propranolol

General information

• Class: Adjunctive therapy
• Common US brands: INDERAL, INDERAL LA
• Typical dose range: Label dosing varies widely by indication (hypertension, arrhythmias, migraine prophylaxis). In psychiatric use, dose selection should be tied to the specific target symptom and the patient’s cardiopulmonary risk.
• Therapeutic drug monitoring not routinely recommended.
• Last reviewed: 2025-12-29

Dosing & forms

• Forms/strengths: Immediate-release tablets: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg.; Extended-release propranolol products exist (brand-dependent); do not substitute without monitoring.
• Typical range: Label dosing varies widely by indication (hypertension, arrhythmias, migraine prophylaxis). In psychiatric use, dose selection should be tied to the specific target symptom and the patient’s cardiopulmonary risk.

Mechanism (brief)

Nonselective beta-adrenergic receptor blocker (beta-1/beta-2 antagonism).

Metabolism & Half‑life

• Metabolism: CYP2D6, CYP1A2, CYP2C19, Glucuronidation
• Half‑life: Single-dose range 3–6 h

Therapeutic Drug Monitoring (TDM)

Recommended: No

Monitoring highlights

• Check baseline heart rate, blood pressure, and asthma/COPD history before starting.
• Monitor bradycardia, hypotension, dizziness, and fatigue after dose changes.
• Reassess mood and sleep after initiation; discontinue or adjust if adverse effects outweigh benefit.
• Taper rather than stopping abruptly after sustained use, especially in coronary disease risk.

Sources

• Propranolol hydrochloride tablets prescribing information — DailyMed (2025)
• Propranolol for the treatment of anxiety disorders — Journal of Psychopharmacology (2016)
• Beta-blockers for the treatment of anxiety disorders — Journal of Affective Disorders (2025)
• Neuroleptic-induced akathisia — propranolol versus benztropine — Biological Psychiatry (1988)