Makindo Medical Notes

Related Subjects: |Hypertension |Acute Heart Failure |Chronic Heart Failure

📖 About

Always check the BNF link here for up-to-date dosing and guidance.

• 💊 First commercially available beta-blocker (introduced in the 1960s).
• Non-selective β-blocker: antagonises β1- and β2-receptors.
• Highly lipophilic → crosses blood–brain barrier → CNS side effects (e.g. vivid dreams, nightmares).

⚙️ Action

• Blocks adrenaline/noradrenaline at β1 (cardiac) and β2 (vascular/bronchial) receptors.
• ↓ Heart rate, ↓ cardiac output, ↓ myocardial oxygen demand.
• ↓ Sympathetic symptoms (e.g. tremor, palpitations, anxiety).

🎯 Indications & Typical Oral Doses Propranolol

• 🩸 Hypertension: 80 mg twice daily (range 160–320 mg/day).
• ❤️ Angina: 40 mg three times daily, titrate up to 320 mg/day.
• 💓 Arrhythmias: 40 mg twice–three times daily.
• 😰 Anxiety (somatic symptoms): 10–40 mg three times daily.
• 🫀 Portal hypertension: 40 mg twice daily (titrate for HR 55–60 bpm).
• 🩺 Post-MI: 40 mg three times daily → 80 mg twice daily.
• 🧠 Migraine prophylaxis: 40–80 mg twice daily.

⛔ Contraindications

• Bradycardia (<60 bpm) or systolic BP <100 mmHg.
• Asthma, COPD, or bronchospasm 🫁.
• 2nd or 3rd-degree heart block.
• Uncontrolled / decompensated / acute severe heart failure.
• Severe hypotension.
• Phaeochromocytoma (unless α-blockade established).
• Sick sinus syndrome.
• Significant peripheral vascular disease 🦵.
• ⚠️ Concomitant verapamil (risk of complete heart block/asystole).
• Caution in diabetes (masks hypoglycaemia, worsens control).

⚠️ Side Effects

• Headache, fatigue, lethargy 😴.
• Cold peripheries, Raynaud’s worsening ❄️.
• Bradycardia, hypotension, heart failure.
• Sleep disturbance: insomnia, nightmares 🌙.
• Worsening diabetic control, hypoglycaemia unawareness.

📚 References

• BNF – Propranolol
• Oxford Handbook of Clinical Medicine.
• ESC Guidelines – Hypertension & Angina.