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Propranolol has a pronounced hypotensive effect in the treatment of essential hypertension and ischemic heart disease by slowing down and normalizing heart activity. Arrhythmias caused by physical exercise, anesthesia, or sympathomimetic drugs (example: amphetamine) can also be treated using this medication.

Propranolol is used for the treatment of heart diseases lacking visible organic causes, such as hyperkinetic heart syndrome. An active substance of the same name can be used to prevent recurrent myocardial infarction and angina attacks. Propranolol has a positive effect on the heart in thyrotoxicosis.

Furthermore, propranolol is used in the prophylactic treatment of migraines, essential tremors, and anxiety disorder.

Indications for use

Main indications for the appointment of propranolol include:

  • Cardiac ischemia;
  • Prevention of myocardial infarction;
  • Stress-induced tachycardia;
  • Hemangioma;
  • Anxiety disorder;
  • Tremor;
  • Restriction of application in veterinary medicine;
  • Prevention of migraine;
  • Symptoms of hyperthyroidism.

The main forms of propranolol release include tablets and ampoules, with a solution for intravenous administration. The dosage of tablets and injections is individually set by the physician depending on the disease to be treated and the success of the therapy. Children under 12 years of age should not take propranolol.

Using propranolol for the treatment of hypertension begins with one tablet two to three times a day (equivalent to 80-120 mg per day). If necessary, the doctor can increase the dosage to two tablets four times a day.

Side effects and contraindications

Side effects such as bradycardia and atrioventricular conduction disorders can occur due to negative chronotropic and dromotropic effects on the heart. Blockade of β-2 receptors in bronchial muscles, especially non-selective blockers, can cause asthma attacks.

Vasoconstriction can reduce tissue perfusion, thereby increasing peripheral circulatory disturbances and creating a feeling of coldness in the hands or feet. β-2 receptor blockade in the liver increases the risk of hypoglycemia in diabetics, while the warning signs (tachycardia, tremor, sweating) remain unnoticed by patients, as symptoms are suppressed by the drug.

In addition to reduced libido, additional adverse effects of the central nervous system may occur (fatigue and depressive mood). Propranolol interacts with numerous antiarrhythmic substances and enhances their bradycardic effects.

Long-term therapy with the drug should not be suddenly interrupted due to the risk of developing withdrawal syndrome, which can be accompanied by tachycardia and hypertension. This effect is caused by an increased sensitivity to catecholamines and increased β-receptor density.

With over 30 potential side effects, this medication may frighten many patients. Therefore, they cease taking medication out of fear of the alleged side effects, regardless of whether they experience them or not. A meta-analysis published in the International Journal of Cardiology showed that, among the beta-blockers, only five side effects are more common than with placebo, namely: hyperglycemia, diarrhea, dizziness, intermittent claudication, and bradycardia. Therefore, most other adverse reactions to medications are the result of a disease or even just patient imagination (nocebo effect).