Inderal (propranolol) is primarily used to manage high blood pressure (hypertension), angina pectoris, and certain cardiac arrhythmias. It is also effective in preventing migraine headaches and reducing the frequency and severity of episodic migraines. Neurologically, Inderal treats essential tremor by reducing tremor amplitude. In psychiatry, low-to-moderate doses are commonly used to control physical symptoms of performance or situational anxiety, such as palpitations, shaking, and sweating. Off-label uses include management of portal hypertension in cirrhosis, postoperative tachycardia, and some forms of hypertrophic cardiomyopathy. The medication’s core action—blocking beta-adrenergic receptors—dampens sympathetic nervous system activity, which explains its wide clinical applications.
Dosage of Inderal varies by indication, formulation, and individual response. For hypertension, common starting doses are 40 mg twice daily of immediate-release propranolol, with gradual titration to 120–240 mg daily as needed and tolerated. For angina, dosing may begin at 80 mg daily divided or as extended-release 80–160 mg once daily. Migraine prophylaxis often uses 80–160 mg daily, sometimes divided; some patients require up to 240 mg per day. For essential tremor, 40 mg twice daily is a common start, increasing to 120–320 mg per day depending on benefit and tolerability. For situational anxiety, single doses of 10–40 mg taken one hour before an event can reduce somatic symptoms. Extended-release (ER) propranolol formulations are typically given once daily and require dose conversion from immediate-release equivalents. Always take Inderal exactly as prescribed—do not abruptly stop therapy, as sudden withdrawal can provoke rebound hypertension, angina, or tachycardia. Dose adjustments may be necessary for elderly patients, those with impaired hepatic function, or when combined with other medications that affect propranolol levels.
Before starting Inderal, review your full medical history with a clinician. Caution is needed in patients with asthma or chronic obstructive pulmonary disease (COPD) because nonselective beta-blockade can precipitate bronchospasm. Diabetes patients should be warned that Inderal can mask adrenergic symptoms of hypoglycemia (like tremor and palpitations) while leaving sweating intact; careful glucose monitoring is important. Those with peripheral vascular disease may experience worsening circulatory symptoms. Monitor heart rate and blood pressure regularly—avoid use in patients with bradycardia, severe hypotension, or certain degrees of heart block without a pacemaker. In pregnancy and breastfeeding, propranolol may be used when benefits outweigh risks, but discuss alternatives and fetal/neonatal monitoring with your provider. Alcohol and sedative use can exacerbate dizziness or fatigue associated with Inderal. Inform healthcare providers about all over-the-counter supplements and herbal remedies, as some can interact or alter cardiovascular response.
Inderal is contraindicated in patients with known hypersensitivity to propranolol or any component of the formulation. It should not be used in those with sinus bradycardia, greater than first-degree heart block, cardiogenic shock, or overt cardiac failure where excessive negative inotropic effects may be harmful. Because propranolol is nonselective, it is generally contraindicated in patients with active bronchospasm or uncontrolled asthma. Caution or avoidance is also advised for individuals with severe peripheral arterial disease, severe depression, or pheochromocytoma unless an alpha-blocker is established first, as propranolol may worsen outcomes if used improperly. Always have a clinician evaluate cardiovascular status and respiratory history before initiating therapy.
Common side effects include fatigue, cold extremities, dizziness, and bradycardia. Gastrointestinal complaints such as nausea, abdominal discomfort, or diarrhea may occur. Some patients report sleep disturbances, vivid dreams, or depression; monitor mood changes closely. Less common but serious adverse effects include heart block, symptomatic hypotension, worsening heart failure, bronchospasm in susceptible individuals, and hypoglycemia masking in diabetic patients. Rare hepatic injury and allergic reactions have been reported. If you experience chest pain, fainting, severe shortness of breath, signs of hepatic dysfunction (jaundice, dark urine), or severe mood changes, seek prompt medical attention. Most side effects are dose-related and can improve with dose reduction or switching formulations under medical supervision.
Inderal interacts with many commonly used medications. Concomitant use with other negative chronotropic agents (e.g., certain calcium-channel blockers like verapamil or diltiazem, digoxin, and other beta-blockers) increases the risk of bradycardia, atrioventricular block, and hypotension. Combining Inderal with clonidine requires careful management—abrupt cessation of clonidine while on a beta-blocker can precipitate severe hypertension. CYP2D6 inhibitors may raise propranolol levels, increasing adverse effects; examples include fluoxetine, paroxetine, and some antiarrhythmics. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect of propranolol. Patients taking insulin or oral hypoglycemics need close monitoring because propranolol can mask hypoglycemic symptoms. Alcohol and sedatives may enhance CNS depression effects. Always provide a complete medication list to your prescriber to manage interactions safely.
