Propranolol

Propranolol is suitable for most adults and children aged 12 years old and over, but always check before taking it.

Propranolol is not suitable for some people. For example, check with your doctor if you have lung disease or asthma.

Propranolol comes as tablets or a liquid that you take up to 4 times a day or capsules you take once a day. Follow the instructions that come with it.

Common side effects of propranolol include feeling tired or dizzy, and cold fingers or toes. More serious side effects can happen in rare cases.

It can cause problems to take propranolol with other medicines, such as ibuprofen, diclofenac or naproxen.

Most adults and children aged 12 years and over can take propranolol. A doctor may prescribe it for children under 12 years old for high blood pressure but it's not licensed for this.

Propranolol is not suitable for some people. To make sure it's safe for you, tell your doctor before starting to take propranolol if you:

• have ever had an allergic reaction to propranolol or any other medicine
• have low blood pressure
• have a slow heart rate
• have heart failure which is getting worse
• have ever had depression or had thoughts about harming yourself
• have diabetes
• have liver or kidney problems
• have severe blood circulation problems in your limbs (such as Raynaud's), which may make your fingers and toes tingle or turn paler than usual or blue
• have metabolic acidosis, when there is too much acid in your blood
• have lung disease or asthma
• are pregnant, trying to get pregnant or breastfeeding
• have a rare tumour of the adrenal glands (phaeochromocytoma)

Propranolol tablets come in strengths of 10mg, 40mg, 80mg or 160mg. The slow release capsules are 80mg or 160mg. The liquid comes in strengths of 5mg, 10mg, 40mg or 50mg in 5ml.

How much you take depends on why you need propranolol.

The usual doses for adults are:

• high blood pressure – the starting dose is usually 80mg, taken twice a day. If this dose is not working well enough to reduce your blood pressure, your doctor may increase it to a maximum of 160mg twice a day
• migraine or angina (chest pain) – 40mg, taken 2 or 3 times a day. This can be increased to 240mg a day. Your doctor or pharmacist will explain how to split the dose over the day
• irregular heartbeat (arrhythmia) – 10mg to 40mg, taken 3 or 4 times a day
• anxiety – 40mg taken once a day, which can be increased to 40mg taken 3 times a day
• too much thyroid hormone (thyrotoxicosis) – 10mg to 40mg, taken 3 or 4 times a day

Doses are usually lower for people aged over 65 or people with kidney or liver problems.

If your child needs propranolol, your doctor will usually use your child's weight to work out the right dose.

How to take it

Swallow the tablets whole with a drink of water. If you find the tablets difficult to swallow, some brands have a score line to help you break the tablet in half. Check the information leaflet for your brand to see if you can do this.

If you're taking capsules, swallow them whole with a drink of water. Do not break, chew or crush them.

If you're taking propranolol as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount of medicine.

Propranolol does not usually upset your stomach so you can take it with or without food. It's best to do the same each day.

These common side effects of propranolol happen in more than 1 in 100 people. They're usually mild and do not last long. There are things you can do to help cope with them:

Make sure you rest and drink plenty of fluids. It's best not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if they do not go away or are severe

As your body gets used to propranolol, these side effects should wear off. If propranolol makes you feel dizzy, sit or lie down until you feel better.

It's best not to drink alcohol as it will make you feel worse. Do not drive or ride a bike until you feel better.

Put your hands or feet under warm running water, massage them and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in, as this can make your blood vessels narrower and further restrict blood flow to your hands and feet.

Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.

Stick to simple meals and do not eat rich or spicy food.

If you're being sick, try small frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having strong-smelling pee.

If you take the combined pill or progestogen-only pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor.

If you take the combined pill or progestogen-only pill and you have severe, watery diarrhoea or diarrhoea that lasts for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Avoid having a big meal, smoking, or drinking alcohol, tea or coffee in the evening. Try not to watch television or use your mobile phone before going to bed. Instead, try to relax for an hour before bedtime.

Talk to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

There are some medicines that may affect the way propranolol works.

Tell your doctor or pharmacist if you're taking any other medicines including:

• other medicines for high blood pressure. The combination with propranolol can sometimes lower your blood pressure too much. This may make you feel dizzy or faint. If this keeps happening to you, your doctor may change your dose
• other medicines for an irregular heartbeat such as amiodarone, digoxin or flecainide
• other medicines which can lower your blood pressure – these include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate like tamsulosin, or Parkinson's disease medicines such as levodopa
• asthma or chronic obstructive pulmonary disease (COPD) medicines
• diabetes medicines, particularly insulin – propranolol may make it more difficult to recognise the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any of the usual warning signs. Check your blood sugar after exercise, and follow usual advice about checking it before driving, cycling or operating machinery
• medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in a pharmacy)
• medicines for allergies, such as ephedrine, noradrenaline or adrenaline
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or naproxen – these medicines may increase your blood pressure, so it's best to keep them to a minimum
• rizatriptan for migraines

These are not all the medicines that may cause problems if you take them with propranolol. For a full list, see the leaflet inside your medicine packet.

You can take propranolol during pregnancy.

Propranolol can sometimes affect your baby's growth. You will be offered extra growth scans in later pregnancy (usually from 32 weeks) to check that your baby is growing.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about whether taking propranolol is right for you, or if different medicine might be better during pregnancy.

For more information about how propranolol can affect you and your baby during pregnancy, visit the Bumps (Best Use of Medicines in Pregnancy) website.

If your baby is healthy, it's OK to take propranolol while breastfeeding. Always check with a pharmacist or doctor before taking it.

Propranolol passes into breast milk in tiny amounts. It has not been known to cause any side effects in breastfed babies.

It's very rare for breastfed babies to have side effects from medicines you're taking. But it's important to keep monitoring your baby if you're taking any medicine while breastfeeding

It's important to keep taking propranolol to keep you well. Breastfeeding will also benefit both you and your baby.

Contact your healthcare professional or call 111 as soon as possible if you notice that your baby:

• is not feeding as well as usual, or not putting on weight as you would expect
• seems unusually sleepy, tired or weak
• looks much paler than usual
• seems sweaty or shaky
• has changes in their breathing
• has an upset stomach (such as constipation or diarrhoea)

If your baby has any symptoms that are not listed, or if you're worried about them, you can also call 111 or contact any healthcare professional.