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Key takeaways
Propranolol is a prescription beta blocker. The immediate-release form takes effect in one to two hours (or sometimes faster) and can last in your system for eight to eleven hours. The extended-release form can last up to 24 hours.
High-fat meals may affect how long the extended-release form of medication takes to work.
Propranolol is generally safe for long-term use, but chronic administration may impact how long it takes the body to eliminate the drug from its system.
Consult your healthcare provider about propranolol or alternatives if you experience side effects.
Propranolol is widely prescribed to treat heart conditions such as high blood pressure, arrhythmias, angina (chest pain), or a combination of these conditions. It belongs to a class of drugs known as beta-adrenergic receptor antagonists, more commonly called beta blockers. Understanding this medication’s duration of action can help you better manage symptoms and avoid potential side effects from missed doses. Propranolol typically lasts up to twenty-four hours in long-acting formulations, though certain factors can affect its duration.
How long does propranolol last?
It depends on which form of propranolol you take. Immediate-release propranolol hydrochloride can last up to eight to eleven hours in a person’s system when taken orally, says Allison Hinkle, Pharm.D., CPH, clinical pharmacy manager with HCA Florida Highlands Hospital. It has a half-life of three to six hours—half of the drug is eliminated from your system in this period. If you’re taking the medication for anxiety, you may notice some of the effects wearing off after this time. After 24 hours, propranolol is fully metabolized, which means the body has broken it down completely, explains Rohit Vuppuluri, DO, an interventional and vascular cardiologist at Chicago Heart & Vascular Specialists. The extended-release form can last up to 24 hours, with a half-life of eight hours.
Propranolol is an FDA-approved beta blocker prescribed to treat a variety of heart problems, including high blood pressure (hypertension), angina (chest pain), certain types of irregular heart rhythms (arrhythmias), hypertrophic cardiomyopathy, migraine, tremors, and post-heart attack care. It’s also used off-label to treat conditions like anxiety disorders, panic disorders, and symptoms of an overactive thyroid. Brand names include Inderal LA and InnoPran XL.
Propranolol works by blocking beta-adrenergic receptors, reducing the effects of adrenaline on the heart and blood vessels, and improving blood flow. This lowers your heart rate and blood pressure and, ultimately, the strain on the heart. It crosses the blood-brain barrier and affects the central nervous system (CNS). This effect helps to relieve physical symptoms of anxiety but can also cause side effects like daytime drowsiness, fatigue, and dizziness, says Dr. Vuppuluri.
In fact, feeling groggy after taking propranolol isn’t out of the ordinary. “Beta blockers such as propranolol are notorious for causing fatigue and exercise intolerance since they block adrenergic receptors in the heart and, in some cases, lungs,” Dr. Hinkle says. “For some patients, this side effect improves over time.”
RELATED: Does propranolol make you tired?
How long does propranolol take to work?
Propranolol can begin to work fairly quickly in some patients, sometimes within 10 to 40 minutes, says Mary Greene, MD, a cardiologist with Manhattan Cardiology in New York City.
In other patients, it may take closer to one to two hours to take effect, Dr. Vuppuluri says.
Certain factors can affect how fast propranolol works. For example, high-fat meals can delay the absorption of extended-release propranolol.
How long should you take propranolol?
It depends on the reason you’re prescribed this medication. If you’re taking it for a heart issue or to prevent migraine, propranolol works best with long-term use. For anxiety, it’s best only to take it as long as you need it.
There are no lasting harmful effects with chronic administration, but the drug may experience a longer half-life, Dr. Hinkle says. That means this medication is generally considered safe for extended use, but the time it takes for half the drug to be eliminated from the body may increase.
If you’ve been taking propranolol for a long time, you may experience withdrawal symptoms if you abruptly stop taking the medication. “In this case, patients may feel increased heart rate, anxiety, higher blood pressure, and possibly even abnormal heart rhythms,” Dr. Vuppuluri explains.
