Propranolol Side Effects
It is possible that some side effects of propranolol may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.
For the Consumer
Applies to propranolol: oral capsule extended release, oral solution, oral tablet
Other dosage forms:
As well as its needed effects, propranolol may cause unwanted side effects that require medical attention.
If any of the following side effects occur while taking propranolol, check with your doctor immediately:More common - in children
- Cough producing mucus
- difficulty with breathing
- tightness in the chest
- Abdominal or stomach pain and tenderness
- black, tarry stools
- blistering, peeling, or loosening of the skin
- blood in the urine
- bloody nose
- bloody stools
- blurred or loss of vision
- body aches or pain
- burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
- chest pain or discomfort
- confusion about identity, place, and time
- cracks in the skin
- decreased awareness or responsiveness
- decreased urine output
- difficulty with swallowing
- dilated neck veins
- disturbed color perception
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- double vision
- dryness or soreness of the throat
- extreme fatigue
- fast, pounding, slow, or irregular heartbeat
- fever and chills
- general feeling of discomfort, illness, or weakness
- hair loss
- halos around lights
- heavier menstrual periods
- irregular breathing
- lightheadedness, dizziness, or fainting
- loss of heat from the body
- mental depression
- mimicry of speech or movements
- muscle or joint pain
- night blindness
- noisy breathing
- overbright appearance of lights
- paleness or cold feeling in the fingertips and toes
- peculiar postures or movements, mannerisms, or grimacing
- pinpoint red or purple spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- quick to react or overreact emotionally
- rapidly changing moods
- rectal bleeding
- red skin lesions, often with a purple center
- red, irritated eyes
- red, swollen skin
- reddening of the skin, especially around the ears
- runny nose
- scaly skin
- seeing, hearing, or feeling things that are not there
- severe sleepiness
- short-term memory loss
- shortness of breath
- skin irritation or rash, including rash that looks like psoriasis
- skin rash, hives, or itching
- sores, ulcers, or white spots in the mouth or on the lips
- swelling of the eyes, face, fingers, feet, or lower legs
- swollen glands
- tender, swollen glands in the neck
- tightness in the chest
- tingling or pain in fingers or toes when exposed to cold
- tunnel vision
- unusual bleeding or bruising
- unusual tiredness or weakness
- voice changes
- weight gain
Some propranolol side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:More common - in children
- dry mouth
- sleepiness or unusual drowsiness
- trouble sleeping
- unusual dreams
- Decreased appetite
- Dry eyes
- loss of strength or energy
- muscle weakness
- pain or discomfort in the chest, upper stomach, or throat
- stomach cramps
- unusual drowsiness, dullness, or feeling of sluggishness
- vivid dreams
For Healthcare Professionals
Applies to propranolol: intravenous solution, oral capsule extended release, oral concentrate, oral liquid, oral solution, oral tablet
Use of a nonselective beta-blocker like propranolol 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.
Rare cases of paresthesias and myasthenia gravis have been associated with propranolol.
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.
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.
Limited data have shown a mean fall in maximal midexpiratory flow rate (MMFR) during propranolol 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.
Beta-blockers, such as propranolol, 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 side effects, such as diarrhea, nausea, constipation, and vomiting are usually transient. Rarely, propranolol has been associated with elevated liver function tests and mesenteric ischemia.
Psychiatric depression is associated with beta-blockers, particularly the more lipophilic, nonselective beta-blockers, like propranolol. 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 is rare. Rare cases of anaphylaxis and contact dermatitis have been reported.
Hematologic side effects are rare. Propranolol may cause platelet dysfunction. Rare cases of purpura with and without normal platelet counts and cases of agranulocytosis have been reported.
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. Alopecia and SLE-like reactions have also been reported.
Limited data show that propranolol 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 side effects have included male impotence and Peyronie's disease.
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 side effects have included myopathy and myotonia.
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