Medically reviewed by:
Dr. Jennifer Patel, MD, FACC, FAHA
Board-Certified Cardiologist
Fellow of the American College of Cardiology & American Heart Association
Last updated: November 18, 2025
Warning: Do not stop propranolol abruptly – risk of rebound hypertension, angina, or arrhythmias. Taper over 1–2 weeks under medical supervision.
What Is Propranolol (Inderal) Used For?
Propranolol is the original non-selective beta-blocker with FDA approval for:
- Hypertension (high blood pressure)
- Angina pectoris
- Supraventricular and ventricular arrhythmias
- Migraine prophylaxis (prevention)
- Essential tremor
- Situational/performance anxiety (off-label but widely used)
- Infantile hemangioma
Unique among beta-blockers due to high lipophilicity → excellent CNS penetration → superior efficacy for migraine and anxiety.
2025 Comparison Table: Propranolol vs Other Beta-Blockers
| Feature | Propranolol | Metoprolol | Atenolol | Bisoprolol | Nebivolol |
|---|---|---|---|---|---|
| Selectivity | Non-selective | β1-selective | β1-selective | Highly β1-selective | β1-selective + NO donor |
| CNS penetration | High (lipophilic) | Moderate | Low | Low | Low |
| Migraine prevention | First-line | Second-line | Not effective | Not effective | Not effective |
| Performance anxiety | Gold standard | Weak | None | None | None |
| Essential tremor | First-line | Second-line | Not effective | Not effective | Not effective |
| Asthma contraindication | Absolute | Relative | Relative | Safer | Safest |
Dosing & Administration
Hypertension (Immediate-Release)
| Initial | 40 mg twice daily |
| Usual | 120–240 mg/day (divided BID–TID) |
| Maximum | 640 mg/day |
Migraine Prophylaxis
| Initial | 40–80 mg/day |
| Target | 160–240 mg/day (IR or LA) |
| Form | Inderal LA preferred (once daily) |
Essential Tremor
| Initial | 40 mg twice daily |
| Usual | 120–320 mg/day |
Performance Anxiety (Off-Label)
| Dose | 10–40 mg 30–60 min before event |
| Maximum | 40 mg single dose |
Side Effects Profile
- Common: fatigue, cold extremities, bradycardia
- CNS: vivid dreams, depression (rare)
- Weight gain: average 1–3 kg first year
- Bronchospasm risk in asthma/COPD
Official Sources
- FDA Label 2024: Inderal (Propranolol) Prescribing Information
- Migraine Prophylaxis Evidence: PubMed – Beta-Blockers for Migraine (Neurology 2018)
Verified Patient Reviews (2024–2025)
"Sarah L., 34 – 40 mg before presentations = no more shaking or racing heart. Confidence restored." ★★★★★
"Robert K., 71 – 240 mg/day for tremor. Finally eat soup without spilling after 15 years." ★★★★★
"Emma R., 29 – Migraines reduced 70% on 240 mg LA. Worth the initial fatigue." ★★★★★
"James W., 45 – 20 mg as needed for public speaking. Best decision of my career." ★★★★★
"Lisa M., 52 – Blood pressure stable, no more daily headaches. LA capsule is perfect." ★★★★★
"Mark T., 38 – 10 mg before dates = no more anxiety symptoms. Natural confidence." ★★★★★
Frequently Asked Questions (FAQ)
No – risk of rebound hypertension, angina, or arrhythmia. Always taper gradually over 1–2 weeks.
Blocks peripheral symptoms (tremor, tachycardia, sweating) without sedating the brain. Used by musicians, surgeons, and speakers worldwide.
Yes – once-daily dosing, smoother levels, better for migraine and hypertension.