A full washout—or time it takes to eliminate the drug from the body fully—may take up to five days. “To avoid withdrawal symptoms, gradually taper off propranolol over two weeks,” Dr. Vuppuluri suggests. “Rebound symptoms from propranolol can last for two to four weeks depending on medication dose and duration of therapy.” Ask your healthcare provider for an individualized tapering schedule.
Propranolol side effects
The most common side effects of propranolol are fatigue and tiredness. “Although it is not a sedative, it may make some people feel slightly drowsy,” Dr. Vuppuluri says.
Some patients may also experience a change in heart rate or rhythm related to the therapeutic effects of propranolol, as well as new or worsening congestive heart failure, dizziness, and weakness, Dr. Hinkle explains. “Beta blockers may exacerbate or worsen existing bronchospastic conditions like asthma and cause low blood sugar in certain populations, particularly those with diabetes,” she says.
Possible side effects of propranolol include:
- Dizziness or lightheadedness
- Tiredness
- Diarrhea
- Constipation
In rare cases, you may experience the following side effects of propranolol:
- Feeling faint
- Unusual weight gain
- Shortness of breath
- Irregular heartbeat
If you experience the following signs of an allergic or skin reaction, seek emergency medical attention:
- Difficulty breathing or swallowing
- Rash
- Blistering or peeling skin
- Hives
- Itching
- Swelling of the face, throat, tongue, or lips
It’s generally advised to avoid drinking alcohol when taking any blood pressure medication, including before or after taking a dose of propranolol. Alcohol can lower blood pressure, ultimately leading to additional side effects like too low blood pressure.
Other potential propranolol interactions include:
- Antacids containing aluminum
- Cimetidine
- Naproxen and other over-the-counter or prescription NSAIDs
- Warfarin
- Propafenone
- Zolmitriptan or rizatriptan
- Theophylline
- Diazepam
Before you begin taking propranolol, it’s important to seek medical advice from your healthcare provider and pharmacist regarding any potential food or drug interactions.
Talk with your healthcare team if you are experiencing any of these potential side effects. A healthcare professional may advise switching to a propranolol alternative if you’ve experienced serious side effects or other side effects that do not improve.
Propranolol alternatives
Several alternatives and treatments can be prescribed in place of propranolol, depending on the condition treated. “Propranolol is a relatively benign medication when taken as prescribed,” Dr. Vuppuluri says. “If escalated therapy is required, alternatives to propranolol are available for any of the diagnoses it is used to treat,” such as:
| Propranolol alternatives | ||
|---|---|---|
| Drug name | Condition treated | Coupons |
| Acebutolol | Hypertension, irregular heartbeat | Acebutolol coupons |
| Tenormin (atenolol) | Hypertension, chest pain, improve survival after heart attack | Atenolol coupons |
| Bisoprolol | Hypertension | Bisoprolol coupons |
| Coreg (carvedilol) | Hypertension, heart failure, left ventricular dysfunction after a heart attack | Carvedilol coupons |
| Labetalol | Hypertension | Labetalol coupons |
| Toprol XL (metoprolol succinate extended-release) | Hypertension, chest pain, heart failure | Metoprolol succinate ER coupons |
| Bystolic (nebivolol) | Hypertension | Nebivolol coupons |
| Lopressor (metoprolol tartrate) | Hypertension, chest pain, improve survival after heart attack | Metoprolol tartrate coupons |
| Zestril (lisinopril) | Hypertension, heart failure, improve survival after heart attack | Lisinopril coupons |
| Norvasc (amlodipine) | Hypertension, coronary artery disease | Amlodipine coupons |
| Nurtec ODT (rimegepant) | Migraine (acute treatment of migraine; preventive treatment of episodic migraine) | Nurtec ODT coupons |
| Qulipta (atogepant) | Migraine prevention | Qulipta coupons |
| Aimovig | Migraine prevention | Aimovig coupons |
However, you should not stop taking propranolol unless a healthcare provider advises switching to a different medication or treatment plan.
Sources
- Innopran XL drug label, U.S. Food and Drug Administration
- Propranolol, DailyMed (2024)
- Propranolol (cardiovascular), Medline Plus
- Propranolol (intravenous route), Mayo Clinic