Propranolol (generic for Inderal®)

Propranolol is the generic equivalent of Inderal®.

By law, a generic drug must be the same as its brand name counterpart in terms of active ingredient, dosage, safety, effectiveness, strength, stability, and quality. A generic may, however, differ in its inactive ingredients (i.e. flavoring, fillers, and preservatives).

Propranolol does come with serious warnings. These include:

• Worsening (or return) of chest pain or heart attack upon sudden discontinuation of propranolol*

• Worsening of heart failure

• Increased risk of heart failure in patients without a history of cardiac failure

• Nonallergic bronchospasm or difficulty breathing

• Masked symptoms of diabetes

• Masked symptoms of overactive thyroid

• Wolff-Parkinson-White Syndrome

• Hypotension (low blood pressure) when combined with other blood pressure medications

If any of the above concern you, speak with your doctor or pharmacist about your perceived risk and other treatment options that exist.

*This warning is a boxed warning. A boxed warning is the most serious type of medication warning assigned by the FDA.

Propranolol is FDA approved for:

• High blood pressure

• Atrial fibrillation

• Cardiovascular protection after a myocardial infarction (or heart attack)

• Prevention of migraine

• Angina pectoris (chronic chest pain)

• Essential tremor

• Thickening and narrowing of heart valves

• Certain kinds of anxiety (off-label)

*Depending on its intended use, your doctor may prescribe a specific formulation of propranolol.

Propranolol is commonly used off-label for physical symptoms of performance anxiety, including:

• Rapid pulse

• Dry mouth, tight throat

• Shakiness of the hands, knees, and voice

• Sweaty, cold hands

• Dizziness

Propranolol is a beta-blocker. It works by blocking certain receptors (beta-1 and beta-2) activated by the hormone epinephrine (or adrenaline). Beta-blockers cause the heart to beat more slowly and with less force, which lowers blood pressure. They also help widen veins and arteries to improve blood flow.

While beta-blockers are most commonly used for heart disease, it can also be used off-label for anxiety symptoms. When someone with performance anxiety takes propranolol, the drug blocks the effects of adrenaline, lessening physical symptoms of stress, like sweaty hands, rapid pulse, and shakiness.

The most common side effects of propranolol include:

• Lowered heart rate

• Dizziness or lightheadedness

• Insomnia

• Nausea/vomiting

• Abdominal cramps

• Difficulty breathing, wheezing

• Constipation, diarrhea

Side effects may improve over time as your body adjusts to the medicine.

This list doesn’t represent all possible side effects (or serious adverse effects) of propranolol. If you’re experiencing any ongoing, bothersome side effect(s), tell your healthcare provider right away.

If you’d like to learn more, speak with your doctor or pharmacist. The Food and Drug Administration (FDA) also has a helpful medication guide for propranolol here.

Propranolol can interact with some medicines and supplements. It’s always recommended to give both your doctor and pharmacist an updated list of the medicines and supplements you’re taking, so drug interactions can be identified.

Propranolol can interact with the following medicines:

• Arrhythmia drugs: propafenone, quinidine, lidocaine

• Migraine drugs: zolmitriptan, rizatriptan

• Thioridazine

• Calcium channel blockers: nifedipine, verapamil, amlodipine, diltiazem

• Other drugs used for high blood pressure: lisinopril, hydrochlorothiazide

• Other beta-blockers: metoprolol, atenolol

• Warfarin

• Alcohol

• Theophylline

• Certain antidepressants: fluoxetine, paroxetine

• Certain anti-infectives: ciprofloxacin, fluconazole, ritonavir

• Phosphodiesterase (PDE) inhibitors: sildenafil, tadalafil

This list doesn’t represent all the drugs that may not be safe to take with propranolol. If you’re unsure whether a certain drug or supplement can be taken with propranolol, seek medical advice from a doctor or pharmacist. The FDA also has a helpful medication guide for propranolol here.

If you accidentally miss your dose of propranolol, take the dose as soon as you remember. If it’s almost time for your next dose (within 2 hours), skip the missed dose and take your next dose at the usual time. Don't take 2 or more doses at the same time. This can cause very low blood pressure, slowed heartbeat, dizziness, or fainting.

If you’re taking propranolol for anxiety, it’s generally recommended to take your pill as needed 30 to 60 minutes before a situation or event you’re feeling anxious about, like a presentation, interview, or performance.

Propranolol can be taken with or without food.

During pregnancy: Propranolol isn’t considered to be harmful during pregnancy, but it may affect your baby’s growth.

While breastfeeding: Very small amounts of propranolol can pass into breast milk, but it isn’t expected to affect breastfed babies.

It’s important to treat active health conditions when pregnant or nursing, as any untreated medical conditions (including hypertension, atrial fibrillation, anxiety) can harm both you and baby. Always let your provider know if you’re pregnant or breastfeeding, so you can discuss the risks and benefits of starting or continuing propranolol.

It’s recommended to avoid alcohol when taking propranolol. Alcohol can increase the levels of propranolol in your blood and increase side effects associated with the drug, including low blood pressure and slowed heart rate.