Inderal Side Effects

Generic name: propranolol

Note: This document contains side effect information about propranolol. Some of the dosage forms listed on this page may not apply to the brand name Inderal.

Some side effects of Inderal may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

For the Consumer

Applies to propranolol: oral capsule extended release, oral concentrate, oral solution, oral tablet

Get emergency medical help if you have any of these signs of an allergic reaction while taking propranolol (the active ingredient contained in Inderal) hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

• fast, slow, or uneven heartbeats;

• feeling light-headed, fainting;

• feeling short of breath, even with mild exertion;

• swelling of your ankles or feet;

• nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

• cold feeling in your hands and feet;

• depression, confusion, hallucinations; or

• severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects of propranolol may include:

• nausea, vomiting, diarrhea, constipation, stomach cramps;

• decreased sex drive, impotence, or difficulty having an orgasm;

• sleep problems (insomnia); or

• tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

For Healthcare Professionals

Applies to propranolol: intravenous solution, oral capsule extended release, oral concentrate, oral solution, oral tablet

Cardiovascular

Use of a nonselective beta-blocker like propranolol (the active ingredient contained in Inderal) may at least blunt cardiac output in some patients, especially those with preexisting left ventricular systolic dysfunction and during exertion. Data have shown that cardiac conditioning can delay or attenuate this side effect of propranolol.

Abrupt cessation of propranolol therapy may result in hypertension, myocardial infarction, and angina pectoris in some patients.

Paradoxical hypertension may occur in patients with pheochromocytoma, unless alpha-adrenergic blockade is already instituted.

At least two cases of electrical alternans associated with propranolol are reported from pediatric cases. In one case, electrical alternans was clearly not rate-related (since it occurred during propranolol therapy at a slower rate than the patient's "native" ventricular tachycardia) and was associated with echocardiographically-demonstrated mechanical alternans.

Cardiovascular side effects are the most common, and include hypotension, bradycardia, exacerbation of Raynaud's phenomenon, atrioventricular block, and congestive heart failure (CHF). Rare reports of weight gain in patients without apparent CHF have been associated with the use of propranolol. The mechanism of weight gain is unclear, but may be due to propranolol-induced water retention.

Nervous system

Rare cases of paresthesias and myasthenia gravis have been associated with propranolol (the active ingredient contained in Inderal)

Nervous system side effects, such as fatigue, dizziness, impaired sleep, and dreams occur in approximately 2% to 5% of patients, and are more common with higher doses of propranolol.

Renal

There are reports of patients who experienced reversible renal insufficiency with no decline in systemic blood pressure, but these patients had preexisting renal disease. This may be important in patients with preexisting renal insufficiency. New or worsened renal dysfunction has been reported in patients with underlying renal disease and no decline in systemic blood pressure.

Renal insufficiency related to lowering of systemic blood pressure occurs in less than 1% of patients.

Respiratory

Limited data have shown a mean fall in maximal midexpiratory flow rate (MMFR) during propranolol (the active ingredient contained in Inderal) therapy relative to placebo in nine of ten patients whose lung function was assessed. Interestingly, the fall was not related to smoking or to atopic status, suggestive of resting beta-adrenergic bronchodilator activity in nonasthmatic subjects.

Non-selective beta-blockers, such as propranolol, are used with caution in patients with asthma and chronic obstructive pulmonary disease due to inhibition of bronchodilation.

Respiratory side effects include potential worsening of reactive airways diseases. Some large studies have shown that many patients, regardless of a history of lung disease, complain of dyspnea during propranolol monotherapy.

Endocrine

Beta-blockers, such as propranolol (the active ingredient contained in Inderal) are used with caution in patients with diabetes due to masking of the catecholamine response to hypoglycemia. Propranolol may also mask the signs of hyperthyroidism by the same mechanism.

Propranolol has been associated with significant increases in serum triglycerides, fasting blood glucose, and LDL and VLDL cholesterol, and significant decreases in HDL cholesterol.

Endocrinologic problems include hyperglycemia and hypertriglyceridemia. This may be important in some diabetic patients where masking symptoms of hypoglycemia, such as sweating and tachycardia may be unsafe. Propranolol, like other nonspecific beta-blockers, may adversely affect serum lipids.

Gastrointestinal

Gastrointestinal side effects, such as diarrhea, nausea, constipation, and vomiting are usually transient. Rarely, propranolol (the active ingredient contained in Inderal) has been associated with elevated liver function tests and mesenteric ischemia.

Psychiatric

Psychiatric depression is associated with beta-blockers, particularly the more lipophilic, nonselective beta-blockers, like propranolol (the active ingredient contained in Inderal) Well described cases of major depressive episodes after initiation of propranolol therapy, which were dose-dependent and remittent upon drug discontinuation, have been reported.

One study of 34 hypertensive patients who were taking propranolol found the incidence of depressive symptoms in this population to be 50% to 74% (depending on the criteria used). Propranolol-induced depression may be more likely in patients with a personal or family history of depression. Of the 34 patients, 12 had a history of depression and 8 had a history of substance abuse, alcoholism, or a family history of psychiatric disorders. Since none of the 12 patients with a history of depression were clinically depressed at the start of propranolol therapy and were comparable by age, diagnosis, and propranolol dosage to the other 22 patients, a comparison was made. Patients with a personal or family history of depression had significantly higher scores on depression scales than those without such histories.

A 72-year-old retired college professor with no history of affective disorders developed progressive sadness, tearfulness, hopelessness, decreased energy, social withdrawal, anhedonia, insomnia, and decreased memory and concentration within two weeks after beginning propranolol monotherapy for hypertension. The signs and symptoms of depression resolved upon substitution with a thiazide diuretic. Interestingly, the patient later was treated for recurrent depression while not receiving propranolol.

Rare cases of psychoses associated with propranolol have been reported.

Hypersensitivity

Hypersensitivity is rare. Rare cases of anaphylaxis and contact dermatitis have been reported.

Hematologic

Hematologic side effects are rare. Propranolol (the active ingredient contained in Inderal) may cause platelet dysfunction. Rare cases of purpura with and without normal platelet counts and cases of agranulocytosis have been reported.

Dermatologic

Dermatologic reactions are rare, and include cases of psoriatic flares. Other cutaneous reactions, including Stevens-Johnson Syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been associated with use of propranolol (the active ingredient contained in Inderal) Alopecia and SLE-like reactions have also been reported.

Immunologic

Limited data show that propranolol (the active ingredient contained in Inderal) can enhance the immune system. The clinical significance of this is unknown.

Propranolol can enhance the immune system by causing an increase in the number of circulating T cells, increased interleukin-2 (IL-2) secretion, increased expression of IL-2 receptors, and increased lymphocyte production in response to the T cell mitogen Con A. Interestingly, NK (natural killer) cell activity may be decreased during propranolol therapy, although the number of circulating NK cells may remain unchanged. These results are consistent with previous data showing decreased immunologic function during periods of elevated sympathetic activity, such as congestive heart failure, uremia, or life-threatening events.

Genitourinary

Genitourinary side effects have included male impotence and Peyronie's disease.

Metabolic

Metabolic side effects have included weight gain.

The mechanism by which propranolol induces weight gain is unknown. Some investigators have reported a 4% to 9% reduction in total energy expenditure and a 25% reduction in thermogenic response to food during beta-blocker treatment.

Musculoskeletal

Musculoskeletal side effects have included myopathy and myotonia.

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