Propranolol

What is propranolol?

Propranolol is a medicine called a beta-blocker. Propranolol controls the heart so that it beats more slowly and more steadily.

Your child may need a beta-blocker to:

• treat high blood pressure
• treat an uneven or fast heart beat
• prevent migraine headaches or tremor

You may hear propranolol called by its brand names, Inderal, Inderal-LA, or Apo-Propranolol. Propranolol comes as a tablet, long-acting capsule, liquid, and injection.

Before giving propranolol to your child?

Tell your doctor if your child has:

• an allergy to propranolol or other beta-blockers

Talk with your doctor or pharmacist if your child has any of the following conditions. Precautions may need to be taken with this medicine if your child has

• kidney disease
• liver disease
• diabetes
• heart disease (such as heart block or heart failure)
• overactive thyroid (hyperthyroidism)
• asthma or bronchitis
• Raynaud's disease (circulation problems in the hands or feet)
• low blood pressure
• depression

How should you give your child propranolol?

Follow these instructions when giving your child propranolol:

• Give your child this medicine exactly as your doctor or your pharmacist tells you to, even if your child seems better.
• Give your child this medicine at the same times every day. Pick times that are easy for you so that you do not miss doses.
• Propranolol may be given with or without food.

If your child is taking liquid propanonol:

• Shake the bottle well. Measure the dose with the special spoon or syringe your pharmacist gave you. You may mix the liquid with water, fruit juice, another liquid, or with a small amount of soft food such as applesauce or ice cream.

If your child is taking propranolol tablets:

• It may be swallowed whole with a full glass of water, or you may crush the tablet and mix it with liquid or a small amount of food.

If your child is taking the long-acting capsule:

• It should be swallowed whole with a full glass of water. Do not break, crush, or chew the long-acting capsule.

If your child takes propranolol regularly, do not stop giving it without checking with your child's doctor. The dose may need to be made smaller before stopping.

What should you do if your child misses a dose of propranolol?

• Give the missed dose as soon as you remember.
• If it is almost time for the next dose, skip the missed dose. Give the next dose at the regular time.
• Do not give your child two doses to make up for one missed dose.

How long does propranolol take to work?

It may take up to several weeks before the full benefit of this medicine is seen.

What are the possible side effects of propranolol?

Your child may have some of these side effects while they take propranolol. Check with your child's doctor if your child continues to have any of these side effects, and they do not go away, or they bother your child:

• feeling dizzy or light headed
• feeling sleepy, tired or weak, or unable to think clearly
• upset stomach (either watery bowel movements, stomach pain, or nausea)
• problems sleeping or bad dreams

Call your child's doctor during office hours if your child has any of these side effects:

• cold hands and feet
• severe or unusual weight gain
• swollen ankles, feet or lower legs
• feeling depressed, withdrawn or other changes in mood
• rash

Most of the following side effects are not common, but they may be a sign of a serious problem. Call your child's doctor right away or take your child to the Emergency Department if your child has any of these side effects:

• problems breathing, shortness of breath or wheezing
• severe dizziness or fainting
• chest pain or tightness
• changes in heart rate (fast, slow, or uneven)
• bluish-colored fingernails or palms of hands
• seizures

What safety measures should you take when your child is using propranolol?

Keep all appointments at the clinic or doctor's office so that the doctor can check your child's reaction to propranolol. The doctor may need to change the dose so that your child is getting the right amount.

Check with your child's doctor or pharmacist before you give your child any other medicines, even medicines that you can buy without a doctor's order (prescription).

There are some medicines that should not be taken together with propranolol or in some cases the dose of propranolol or the other medicine may need to be adjusted. It is important that you tell your doctor and pharmacist if your child takes any other medications including:

• other medicines that affect the heart or blood pressure (including digoxin)
• cisapride
• certain antibiotics
• medicines for depression
• antihistamines or cold or flu medicines you can buy over the counter

If your child feels dizzy or faint when getting up from a lying or sitting position, they should get out of bed or get up from a sitting position slowly.

In newborns and infants, propranolol may lower blood sugar levels (hypoglycemia). If your child is diabetic, propranolol may affect blood sugar control and your child may need to test for blood sugar levels more often. Also, propranolol may cover up signs of hypoglycemia (low blood sugar), such as a change in heart rate.

What other important information should you know about propranolol?

• Make sure you always have enough propranolol to last through weekends, holidays and vacations. Call your pharmacy at least two days before your child runs out of medicine to order refills. This is especially important for propranolol liquid, as your pharmacy may have to make this specially for your child.
• Keep propranolol tablets, capsules and liquid at room temperature in a cool, dry place away from sunlight. Do not store them in the bathroom or kitchen.
• Do not keep any medicines that are out of date. Check with your pharmacist about the best way to throw away outdated or leftover medicines.
• Keep a list of all medications your child is on and show the list to the doctor or pharmacist.
• Do not share your child's medicine with others. Do not give anyone else's medicine to your child.
  

References

Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D, Drolet BA (2010). Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Arch Dermatol. 146(7):775–778. Retrieved from: https://jamanetwork.com/journals/jamadermatology/fullarticle/421616

The Birthmark Unit in collaboration with the Child and Family Information Group (2018). Treating haemangiomas with propranolol. Great Ormond Street Hospital for Children, NHS Foundation Trust. Retrieved from: https://www.gosh.nhs.uk/conditions-and-treatments/medicines-information/treating-haemangiomas-propranolol.

Keep propranolol out of your child’s sight and reach and locked up in a safe place. If your child takes too much propranolol, call your local Poison Information Centre at one of these numbers. These calls are free. 

• Call 1-844 POISON-X, or 1-844-764-7669, from anywhere in Canada except Quebec.
• Call 1-800-463-5060 if you live in Quebec.