Drug Details

PROPRANOLOL

Dr C P Ravikumar
 
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Dr. C P Ravi Kumar

Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology, The Krishna Institute of Medical Sciences (KIMS), Mahadevapura, Bangalore

 

What is Propranolol?

Propranolol is a medicine that helps regulate your heart rate, maintain appropriate blood pressure, treat migraines, and shrink certain skin growths called haemangiomas.

What are the paediatric uses of Propranolol?

  • Infantile haemangioma: a type of birthmark that looks like a red or purple bump on a baby’s skin. It happens when extra blood vessels form under the skin.

  • Congenital heart conditions.

  • Prophylaxis for migraine attacks.

How does Propranolol work in haemangioma?

Propranolol works by blocking beta adrenergic receptors, which helps make the blood vessels smaller. It stabilises blood vessels, and reduces the amount of blood flowing through them and causes the blood vessels in the haemangioma to shrink.

How does Propranolol work in migraine?

Propranolol prevents migraines primarily by blocking β-adrenergic receptors (both β₁ and β₂), which reduces sympathetic outflow and stabilizes blood vessel behavior. Blocking β1receptors is believed to help prevent migraines by inhibiting the trigeminovascular system.

What need to be discussed with my doctor before starting Propranolol?

  • Inform doctor if your baby was born premature

  • If your child had a previous history of asthma or breathing problems

  • Any heart problems

  • If any of your family members have history of glaucoma

When Propranolol should be consumed?

Propranolol should be taken after meals, at the same time every day, as prescribed by your doctor.
Depending on the indication, you may have to take once or twice a day, please follow your doctors advise.

Does Propranolol show its effect immediately?

Propranolol reaches peak plasma levels in about 1–3 hours, giving an immediate effect on heart rate and blood pressure, but its full cardiovascular effect may take several days of regular use. For migraine prevention, improvement usually begins after 2–6 weeks, with full effect often requiring up to 8 weeks.

What precautions need to be taken when my child is on Propranolol?

  • Your child’s blood pressure and heart rate should be monitored regularly

  • Make sure that you are administering the right dose for your child as there are many doses available in the market.

  • This medicine can make your child feel drowsy, keep an eye on your child while playing.

  • Propranolol can make your child hypoglycaemic (low blood sugar levels). you need to be aware of its symptoms and remedies

What are the parameters that should be monitored when my child is on Propranolol?

  • Heart rate: Propranolol can make the heart rate slower, so it's important to regularly check the baby’s heart rate to make sure it stays safe. A very slow heart rate (bradycardia) can be a problem, especially in the first few days of treatment.

  • Blood Pressure: Blood pressure should be monitored to check for hypotension (low blood pressure), particularly in the early phase of treatment.

  • Blood Glucose Levels: Propranolol can lower blood sugar, especially in babies and elderly, so it’s important to monitor glucose levels for potential hypoglycaemia, especially during the first 24 to 48 hours of treatment.

  • Growth and Weight: Propranolol can sometimes affect growth, so regular monitoring of weight and overall development is important to ensure the infant is growing normally.

 

propranolol

 

Who should avoid taking Propranolol?

  • Child with heart problems like abnormal heartbeat, low blood pressure, poor blood flow to arms or legs
  • If your child have/had asthma or other breathing problems
  • If your child has liver disease

What foods to be avoided while taking Propranolol?

Avoid taking excess quantity of potassium rich foods like potato, beans, banana.

What to be done if you miss a dose?

You can administer the medicine as soon as you remember in case you forget to give it your child. If it’s almost time for the next dose, just skip the one you missed and keep giving the medicine like normal. Don’t give two doses at the same time. If you keep forgetting, try setting an alarm to remind you. If you miss two or more doses, call your doctor to ask what to do.

What are the side effects of Propranolol?

Every drug has their own side effects. But some may experience, and some do not have any side effects.
Taking Propranolol could result in certain side effects. Reach out to your doctor immediately if any of these symptoms are getting worsened and do not subside.

  • Sleep disorders: Difficulty in sleeping

  • Abdominal pain

  • Agitation: Feeling restless or nervous.

  • Dizziness: Feeling light headed or like you might faint.

  • Nightmares: Bad dreams

What are the signs that indicate you should go to the hospital immediately?

Some side effects, though rare, need immediate medical attention. These include:
  • Severe allergic reaction (rash, itching, swelling, trouble breathing)

  • Dyspnoea: Difficulty breathing

  • Extreme sedation or difficulty waking up

  • Mood or behavior changes (agitation, hallucinations)

Do not take any OTC/ herbal medications without informing to the doctor.

Is it safe to take Propranolol during pregnancy?

Propranolol is safe to be used during pregnancy, but with caution and only if the potential benefits outweigh the risks. It is not considered the first-line choice; it will be prescribed it only when necessary.

Summary

Propranolol is a beta-blocker used to control heart rate, blood pressure, prevent migraines, and treat infantile haemangiomas by shrinking abnormal blood vessels. It works by blocking beta-adrenergic receptors, reducing adrenaline effects. The medicine requires monitoring of heart rate, blood pressure, and blood sugar, especially in children. It should be taken after meals and not stopped suddenly. Side effects can include dizziness, sleep disturbances, or agitation, and severe reactions like breathing problems need immediate medical attention. Propranolol can be used during pregnancy if necessary, under doctor supervision, and may pass into breast milk, so caution is advised while breastfeeding.
 
Let us know if you find this helpful!
 
Author:
  1. Dr. Likitha B S, Pharm. D, Clinical Pharmacologist, Aster Hospitals, Bengaluru
  2. Dr Praveen Kumar, B. Pharm, Pharm D(PB), Lead Clinical Pharmacologist, REGIONAL HEAD KIMS Hospitals, Bengaluru
  3. Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology KIMS HOSPITALS BENGALURU
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