Below are the general guidelines for dosing propranolol. Note that these dosages may be adjusted on a case-by-case basis for individual patients. Always follow your prescribing physician’s instructions for taking propranolol.
The following information comes from DailyMed, an FDA label information provider.
What if I miss a dose of propranolol?
According to Mayo Clinic, if you miss a dose of propranolol, take the missed dose immediately unless you are closer in time to your next available dose. Never double doses.
What if I overdose on propranolol?
**If you believe you or someone you know has overdosed, call 911 immediately for medical assistance.
Propranolol is not significantly dialyzable. In the event of overdosage or exaggerated response, the following measures should be employed:
General: If ingestion is or may have been recent, evacuate gastric contents, taking care to prevent pulmonary aspiration.
Supportive Therapy: Hypotension and bradycardia have been reported following propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a propranolol overdose. Glucagon should be administered as 50-150 mcg/kg intravenously followed by continuous drip of 1-5 mg/hour for positive chronotropic effect. Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine, however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing.
The electrocardiogram, pulse, blood pressure, neurobehavioral status and intake and output balance must be monitored. Isoproterenol and aminophylline may be used for bronchospasm.
Dosage and Administration
General
Because of the variable bioavailability of propranolol, the dose should be individualized based on response.
Hypertension
The usual initial dosage is 40 mg propranolol hydrochloride twice daily, whether used alone or added to a diuretic. Dosage may be increased gradually until adequate blood pressure control is achieved. The usual maintenance dosage is 120 mg to 240 mg per day. In some instances a dosage of 640 mg a day may be required. The time needed for full antihypertensive response to a given dosage is variable and may range from a few days to several weeks.
While twice-daily dosing is effective and can maintain a reduction in blood pressure throughout the day, some patients, especially when lower doses are used, may experience a modest rise in blood pressure toward the end of the 12-hour dosing interval. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. If control is not adequate, a larger dose, or 3-times-daily therapy may achieve better control.
Angina Pectoris
Total daily doses of 80 mg to 320 mg propranolol hydrochloride, when administered orally, twice a day, three times a day, or four times a day, have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG. If treatment is to be discontinued, reduce dosage gradually over a period of several weeks.
Atrial Fibrillation
The recommended dose is 10 mg to 30 mg propranolol hydrochloride three or four times daily before meals and at bedtime.
Myocardial Infarction
In the Beta-Blocker Heart Attack Trial (BHAT), the initial dose was 40 mg three times daily, with titration after 1 month to 60 mg to 80 mg three times daily as tolerated. The recommended daily dosage is 180 mg to 240 mg propranolol hydrochloride per day in divided doses. Although a three times daily regimen was used in BHAT and a four times daily regimen in the Norwegian Multicenter Trial, there is a reasonable basis for the use of either a three times daily or twice daily regimen. The effectiveness and safety of daily dosages greater than 240 mg for prevention of cardiac mortality have not been established. However, higher dosages may be needed to effectively treat coexisting diseases such as angina or hypertension (see above).
Migraine
The initial dose is 80 mg propranolol hydrochloride daily in divided doses. The usual effective dose range is 160 mg to 240 mg per day. The dosage may be increased gradually to achieve optimum migraine prophylaxis. If a satisfactory response is not obtained within four to six weeks after reaching the maximum dose, propranolol therapy should be discontinued. It may be advisable to withdraw the drug gradually over a period of several weeks.
Essential Tremor
The initial dosage is 40 mg propranolol hydrochloride twice daily. Optimum reduction of essential tremor is usually achieved with a dose of 120 mg per day. Occasionally, it may be necessary to administer 240 mg to 320 mg per day.
Hypertrophic Subaortic Stenosis
The usual dosage is 20 mg to 40 mg propranolol hydrochloride three or four times daily before meals and at bedtime.
Pheochromocytoma
The usual dosage is 60 mg propranolol hydrochloride daily in divided doses for three days prior to surgery as adjunctive therapy to alpha-adrenergic blockade. For the management of inoperable tumors, the usual dosage is 30 mg daily in divided doses as adjunctive therapy to alpha-adrenergic blockade.
How is propranolol supplied?
Propranolol Hydrochloride Tablets USP 10 mg are 9/32″, scored, round, orange tablets imprinted DAN 5554 and 10 .
Propranolol Hydrochloride Tablets USP 20 mg are 9/32″, scored, round, blue tablets imprinted DAN 5555 and 20.
Propranolol Hydrochloride Tablets USP 40 mg are 11/32″, scored, round, green tablets imprinted DAN 5556 and 40 .
Propranolol Hydrochloride Tablets USP 80 mg are 12/32″, scored, round, yellow tablets imprinted DAN 5557 and 80 .
They are supplied by State of Florida DOH Central Pharmacy as follows:
| NDC | Strength | Quantity/Form | Color | Source Prod. Code |
| 53808-0771-1 | 20 mg | 30 Tablets in a Blister Pack | blue | 0591-5555 |
| 53808-0772-1 | 40 mg | 30 Tablets in a Blister Pack | green | 0591-5556 |
Dispense in a well-closed, light-resistant container with child-resistant closure.
Store at 20°-25°C (68°-77°F). [See USP controlled room temperature.] Protect from light.
Manufactured By:
Watson Pharma Private Limited
Verna, Salcette Goa 403 722 INDIA
Distributed By:
Watson Pharma, Inc.
Corona, CA 92880 USA
This Product was Repackaged By:
State of Florida DOH Central Pharmacy
104-2 Hamilton Park Drive
Tallahassee, FL 32304
United States
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