Propranolol

Also indexed as: Betachron®, Inderal®

Combination drugs: Inderetic®, Inderex®, Inderide®

Propranolol is a beta-blocker drug. Propranolol is used to treat or prevent some heart conditions, reduce the symptoms of angina pectoris (chest pain), lower blood pressure in people with hypertension, and improve survival after a heart attack. Propranolol is sometimes used to prevent migraine headaches, to reduce movement associated with essential tremor, and to reduce performance anxiety.

Safetychecker Summary for Propranolol
(for details about the summarized interactions, read the full article)

Beneficial May be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them.

Coenzyme Q10*
Beneficial May be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication.

Coenzyme Q10*
Avoid Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results.

High-potassium foods*

Pleurisy root*

Potassium supplements*

Tobacco
Check Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details.

Pepper
Supportive interaction

None known
Reduced drug absorption/bioavailability

None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Dietary Supplements

Coenzyme Q10
Propranolol inhibits enzymes dependent on coenzyme Q10 (CoQ10). In one trial, propranolol-induced symptoms were reduced in people given 60 mg of CoQ10 per day.1

Potassium
Some beta-adrenergic blockers (called “nonselective” beta blockers) decrease the uptake of potassium from the blood into the cells,2 leading to excess potassium in the blood, a potentially dangerous condition known as hyperkalemia.3 People taking beta-blockers should therefore avoid taking potassium supplements, or eating large quantities of fruit (e.g., bananas), unless directed to do so by their doctor.

Interactions with Herbs

Pepper (Piper nigrum, Piper longum)
In a single-dose human study, piperine, a chemical found in black pepper and long pepper, was reported to increase blood levels of propranolol,4 which could increase the activity and risk of side effects of the drug.

Pleurisy root
As pleurisy root and other plants in the Aesclepius genus contain cardiac glycosides, it is best to avoid use of pleurisy root with heart medications such as beta-blockers.5

Interactions with Foods and Other Compounds

Food
Food increases the absorption of propranolol.6 Propranolol should be taken at the same time every day, always with or always without food. High-protein foods may interfere with propranolol metabolism, increasing propranolol blood levels and activity.7

Alcohol
Propranolol may cause drowsiness or dizziness.8 Alcohol may intensify this action. To prevent accidental injury, people taking propranolol should avoid alcohol.

Tobacco
In a double-blind study of ten cigarette smokers with angina treated with propranolol for one week, angina episodes were significantly reduced during the nonsmoking phase compared with the smoking phase.9 People with angina taking propranolol who do not smoke should avoid starting. Those who smoke should consult with their prescribing doctor about quitting.

References:

1. Hamada M, Kazatain Y, Ochi T, et al. Correlation between serum CoQ10 level and myocardial contractility in hypertensive patients. In Biomedical and Clinical Aspects of Coenzyme Q, vol 4, ed. K Folkers, Y Yamamura. Amsterdam: Elsevier, 1984, 263–70.

2. Rosa RM, Silva P, Young JB, et al. Adrenergic modulation of extrarenal potassium disposal. N Engl J Med 1980;302:431–4.

3. Lundborg P. The effect of adrenergic blockade on potassium concentrations in different conditions. Acta Med Scand Suppl 1983;672:121–6 [review].

4. Bano G, Raina RK, Zutshi U, et al. Effect of piperine on bioavailability and pharmacokinetics of propranolol and theophylline in healthy volunteers. Eur J Clin Pharmacol 1991;41:615–7.

5. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213–4.

6. Threlkeld DS, ed. Diuretics and Cardiovasculars, Beta-Adrenergic Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1993, 159a–9c.

7. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 225.

8. Threlkeld DS, ed. Diuretics and Cardiovasculars, Beta-Adrenergic Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1993, 159a–9c.

9. Deanfield J, Wright C, Krikler S, et al. Cigarette smoking and the treatment of angina with propranolol, atenolol, and nifedipine. N Engl J Med 1984;310:951–4.