolol.

Indications for taking Propranolol

The original indications for taking Propranolol were high blood pressure control, used either alone or in combination with other medicines.

Propranolol for hypertension

Propranolol was not able to be used for the hypertensive emergencies, it could be used for angina – in people who had a chest pain when they walked a little bit. They could walk a little bit further if they were taking Propranolol against angina.

Propranolol could reduce the likelihood of cardiovascular death in people who suffered from heart attacks if it was begun two to three days after the heart attack. It would control the heart rate if atrial fibrillation did not get to normal synus rhythm, it controlled the ventricular response.

Propranolol for migraine prophylaxis

Propranolol for migraine prophylaxis, propranolol for prevention of migraine headaches – not the treatment of but the prevention of the migraine headaches.

It was also usded for treating an essential tremor.

Propranolol to keep the heart rate down

Off label it was used in people who were hyperthyroid and thyrotoxicosis and had to manage the high ventricular rate so it managed the high ventricular rate. Performance anxiety in musicians, and actors and public speakers was an issue and it seems that Propranolol could keep the heart rate down and about twenty five percent of those individuals take medicine like this. It was used for proliferating capillary hemangiomas in newborn infants, it was used as performance enhancing drug in those sports that require high degree of accuracy – like shooting or archery. Propranolol was used in people with cirrhosis to prevent esophageal bleeding from the dilated veins in the bottom of the esophagus. It is used in people who had aggressive behavior after brain injuries and sometimes we use propranolol for prevention of the cluster headaches.

Propranolol for treatment of Hyperhidrosis

Propranolol for treatment of Hyperhidrosis and Propranolol for treatment of excessive sweating, controlling glaucoma is not a first choice of course, but it does lower the intraocular pressure. Inderal for PTSD – posttraumatic stress disorder can be used as well, but it seems to alter the consolidation of those negative memories.

Additionally, it has been studied for treatment of specific phobias, for instance people who are afraid to go to the dentist or people who are afraid of certain insects – it seems to be helpful, but on the other side if you happen to have bronchial asthma or you already have slow heart rate – this drug is not for you , it is not for most people who have heart failure or people, obviously, who are hypersensitive to the drug, or people who have toxicity from taking too much cocaine.

Also it seem s that you should not stop the medicine abruptly. If you have a coronary artery disease (and you don’t need to know that you have a coronary artery disease), and if you stop taking Inderal abruptly it might lead to an increased incidence of angina or heart attack. If you want to stop the medicine – you do it slowly.

Some people develop hypersensitivity reaction to propranolol – you will know that, and fortunately it is relatively rare, so it should not be an issue.

There is an issue with heart failure. A lot of people have a problem with heart failure unfortunately, after a heart attack or a variety of other reasons. It seems that beta blockers can reduce the sympathetic regulation of the adrenalin and the noradrenalin the heart needs, so it might worsen congestive hear failure. People who happen to have asthma or who have bronchial spastic lung disorder – even chronic or intermittent – then those individuals might be at increased risk. Also, if you happen to have slow heart rate and you take Inderal with another beta blocker or Inderal with the Calcium blocker like diltiazem or Verapamil or you are taking Digitalis or even Clonidine – that might lead to problems.

Propranolol in diabetes

If you happen to be diabetic – it can reduce the awareness of the warning symptoms of hyperglycemia. It could be relatively dangerous if you happen to be diabetic and you have these issues with hyperglycemia.

Propranolol in hyperthyroidism

People who have an increased thyroid and they are taking the beta blocker – everything is good. After they are off the beta blocker if they have worsening of the thyroid issue – that might become apparent when a person develops a very high heart rate or develops an angina and a heart attack after.

There is another condition, a heart condition called Wolf Parkinson White or WPW syndrome – it is not appropriate to take Inderal with WPW syndrome.

