Propranolol Dosing and Administration

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Angina

Adults

PO 80 to 320 mg/day in 2 to 4 divided doses or 80 mg/day of sustained-release medication (max, 320 mg/day).

Arrhythmias

Adults

PO 10 to 30 mg 3 to 4 times daily before meals and at bedtime.

Arrhythmias (Life-Threatening)

Adults

IV 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses every 4 h.

Essential Tremor

Adults

PO 40 mg twice daily initially; titrate to response. The maintenance dose is 120 to 320 mg/day in 2 to 3 divided doses (max, 320 mg/day).

Hypertension

Adults

PO The initial dose is 40 mg twice daily initially or 80 mg sustained-release medication/day; titrate to response. The usual maintenance dose is 120 to 240 mg/day in 2 to 3 divided doses or 120 to 160 mg/day sustained-release medication, except for InnoPran XL (do not exceed 120 mg/day). Do not exceed 640 mg/day.

Children

PO 0.5 mg/kg twice daily; titrate every 3 to 5 days to max dose of 16 mg/kg/day.

Hypertrophic Aortic Stenosis

Adults

PO 20 to 40 mg 3 to 4 times daily before meals and at bedtime or 80 to 160 mg sustained-release medication once daily.

Migraine

Adults

PO 80 mg in divided doses daily or once daily (sustained release); titrate to response (max dose, 240 mg/day); discontinue after 6 wk if no response.

MI

Adults

PO 180 to 240 mg/day in 3 to 4 divided doses up to 240 mg/day.

Pheochromocytoma

Adults

PO 60 mg/day for 3 days prior to surgery, given with alpha-blocker.

General Advice

Immediate-release and extended-release dose forms may not be interchangeable on a mg to mg basis. Be prepared to retitrate dose to maintain desired therapeutic effect.

Immediate-release tablets

• Administer without regard to meals but administer with food if GI upset occurs.

Extended-release capsules

• Administer prescribed dose once daily (InnoPran XL should be administered at bedtime).
• Administer without regard to meals but administer with food if GI upset occurs. Administer consistently either with or without food.
• Have patient swallow capsules whole; do not crush, chew, break, or open capsule.

Oral solution

• Measure and administer prescribed dose using dosing syringe, spoon, or cup.
• Administer without regard to meals but administer with food if GI upset occurs.

Concentrated oral solution

• Use supplied dropper to measure prescribed dose. Squeeze dropper contents into a liquid (e.g., water, juice, soda, soda-like beverage) or semisolid food (e.g., applesauce, pudding) and mix by gently stirring the mixture. Entire amount of mixture should be consumed immediately.
• Do not prepare mixtures ahead of time and store for future use.

Injection

• For IV administration only. Not for intradermal, subcutaneous, IM, or intraarterial administration.
• Do not administer if solution is discolored or cloudy, or if particulate matter is noted.
• Administer IV bolus dose at rate not exceeding 1 mg (1 mL) per minute. A second dose may be administered 2 min later if response to first dose is inadequate. Additional drug should not be given in less than 4 h.
• Discard any unused solution. Do not save for future use.

Adapted from the FDA Package Insert.