There’s a wide variety of medications used to treat Migraine, many of which are prescribed off-label. However, propranolol, under the brand name Inderal, is approved by the FDA for Migraine prevention. If propranolol has been prescribed for you, or if you and your doctor have been considering it, here is some information that should be helpful.
Type of medication:
Propranolol is a medication that has been used as a Migraine and headache preventive for many years, among the first medications approved for Migraine prevention. It’s a beta blocker and is used to treat hypertension, serious chest pain, erratic heartbeats, essential tremor and thickening of the heart muscle. It can be used to treat subaortic stenosis, adrenal gland tumors, and other problems with the circulation of the heart. Propranolol may be used for heart attack prevention and treatment.
- It’s not advised to take propranolol if you have an allergy to this medication or if you have asthma.
- Do not take propranolol if you have a slow heart rate or any serious heart problems, such as “AV block” or “sick sinus syndrome.”
- Do not stop propranolol suddenly because it may create an increase in symptoms of angina, or other heart problems.
- This medication can cause some blood work results to be abnormal.
- Be sure to tell your surgeon or dentist that you are taking propranolol before you have surgery, as you might have to stop taking it for a short time.
- Stay away from alcohol because it may increase the level of propranolol in your blood stream.
- Don’t stop taking propranolol or skip any doses without first having a conversation with your doctor.
- It’s very important to continue to take this medication just as your doctor has instructed even though you may be feeling better; you may not be symptomatic if you have and are being treated for hypertension.
- Be careful when getting up from a lying down or sitting position because you may become dizzy if you move too fast. Try to get up slowly so you don’t fall.
Pregnancy and Breastfeeding:
- FDA Pregnancy Category C. This generally means there are no sufficient studies done on pregnant women OR no animal studies have been conducted. But in the case of propranolol, there have been some animal studies that show high doses of propranolol may harm an unborn baby.
- This medication has been used during pregnancy to treat a range of disorders (including hypertension) without any evidence of malformations to the baby.
- If you are pregnant, the benefits should outweigh the risks of taking propranolol.
- This medication passes into breast milk but there have been no undesirable effects mentioned. It is recommended that a three hour wait occur after a breastfeeding mom has taken propranolol.
- A nursing baby should be monitored carefully to make sure there are no indications of beta-blockade.
Other medical conditions:
Be sure to let your doctor know of other medical problems you may have, including:
- a thyriod condition
- an adrenal gland tumor
- any type of heart problems
- any type of muscle disorder
- breathing disorders
- circulation problems
- kidney problems
- liver problems
- low blood pressure
Be sure to tell your doctor about all the various medications you are taking. But the following medications are contraindicated (should not be used together):
Medications to be avoided or find alternatives include:
- central alpha 2 agonists
- cocaine oronsolaryngeal
- fibric acid derivatives
- NASIDs and NSAID combinations
Your treatment while on propranolol may be monitored or modified when taking these medications:
- acetaminophen and acetaminophen combinations
- ophthalmic alpha 2 agonists and ophthalmic beta blockers
- aspirin combinations such as aspirin with chlorpheniramine/dextromethorphan/phenylephrine
- bismuth subsalicylate/metronidazole/tetracycline
- antihistamine and antihistamine combinations
- bupropion (Wellbutrin) and other antidepressants like Celexa, Cymbalta, Lexapro, Prozac,
- butalbital and butalbital combinations
- calcium channel blockers
- alpha 2-adrenoceptor agonists and alpha 2-adrenoceptor agaonists combinations
- diclofenac - topical
- opiate and combinations
- ephedra and ephedrine
- epinephrine orally and inhaled and local anesthetics
- hydralazine and hydralazine/hydrocholorothiazide
- hydrocodone and hydrocodone combinations
- anesthetics, inhaled
- medications for breathing problems like asthma
- metformin/sulfonylurea combinations
- oxymetazoline nasal
- perphenazine and combinations
- promethazine and combinations
- propoxyphene and combinations
- non-acetylate salicylates
- stimulants or anorexiants
- sumatriptan/naproxen sodium
Medications to be used with caution when taking propranolol:
- alpha blockers, non-selective
- beta 2 agonists, all
- cholinergic agents
- cholinesterase inhibitors
- cyclopentolate/phenylephrine ophthalmic
- ergot alkaloids
- iloprost, inhaled
- non-selective MAOI’s
- morphine liposomal
- nitrites/sodium thiosulfate
- ophthalmic decongestants
- willow bark
Potential side effects:
Seek emergency help if you suffer any of the following allergic reactions:
- breathing problems
- swelling of the throat, lips, face or tongue.
Call your doctor immediately if you have any of the following potentially serious side effects:
- any shortness of breath, including when you mildly exert yourself
- cold feet and hands
- confusion or hallucinations
- dark urine or clay-colored stools
- fainting, or a feeling of light-headedness
- heartbeat irregularities
- loss of appetite
- serious skin reaction which may be followed by a rash that may blister and peel
- sore throat
- swelling of feet or ankles
- upper stomach pain and nausea
- yellowing of the eyes or skin - this is called jaundice
Other less serious potential side effects may include:
- diarrhea, stomach pains or constipation
- feeling tired
- impotence or less of a sex drive or the inability to have an orgasm
- nausea and/or vomiting
- trouble with sleep
- U.S.: Inderal, Inderal LA, Innopran XL
- Migraine preventive medications - too many options to give up
- Preventive, Abortive, and Rescue Medications - What’s the Difference?
- The Evolving Role of Migraine Prevention - Video
Wolters Kluwer. "Propranolol." Drugs.com. Last revised June 18, 2012.
Cerner Multum, Inc. “Propranolol.” Epocrates.com Last revised September 20, 2011.
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_ © The HealthCentral Network, 2012
Last Updated July 9, 2012._