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Propranolol (INDERAL)

Beta Blocker - antihypertensive.
Psychiatric relevance: treatment for aggression, impulse control, performance anxiety.
Daily use may cause fatigue and depression.

Dosage forms:
Propranolol: 10,20,40,60,80
Propranolol ER: 60,80,120,160

HTN Dosing
80-240 mg PO bid
Start: 40 mg PO bid (or 20 QID) incr. dose q3-7 days;
Start: 60 ER or 80 ER
Max: 640 mg/day

Performance Anxiety Dosing: (Test Anxiety / Speaker’s Anxiety)

Start 20mg PO one hour prior to performance

Increase as necessary and tolerated


Dosing for aggression in chronically hospitalized patients

Start 20mg PO qid

Go up to 80mg qid if necessary, or higher if vitals monitored carefully, see:

Dosing from Propranolol Treatment of Chronically Hospitalized Aggressive Patients, Jonathan M. Silver MD, et al, J Neuropsychiatry Clin Neurosci 11:3, Summer 1999:

Essentially, they dosed propranolol as high as tolerated, always taking vitals prior to dose.  They started 20mg qid x4 days, then 40mg qid, continuing to increase 20mg qid every other day until 100mg qid reached, then increased by 20mg qid daily until 360mg qid (total 1440mg daily !! - well above the usual HTN max of 640mg daily) or 20mg/kg, whichever was higher!!   Vitals were taken before each dosage.  If the patient had c/o dizziness, ataxia or wheezing, or HR < 50 or systolic BP <90, propranolol was not increased and maintained at a dosage that was better tolerated. 


Essential tremor dosing:

120 mg/day PO div bid-tid

Start: 40 mg PO bid


Migraine headache prophylaxis dosing:

160-240 mg/day PO div bid-qid

Start: 80 mg/day PO div bid-qid;



Avoid abrupt cessation (especially  with angina)


Side effects:

Breathing difficulty with asthma - decrease dose or d/c if wheezing









Pregnancy: C

Lactation: Probably Safe