Propranolol Therapy

Mechanism of Action and Dosage

The American Heart Association recommends propranolol for taquiarritmias, with a dosage of 0.5-1 mg administered during 1 minute, repeated until a total dose of 0.1 mg/kg if necessary, due to its ability to block beta-1 and beta-2 adrenergic receptors, reducing the effects of circulating catecholamines 1, 2
The American College of Cardiology suggests propranolol for migraine prophylaxis, with a dosage of 80-240 mg/day, as recommended by guidelines 3
For infantile hemangioma, the American Academy of Pediatrics recommends a dosage of 2-3 mg/kg/day divided into 2-3 doses, with administration with meals and suspension of doses if there is compromise of oral intake to reduce the risk of hypoglycemia 4, 5, 6
The American College of Cardiology recommends propranolol for hypertrophic cardiomyopathy, with a dosage of up to 480 mg/day (2 mg/kg in children) 7

The American Heart Association indicates propranolol for stable narrow-complex tachyarrhythmias, control of ventricular rate in patients with atrial fibrillation or atrial flutter, and certain forms of polymorphic ventricular tachycardia 1, 2
Propranolol is contraindicated in patients with asthma and chronic obstructive pulmonary disease, as well as those with decompensated heart failure, due to its potential to worsen these conditions 1, 2
The Journal of the American Medical Association suggests that propranolol may be used after myocardial infarction, but with caution 8

The American Heart Association reports that propranolol may cause cardiovascular effects such as hypotension, bradycardia, and precipitation of heart failure, as well as respiratory effects like bronchospasm and dyspnea 1, 2, 9
Propranolol may also cause neurological effects, including dizziness, fatigue, sleep disorders, and nightmares, as well as metabolic effects like hyperglycemia 9

The American Academy of Pediatrics recommends monitoring heart rate and blood pressure, especially at the start of treatment, and avoiding abrupt discontinuation of propranolol to prevent rebound tachycardia or exacerbation of ischemic heart disease 5, 6
Alternative beta-blockers like metoprolol, atenolol, or nadolol may be considered in patients who do not tolerate propranolol 10