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Propranolol
General Information
Beta-blockers, such as propranolol, are known for their heart rate-regulating capabilities and have proven to be a key ally in the management of symptoms such as tachycardia (fast heart rate) and palpitations - symptoms that frequently impact people with POTS and Long COVID.
Dosing Instructions
Please carefully follow your dosing instructions in your RTHM patient dashboard. It is important to regularly monitor your heart rate and blood pressure to adjust your optimal dose accurately.. Maintaining a detailed log of symptoms, heart rate and blood pressure can help our RTHM providers and your primary care provider to better evaluate your dosing needs.
Do NOT increase a dose more often than once a week to best assess the effect of the new dose.
Please read this treatment guide in its entirety for additional important information.
Required Materials
Some doses of propranolol require cutting tablets. We recommend you obtain a pill cutter to divide higher-strength tablets into the necessary dose. Follow these steps when using a pill cutter:
  1. Clean the pill cutter before first use and ensure it`s dry.
  2. Place the tablet in the designated area of the cutter that aligns with the blade.
  3. Carefully press down on the cutter to divide the tablet into the desired portion. For a 10 mg tablet, you would cut it in half and then cut one of the halves in half again to approximate a 2.5 mg dose.
  4. Store the unused portions in a labeled container to maintain their integrity.
Best Time to Take Propranolol
Your first dose of propranolol can make you feel dizzy, so it is recommended to take it at bedtime. If you do not experience dizziness with the first dose, you can change to taking it in the morning.
Take With or Without Food
Propranolol can be taken with or without food. If you experience stomach upset, try taking it with food.
What To Do If I Miss a Dose
If you miss a dose, take it as soon as possible. If you are close to the time of your next dose, wait to take the next dose and then resume your normal dosing schedule. Do not “double-up” the dose.
Precautions When Starting Propranolol
  • Read the medication guide provided by your pharmacist and the guide in your RTHM patient portal before you start taking propranolol. If you have any questions, message the RTHM Medical Team.
  • Try to take your propranolol at the same time each day.
  • If you are on a stable dosage, do not increase or decrease the dose on your own without talking to your clinician first.
  • Do not stop taking this medication suddenly on your own without talking to your medical provider first. Rebound elevations in heart rate or blood pressure may occur if stopped suddenly, so it`s best to taper off of this medication.
  • It is essential to check in with your provider regularly while taking propranolol to ensure that it is working properly and not causing any unwanted side effects.
  • If you are newly starting propranolol with RTHM , you will be prompted to fill out questions about symptoms, side effects, updated blood pressure and heart rate readings 2-3 weeks into starting the medication so our providers can make sure you are on the best dose for your unique situation and that it is safe to continue.
  • People on stable doses through RTHM will be prompted to update our providers about blood pressure, heart rate, symptoms, and side effects & any changes to other medications or allergies every 2.5-3 months to make sure your dose is the best one for you and that it is safe to continue.
  • Propranolol masks the symptoms of low blood sugar. If you have diabetes, you need to closely monitor your blood sugars as you may not feel the typical hypoglycemia symptoms. If you experience a fast heartbeat, dizziness, increased hunger, nervousness or anxiety, sweating, shaking, irritability, or confusion, seek medical help immediately. In many cases, propranolol is not recommended for those with uncontrolled diabetes.
  • Propranolol will enhance the effects of central nervous system depressants, such as alcohol, antihistamines, pain medications, and muscle relaxants. Check with your provider before taking these medications.
  • Propranolol can cause you to be less alert than normal. Do not drive or operate heavy machinery if this occurs, or when you are first starting propranolol or increasing to a higher dose until you know how it affects you.
  • Tell your dentist that you are using this medication.
Potential Side Effects
Common symptoms seen with propranolol include:
  • Headaches
  • Dry mouth
  • Fatigue
  • Restlessness
  • Unusual dreams
  • Dizziness, lightheadedness, or weakness
  • Cold fingers and toes
  • Nausea or vomiting
  • Diarrhea
  • Stomach pain
When to Seek Medical Attention
Some side effects may require immediate medical attention. These can include:
  • Chest tightness
  • Cough producing mucus
  • Difficulty breathing
  • Worsening of chest pain
  • Very slow heartbeat or heart rate
  • Erectile dysfunction
  • Rapid weight gain, swelling in your hands, feet, or ankles
Propranolol can cause serious allergic reactions in some individuals. If you experience rash, itching, trouble breathing, trouble swallowing, or swelling of the hands, face, or mouth, seek immediate medical attention.
Interactions with Propranolol
  • Propranolol can negatively interact with many different medications. Some medication combinations should be completely avoided while other times combinations may be necessary but with specific precautions in place, such as altered dosing or timing of when medications are taken.
  • OTC medicines like Mylanta, Tagamet, Advil, and Aleve are best avoided while on propranolol, or taken further away from doses, so make sure your healthcare provider and pharmacist are aware of all the medications and supplements you are taking. (3)
  • It is important to maintain a list of all medications and supplements you take to best inform your healthcare provider and pharmacist to help avoid potential drug interactions.
  • Do not start any new medications or supplements before checking with your healthcare provider and pharmacist.
  • Avoid alcohol and tobacco when taking propranolol. Alcohol can increase the amount of propranolol remaining in your body while tobacco can decrease the effectiveness.
Who Should Not Take Propranolol
Propranolol is not recommended for everyone. Do not take propranolol if you have any of the following conditions
  • Liver or kidney disease
  • Pregnant or breastfeeding
  • Diabetes
  • Circulation conditions
  • Thyroid disorders
  • Congestive heart failure
  • Severe allergies (that may require an epi-pen)
  • Muscular disorders like myasthenia gravis
  • Depression
  • Asthma
  • Angina (chest pain)
  • Sever bradycardia (very low heart rate)
  • Heart block
  • Psoriasis
  • Glaucoma
What If I Become Pregnant While Taking This Medication?
  • Inform your doctor when you become pregnant. Propranolol has been linked to reduced fetal growth and, in late pregnancy, can cause the baby to experience symptoms of the drug that affect the heart, blood vessels, and metabolism.
  • Propranolol also passes into breast milk, though studies have found no adverse reactions in infants fed breast milk from a mother taking propranolol.
Medication Storage
  • Keep this medication in the container provided by the pharmacy. Ensure it is properly closed and out of the reach of children. Store at room temperature and away from excess heat, direct light, and moisture (not in the bathroom).
  • Do not share this medication with anyone else.
  • Do not throw away unwanted or expired medications. Do not flush down the toilet or pour down the drain. Ask your local pharmacist about local drug take back programs to discard your medication.
In Case of Overdose
Take medication only as directed. In the event of an accidental overdose, contact emergency services immediately.
Symptoms of an overdose of low-dose naltrexone can include:
  • Slow heartbeat
  • Dizziness
  • Fatigue or weakness
  • Difficulty breathing
  • Cough or wheezing
Questions
If you have questions about this medication, please contact us by using our support form. We generally respond within 2 business days. If you have a more urgent issue, please seek care from your local primary care provider, urgent care or emergency services.
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