Propranolol Dosing and Administration

Introduction to Propranolol

The American College of Cardiology and Circulation guideline societies recommend propranolol doses ranging from 10-40mg three or four times daily for various indications, with 10mg twice daily considered a relatively low dose 1, 2

For patients with conditions such as anxiety or panic attacks, lower doses of propranolol may be sufficient while minimizing side effects, according to the American College of Cardiology and other guideline societies 3

The American Heart Association and Circulation guideline societies state that propranolol is contraindicated in patients with bradycardia, heart block, cardiogenic shock, or uncontrolled heart failure, and should be used with caution in patients with bronchospastic airway disease 1, 2, 4
Patients on propranolol should be monitored for potential side effects, including bradycardia, hypotension, fatigue, dizziness, or cold extremities, and for signs of excessive beta-blockade such as dizziness, extreme fatigue, or syncope 3

The American College of Cardiology recommends avoiding abrupt discontinuation of propranolol as this can lead to rebound effects, and if side effects occur at the higher dose, returning to the previous dose is reasonable 1, 2, 3
For elderly patients, the American College of Cardiology suggests starting at the lower dose and titrating more gradually due to increased sensitivity to beta-blockers 1