Does propranolol make you sleepy?

In this article:

• Does propranolol make you tired?
• Why does propranolol make you tired?
• Managing propranolol fatigue
• When to see your healthcare provider

In this article

• Does propranolol make you tired?
• Why does propranolol make you tired?
• Managing propranolol fatigue
• When to see your healthcare provider

Propranolol is a generic prescription medication sold under different brand names, such as Inderal LA, Inderal XL, Hemangeol, and InnoPran XL. It is used to treat cardiovascular conditions such as high blood pressure, conditions that cause irregular heartbeat, heart failure, and heart attacks. Propranolol belongs to a class of medication called beta blockers. Beta blockers work by preventing the release of adrenaline and noradrenaline, which are stress hormones that cause the heart to work faster and harder.

Aside from its use in treating heart diseases, propranolol has other uses. “While propranolol is very well known for its ability to lower blood pressure, many people don’t realize it is also often prescribed for instances of social anxiety or stage fright/fear of public speaking,” says Leah Kaylor, Ph.D., a licensed clinical psychologist. It’s also used for treating migraine headaches, overactive thyroid, and severe chest pain (angina).

However, this medication can cause side effects. Its mild side effects include tiredness, lightheadedness, and drowsiness. Keep reading to learn more about the adverse effects of propranolol and how to manage fatigue caused by this medication.

Does propranolol make you sleepy?

“Yes, People often complain of propranolol making them feel sleepy within the first few weeks,” Kaylor confirms, explaining that the sleepiness is worse when you first start taking this medication. If you feel sleepy after taking your propranolol dose, healthcare providers sometimes recommend taking the first dose prior to bedtime, says Kaylor.

While taking this medication at night may be best if you are new to it, there is no one best time for taking it. “The timing of propranolol doses depends on the condition being treated and how the medication affects each individual,” says Michael Genovese, MD, chief medical advisor at Ascendant New York, a mental health treatment facility. He further adds that, in general, propranolol is most effective when taken at the same time every day, whether morning or night, to maintain steady levels in the bloodstream.

Aside from causing drowsiness, propranolol can also affect the pattern or quality of your sleep by causing difficulty sleeping and nightmares. “In some cases, it can cause insomnia, as it interferes with melatonin production,” Mike McGrath, MD, a board-certified psychiatrist based in Hawaii, says.

Other common side effects people may experience while on propranolol include:

• Diarrhea
• Constipation
• Skin rashes
• Unusual weight gain
• Itching

Serious side effects of propranolol, like hives, shortness of breath, and trouble breathing or swallowing, may also occur. It is important to know that even one adult dose of propranolol can be life-threatening if ingested by an infant or child, and Poison Control should be contacted immediately. Propranolol side effects in children may include:

• Agitation
• Decreased appetite
• Irritability
• Cold hands or feet
• Sudden weakness of an arm or leg

Why does propranolol make you tired?

An older review of studies published in JAMA found a small significant annual increase (18 per 1000 patients) in the risk of reported fatigue among people taking beta blockers. This is equivalent to one additional report of fatigue for every 57 patients treated per year with beta blockers. In other words, it’s a common side effect.

Like other beta blockers, propranolol works by blocking beta-adrenergic receptors, reducing the effects of adrenaline in the body. By inhibiting these hormones, propranolol slows heart rate, lowers blood pressure, and reduces the physical symptoms of anxiety.

“However, these calming effects can also lead to fatigue, tiredness, and drowsiness because the medication impacts the central nervous system (CNS) and reduces overall energy levels,” Dr. Genovese explains. He also adds that the combination of reduced adrenaline activity, slowed heart rate, and potential melatonin interference explains why many people on propranolol feel tired or overly sleepy, especially when they first start taking the medication.

Fatigue from propranolol is most noticeable during the first few weeks of starting the medication as the body adjusts to its effects. “However, in my experience, this side effect usually goes away pretty quickly,” says Dr McGrath.

Still, in some cases, especially at higher doses, “fatigue can persist for as long as the person continues taking the medication,” Genovese notes, adding that if the fatigue disrupts daily activities, worsens, or doesn’t improve after a few weeks, your healthcare provider might adjust the dosage, switch to an extended-release version, or consider alternative medications to address the issue.

Patience during the initial adjustment period is key, but persistent tiredness shouldn’t be ignored.

Managing propranolol fatigue

How long the effects of propranolol last depends on factors like the dosage form and its use. Its immediate-release form, which works faster than the extended-release and is typically prescribed for performance anxiety, can last for about 6-12 hours after a dose. However, the effect of the extended-release capsule can last up to 24 hours.

While fatigue typically kicks in, especially after the first dose of propranolol, McGrath says it normally goes away after a couple of weeks as the body gets used to it. The length of time it takes for the body to adjust to medication varies from person to person, depending on various factors such as age, weight, other medications, and dietary habits.

If you experience fatigue, lightheadedness, or drowsiness while on propranolol, Genovese proposes that these strategies may help you manage these side effects:

• Consider the timing of your dose. Some people find taking propranolol at night helps them avoid daytime drowsiness, while others prefer morning doses to prevent sleep disturbances.
• Adopt good sleep hygiene. This can also help. Aim for seven to nine hours of quality sleep each night and establish a consistent bedtime routine.
• Engage in regular physical activities. Even light exercises, such as walking or stretching, can help combat sluggishness and improve overall energy levels.
• Drink enough water. Staying hydrated is equally important, as dehydration can worsen fatigue. The Academy of Nutrition and Dietetics recommends about 2.5 liters of water every day for adult females and about 3.7 liters for adult males.
• Opt for healthier meal options. Eating a balanced diet rich in fruits, vegetables, lean proteins, and whole grains can stabilize energy throughout the day.
  

Other lifestyle modifications for managing fatigue may also help, such as managing stress, limiting caffeine intake, and drinking alcohol in moderation. Kaylor also recommends getting some fresh air or occasionally switching to more stimulating activities like games, dancing, and painting. If you experience drowsiness while on propranolol, it is important not to drive a car or operate machinery.

When to see your healthcare provider

Experiencing mild fatigue or sleepiness during the first few weeks of taking propranolol is pretty common and is not a cause for alarm. However, you should speak with your healthcare provider if these symptoms don’t improve, disrupt your normal activities, persist for long, or affect the state of your mental health, especially after you have tried out management strategies.

Also, consider seeking medical advice if you experience other more severe side effects, such as rashes, breathing problems, and difficulty swallowing while on propranolol. These could be signs of an allergic reaction.

McGrath advises that you do not abruptly stop taking your propranolol tablets. Instead, talk to your provider to devise a plan for discontinuing the medication. It’s best to slowly taper or reduce this medication over time.

It’s important to let your healthcare provider know if you are taking other medications, particularly those that cause low blood pressure, antacids, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. These may interact with propranolol or worsen its side effects. Your healthcare provider should also be notified if you have other health conditions or are pregnant or breastfeeding.