Name: PROPRANOLOL (InderalR)
Classification: beta 1 and beta 2 receptor blocker
  • decreases heart rate
  • prolongs diastolic time; increases time for coronary perfusion and cardiac filling
  • decreases AV conduction; useful in treating rapid supraventricular arrhythmias
  • decreases myocardial contractility 
  • decreases myocardial 02 consumption in angina (decreased rate and contractility); strongly recommended to prevent or manage heart failure post MI
  • decreases blood pressure
  • can be used as prophylaxis against migraine headaches
  • can cause bronchoconstriction
Dose:
  • Bolus: 
    • 1-3mg IV direct at 0.5mg/min (maximum 0.15mg/kg)
  • IV Infusion: 
    • 0.1-5mg/hour; titrate to effect
Administration: IV Infusion: 
10mg/100mL D5W, NS, RL (maximum 50mg/100mL)
  • should be weaned off
  • use in pheochromocytoma should be PRECEDED by an alpha-blocker as peripheral beta-blockade may worsen the alpha induced vasoconstriction
Adverse Effects:
  • bradycardia
  • AV blocks
  • hypotension
  • decreased cardiac output
  • bronchospasm
  • acute pulmonary edema
  • electrolyte imbalances
  • may mask tremors and tachycardia associated with insulin induced hypoglycaemia
  • may increase systemic vascular resistance
Caution:
  • should be used with caution in patients with asthma or COPD as beta blockade may cause bronchoconstriction
  • should be used with caution in patients with peripheral vascular disease, bradyarrhythmias or AV block
Antidote:
  • glucagon (for treatment of overdose only)
Drug Interactions:
  • propranolol + beta sympathomimetics = antagonizes bronchodilation
  • propranolol + epinephrine = resistance to epinephrine effect; may result in unpredictable and potentially fatal interaction (hypertension, bradycardia)
  • propranolol + lidocaine = increased lidocaine toxicity
  • propranolol + procainamide = increased procainamide levels
  • propranolol + verapamil = hypotension, AV block
  • propranolol + theophylline = mutual antagonism of therapeutic effect
Monitoring Therapy:
  • ECG: HR, rhythm, PR interval
  • BP
  • cardiac index
  • urine output
  • blood glucose
  • SVRI (may drop SVRI)
  • PWP (may cause increase due to myocardial depression)
  • breath sounds, SpO2, chest xray 
CCTC Protocol:
  • May be administered by IV infusion by an approved nurse in CCTC.
  • May be administered IV direct at a rate of 0.5mg/min by an approved nurse in CCTC.
  • May be titrated by an approved nurse in CCTC.
  • Must be administered via a central line.
  • Continuous infusion must be administered via an infusion pump.
  • Should not be infused through the proximal injectate port (blue) of the Swan Ganz catheter.
  • Patient requires placement of an arterial line to monitor BP.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: August 7, 2006  Reviewed: January 12, 2017

LHSCHealth Professionals

Last Updated January 12, 2017 | © 2007, LHSC, London Ontario Canada