If you miss a dose of Inderal, take it as soon as you remember unless it is almost time for your next scheduled dose. Do not double up to make up for the missed dose. For extended-release formulations, maintain once-daily dosing and avoid taking extra tablets to catch up. Consistent dosing helps maintain steady blood levels and optimizes efficacy while reducing the risk of rebound sympathetic symptoms. If you miss doses frequently, discuss a simplified or switched regimen with your healthcare provider to improve adherence.
Acute overdose of propranolol can be life-threatening. Symptoms may include severe bradycardia, hypotension, heart block, bronchospasm, seizures, and hypoglycemia. Immediate medical attention is critical—call emergency services or go to the nearest emergency department. Management typically involves supportive care, gastric decontamination if appropriate, intravenous fluids, atropine for bradycardia, glucagon (a specific antidote that can increase heart rate and contractility), vasopressors for persistent hypotension, and respiratory support for bronchospasm or depressed respiratory drive. If you suspect an overdose, do not wait; prompt intervention improves outcomes.
Store Inderal at room temperature in its original container, away from excessive heat, moisture, and direct sunlight. Keep out of reach of children and pets. Do not store in the bathroom, and discard expired medication properly per local regulations or take-back programs. For extended-release tablets, avoid crushing or breaking the tablet—swallow whole to preserve extended-release properties. If you have questions about proper disposal, consult a pharmacist or local waste management resources.
In the United States, Inderal (propranolol) is a prescription medication and should be obtained through a licensed clinician. Many healthcare systems now offer telemedicine and structured clinical pathways that permit remote evaluation and, where appropriate, prescribing. Southwest Georgia Regional Medical Center provides a legal, structured solution for patients seeking Inderal without a prior in-person prescription: patients undergo a virtual or clinic-based medical assessment by a qualified clinician, including review of medical history, vital signs, and medication interactions. If propranolol is appropriate, the medical team will issue an official prescription and arrange follow-up and monitoring. This approach balances access with safety, ensuring that patients receive professional screening, dosing guidance, monitoring instructions, and education on precautions and interactions. Avoid unregulated online sellers or informal channels that offer prescription medications without medical oversight—those routes carry significant safety risks. For residents of Southwest Georgia and surrounding areas, contact Southwest Georgia Regional Medical Center to learn about their evaluation process, eligibility criteria, and follow-up care options to obtain Inderal safely and legally under clinical supervision.
Inderal is a brand name for propranolol, a nonselective beta-adrenergic blocker used to treat high blood pressure, angina, certain arrhythmias, migraine prevention, essential tremor, and situational anxiety.
Propranolol blocks beta-1 and beta-2 adrenergic receptors, reducing heart rate and contractility, lowering blood pressure, decreasing cardiac oxygen demand, and dampening sympathetic nervous system responses that contribute to tremor and performance anxiety.
Common uses include hypertension, stable angina, supraventricular and some ventricular arrhythmias, migraine prophylaxis, essential tremor, hyperthyroid symptoms, and situational (performance) anxiety; it may also be used in certain types of portal hypertension or after myocardial infarction.
Inderal comes in immediate-release tablets and extended-release (LA) capsules; dosing varies widely by indication, from low single-digit milligrams for anxiety up to several hundred mg daily for hypertension or migraine prevention under medical supervision.
Typical side effects include fatigue, dizziness, cold hands and feet, slow heart rate (bradycardia), sleep disturbances, and gastrointestinal upset; sexual dysfunction and weight gain can also occur in some people.
Signs that need urgent care include severe bradycardia, fainting, worsening shortness of breath or wheeze (possible bronchospasm), chest pain, very low blood pressure, or signs of allergic reaction such as rash, swelling, or difficulty breathing.
Contraindications include asthma or active chronic obstructive pulmonary disease with bronchospasm, untreated severe bradycardia, higher-degree atrioventricular block without a pacemaker, cardiogenic shock, and uncontrolled heart failure; use caution in diabetes and peripheral vascular disease.
Propranolol can mask typical adrenergic warning signs of hypoglycemia (tremor, palpitations) and may prolong hypoglycemia by inhibiting glycogenolysis; diabetics should monitor blood glucose closely and discuss risks with their clinician.
Inderal may be used in pregnancy when benefits outweigh risks, but it can cause fetal growth restriction and neonatal bradycardia or hypoglycemia; it is excreted in breast milk, so breastfeeding mothers should discuss alternatives and monitoring with their provider.
Inderal should not be stopped abruptly after prolonged use because sudden withdrawal can precipitate angina, myocardial infarction, or tachycardia; a gradual taper over days to weeks under medical guidance is recommended.