Propranolol in slow heart rate

If we look at the medicine, it is not good if you already have a slow heart rate – it is going to slow down your heart rate even more, it is not good if you have bronchial asthma, diabetes or hyperthyroidism – you have to be extra careful then. Peripheral arterial disease – if you have narrowing of vessels going to your limbs – you have to be extra careful with propranolol. If you have myasthenia gravis – an issue is certainly possible – it can lead to decreased intraocular pressure, but that means that if you go to see your eye doctor and get a screen for glaucoma – it may give you a false low reading – so you might say everything is fine when indeed it is not. If you happen to be taking the drug and you are subject to anaphylactic reactions for whatever reason – because of obesity, certain food like nuts etc. If you are taking the beta-blocker than epinephrine, injection is not going to work as well.

If you have a high blood pressure – it can be related not only with a pill, but most appropriately with weight loss, with diet and exercise, getting off the cigarettes, controlling your blood lipids and consuming a low salt diet – then you add a blood pressure medicine if you need it.

How do I know if Propranolol is going to work for me?

It seems that certain individuals do not tend to respond very well to the beta-blockers. African Americans tend not to respond as well as the Caucasian population. If the African American individual takes the beta-blocker and a diuretic – then it seems to eliminate the racial disparity. On the other hand, there are better drugs to take because a person wants more out of treating the blood pressure than simply reducing the number. What you want to do is to reduce the likelihood that you are going to have a coronary event, a coronary vascular event. It seems like the ACE inhibitors or the angiotensin receptor blockers calcium blockers or even a diuretic might be a better choice for blood pressure control. As a matter of fact in European countries, UK for instance, they have downgraded Propranolol to fourth line drug. Not recommended anymore in United States, it is a first line drug by the national commission. They say if you take the drug and we look overall over a period of time might actually be associated with an increased risk of cardiovascular disease and increased incidence of heart attack and stroke. So, especially since the drug does not seem to work as well in African Americans, does not seem to work as well in elderly individuals, it might promote the diabetes in some individuals. If you are going to take Propranolol for high blood pressure control – better consider taking Metoprolol or Bisoprolol or Carvedilol – also other beta-blockers – they seem to work a little bit better.

As far as atrial fibrillation is concerned the drugs are accepted by the American College of Cardiology, but they say that Atenolol, Carvedilol or Metoprolol might be better choices. As as a rate control goes – if a person has atrial fibrillation it seems like it is a first line drug, as far as a rate control is concerned. But again we have gone from the predominance of the Propranolol to Metoprolol or Bisoprolol – they might be the first choice.

Propranolol for angina

As far as angina is concerned – there is no evidence that any of the beta-blockers is better than any other. The patient’s choice and the doctors choice is usually made on the basis of side effects.

Taking Propranolol after heart attack

If we look at heart attacks – taking Propranolol after heart attack – there were some basic studies conducted many years ago, and they show that if you are taking a beta blocker, if you start taking Propranolol after heart attack a couple of weeks after and continue for at least three years – it might decrease the mortality by significant amount. The cardiovascular mortality and the all-cause mortality will decrease by about forty percent in the first year.


That is significant, it seems that taking Propranolol after a heart attack prevents dysplastic remodeling of the ventricle.

Guidelines to how to take Propranolol

There are guidelines to how to take Propranolol. Those guidance are common to all beta-blockers, they don’t say which beta blocker in particular.

Most people are now opting for Carvedilol or z-beta or Metoprolol. You want to continue the drug for at least six months. You take Propranolol after heart surgery for six month, if you have not had a heart surgery – you have to take it even longer.

Is Propranolol outdated?

There is an issue with drugs, when the old drugs don’t seem to work nearly as effective as new drugs. If we are talking about taking Propranolol for heart – it is a non-selective beta-blocker. It works not only in the heart but also in the lung, so we now have these cardio selective beta-blockers that just concentrate their activity in the heart.

They don’t have some of the other side effects that are associated with the non-specific beta blockers. We have to switch away from the non-selective beta blockers like Propranolol if the person has chronic obstructive heart disease. You can take the drug, but the better choice would be the beta one selective drug. If we talk about migraine headaches – we might reduce the incidence of headaches by about one and a half headaches a month, which might be in line with some of the newer more fancier and much more expensive medicines.

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