Propranolol ER
INDERAL LA
Pronunciation: proe-PRAN-oe-loel
What it isLong-acting beta-1, beta-2, and cardiac sodium-channel antagonist; hypertension and migraine prevention.
Why this oneIts CNS penetration and broad use for tremor, migraine, and adrenergic symptoms distinguish it from selective beta blockers.
What limits itBradycardia and bronchospasm limit use; it masks hypoglycemia and must be tapered to avoid rebound adrenergic effects.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hypertension | Adults | 80 mg QD | 120–160 mg QD | 640 mg/day |
| Angina pectoris | Adults | 80 mg QD | 160 mg QD | 320 mg/day |
| Migraine prophylaxis | Adults | 80 mg QD | 160–240 mg QD | |
| Hypertrophic subaortic stenosis | Adults | 80–160 mg QD |
Titration Angina: increase gradually at 3–7 day intervals; migraine: increase gradually (assess over 4–6 weeks).
Renal Use with caution in impaired renal function.
Hepatic Use with caution in impaired hepatic function.
Instructions
- Administer once daily
- Not a simple mg-for-mg substitute for immediate-release propranolol
- Taper gradually over a few weeks when discontinuing (risk of angina/MI)
Available strengths
- ER cap 60, 80, 120, 160 mg
- tab 10, 20, 40, 60, 80 mg
- sol 20, 40 mg/5 mL
- sol 4.28 mg/mL
- inj 1 mg/mL
Contraindications
- Cardiogenic shock
- Sinus bradycardia and greater than first-degree heart block
- Bronchial asthma
Cautions
- Abrupt withdrawal (angina exacerbation/MI)
- Cardiac failure
- Bronchospasm
- Masking of hypoglycemia/hyperthyroidism
- Hypersensitivity/serious skin reactions
Adverse reactions
- Bradycardia
- Hypotension
- Fatigue/lethargy
- Dizziness/lightheadedness
- Depression/insomnia
- Vivid dreams
- Bronchospasm
- GI upset
Pregnancy Pregnancy Category C; IUGR, small placentas, and neonatal bradycardia/hypoglycemia/respiratory depression reported.
Lactation Undefined.
Cost
| Strength | #/mo | generic $/mo | CostPlus | |
|---|---|---|---|---|
| 60 mg | ER cap | 30 qd | $5.10 | offered |
| 80 mg | ER cap | 30 qd | $5.72 | offered |
| 120 mg | ER cap | 30 qd | $5.87 | offered |
| 160 mg | ER cap | 30 qd | $9.15 | offered |
Other forms: Propranolol (INDERAL)
NO BOXED WARNINGS
Principal riskAngina or MI after abrupt withdrawal