Propranolol can interact with calcium channel blockers (additive bradycardia and hypotension), antiarrhythmics, digoxin, certain antidepressants and CYP inhibitors (which can raise propranolol levels), and medications that affect blood sugar; check all medications with your clinician or pharmacist.
Because propranolol blunts heart rate and peak cardiac output, it can reduce exercise capacity and the heart rate response to exertion; patients should be counseled to monitor perceived exertion rather than heart rate alone.
Overdose may cause severe bradycardia, hypotension, bronchospasm, and altered mental status; emergency medical treatment may involve activated charcoal if recent, IV fluids, atropine, glucagon, vasopressors, and supportive care—call emergency services immediately.
Store at room temperature away from moisture and heat, in the original container, out of reach of children; follow expiration dating and local disposal guidance for unused medication.
Propranolol is FDA-approved for migraine prophylaxis; preventive benefit often appears after 4–8 weeks of consistent treatment, with dose adjusted for tolerance and response.
Inderal can cause dizziness, fatigue, or visual disturbances in some people; avoid driving or operating heavy machinery until you know how it affects you.
Metoprolol is cardioselective (beta-1 predominant) while Inderal (propranolol) is nonselective (blocks beta-1 and beta-2); metoprolol often has a lower risk of bronchospasm and may be preferred in patients with reactive airways or peripheral vascular disease, while propranolol may be chosen for migraine or tremor due to central nervous system effects.
Propranolol crosses the blood–brain barrier and is more effective for central indications like migraine prophylaxis and essential tremor; atenolol is more cardioselective and has a different pharmacokinetic profile, so choice depends on the primary indication and comorbidities.
Nadolol has a much longer half-life and can be dosed once daily with more stable plasma levels, whereas propranolol typically requires more frequent dosing or an extended-release formulation for once-daily use; nadolol’s prolonged action may suit some chronic indications.
Carvedilol blocks beta-1, beta-2, and alpha-1 receptors and has proven mortality benefit in chronic heart failure when initiated appropriately; propranolol is not typically used as first-line beta-blocker for heart failure because carvedilol, metoprolol succinate, and bisoprolol have specific evidence supporting reduced mortality.
Timolol is used topically for glaucoma with minimal systemic absorption compared with oral propranolol; oral propranolol has greater systemic effects and risks—topical timolol still may cause systemic beta-blockade but at lower magnitude.
Pindolol and acebutolol have partial agonist (intrinsic sympathomimetic) activity, which may cause less resting bradycardia and fewer adverse metabolic effects for some patients; propranolol lacks ISA and produces more pronounced beta-blockade.
Inderal is the brand name for propranolol; the LA (long-acting) propranolol capsule delivers similar active drug but with slower release for once-daily dosing, which can improve adherence and reduce peak–trough fluctuations.
Bisoprolol is a beta-1 selective blocker with a long half-life and proven efficacy in hypertension with potentially fewer pulmonary side effects; propranolol is nonselective and may be chosen for comorbid conditions like migraine or essential tremor rather than as a first-line pure antihypertensive in patients with lung disease.
Propranolol is lipophilic and readily crosses into the CNS, increasing the likelihood of fatigue, vivid dreams, or depression in susceptible individuals; more hydrophilic agents (e.g., atenolol, nadolol) have lower CNS penetration and may cause fewer central side effects.
Inderal (propranolol) is often preferred for performance or situational anxiety because its nonselective blockade, rapid onset, and central effects reduce tremor and autonomic symptoms; a single low dose taken before an event is commonly effective under clinician guidance.
Because propranolol blocks beta-2 receptors in bronchial smooth muscle, it poses a higher risk of bronchospasm in asthmatic patients than selective beta-1 blockers like metoprolol or bisoprolol; cardioselective agents are generally safer when lung disease is present, though caution is still required.
Titration and cross-tapering should be managed by a clinician; differences in selectivity, half-life, dosing frequency, and indications mean dose equivalence isn’t one-to-one—monitor heart rate, blood pressure, and symptoms during the transition.
Some beta-blockers (metoprolol, carvedilol, bisoprolol) have solid evidence for reducing mortality post-myocardial infarction when used appropriately; propranolol was used historically but contemporary guidelines often favor agents with modern outcome data for post-MI mortality benefit.
No—choice of beta-blocker depends on the condition being treated, comorbidities, pharmacokinetics, and side effect profile; while many share core beta-blocking effects, some (like propranolol) are better for migraine and tremor, whereas others are preferred for heart failure or asthma-prone patients.
Decisions should weigh indication-specific evidence, patient comorbidities (lung disease, diabetes, depression), desired dosing schedule, potential interactions, and side effect profiles; shared decision-making with a clinician ensures the selected agent matches therapeutic goals and safety considerations.