Increasing Propranolol Dosage for Anxiety and Tremor

Recommended Dosing Adjustment

• The American College of Cardiology recommends a reasonable target dose of 20-40mg 3-4 times daily (total daily dose of 80-160mg) for anxiety and tremor 1

Monitoring During Dose Increases

• The American Heart Association recommends monitoring heart rate and blood pressure with each significant dose increase 2
• The American Heart Association warns of potential side effects including bradycardia (heart rate below normal range) 3
• The American Heart Association notes potential side effects including hypotension 2
• The American College of Cardiology notes potential side effects including fatigue or sleep disturbances 4
• The American College of Cardiology warns of potential side effects including bronchospasm in susceptible individuals 1

Important Considerations

• The American College of Cardiology advises against abrupt discontinuation and recommends tapering gradually if stopping treatment is necessary 5
• The American College of Cardiology states that propranolol is contraindicated in patients with decompensated heart failure 1
• The American Heart Association states that propranolol is contraindicated in patients with bradycardia or heart block 2
• The American College of Cardiology states that propranolol is contraindicated in patients with asthma or reactive airway disease 1
• The American Academy of Pediatrics states that propranolol is contraindicated in patients with uncontrolled hypoglycemia 6