When Your Patient Can't Fill Their Propranolol Prescription

You've prescribed Propranolol — a medication with decades of evidence behind it — and your patient calls to say their pharmacy doesn't have it. Maybe they've tried two or three locations. Maybe they're anxious because they're running low and worried about withdrawal. This scenario is becoming more common in 2026, and it's adding frustration for both patients and providers.

The Propranolol shortage is not across the board. Oral tablets and extended-release capsules remain generally available from multiple generic manufacturers. However, the oral solution (on ASHP shortage list since February 2025) and injectable form (back order, no ETA) are significantly constrained. And even for tablet forms, some pharmacies — particularly large chains in high-demand areas — may experience intermittent stock-outs of specific strengths.

This guide provides a practical, step-by-step approach to helping your patients navigate these supply issues efficiently.

Current Availability at a Glance

• IR tablets (10, 20, 40, 60, 80 mg): Generally available. Occasional stock-outs at individual pharmacies, especially 10 mg and 20 mg.
• ER capsules (60, 80, 120, 160 mg): Generally available from multiple manufacturers.
• Oral solution (20 mg/5 mL, 40 mg/5 mL): ASHP shortage. Hikma on allocation. Difficult to obtain.
• Injectable (1 mg/mL): Back order. No estimated release. Impacts inpatient settings.

For the latest status, refer to the Propranolol shortage update for prescribers.

Why Patients Can't Find Propranolol

Understanding the "why" helps you anticipate which patients are most likely to call:

Oral Solution Patients

The oral solution shortage primarily affects pediatric patients being treated for infantile hemangioma, patients with dysphagia, and patients requiring precise non-tablet dosing. These patients have the fewest alternatives and the most urgent need for intervention.

Low-Dose Tablet Patients

The 10 mg and 20 mg IR tablets are the most prescribed strengths for performance anxiety and essential tremor — two indications that have seen significant growth, partly driven by telehealth prescribing. In areas with high telehealth adoption, local pharmacy demand may outstrip supply temporarily.

Patients at Chain Pharmacies

Large chain pharmacies (CVS, Walgreens, Rite Aid) use centralized purchasing systems that can be slow to respond to localized demand spikes. Independent pharmacies, with more flexible supplier relationships, often have better availability during shortages.

What Providers Can Do: 5 Steps

Step 1: Direct Patients to Real-Time Availability Tools

The single most effective thing you can do is point patients to Medfinder. This tool shows real-time pharmacy availability by ZIP code, eliminating the need for patients to call multiple pharmacies. Include this recommendation in your after-visit summary or patient portal messaging.

A simple message like: "If your pharmacy doesn't have Propranolol in stock, try searching at medfinder.com to find a nearby pharmacy that does" can save your patient hours and reduce call-backs to your office.

Step 2: Write Flexible Prescriptions When Appropriate

When clinically safe, consider writing prescriptions that give the pharmacist some flexibility:

• If the patient is on 20 mg IR twice daily, a prescription for 40 mg IR with instructions to take half a tablet twice daily (if scored) allows the pharmacist to fill from available stock
• Consider whether the patient could switch from IR to ER, or vice versa, and document both options
• For performance anxiety patients on as-needed dosing, a range (e.g., "10 to 40 mg as needed") with multiple strength options gives the pharmacy more fill options

Step 3: Maintain a Compounding Pharmacy Referral List

For patients who need the oral solution — particularly pediatric patients — a compounding pharmacy can prepare Propranolol oral solution from powder. Maintain a list of compounding pharmacies in your area and include one or two in your referral network. The Professional Compounding Centers of America (PCCA) can help you locate member pharmacies.

Step 4: Document a Backup Medication Plan

For patients on chronic Propranolol therapy, document a contingency plan in their chart. This might include:

• A specific alternative beta-blocker with equivalent dosing (e.g., "If Propranolol unavailable, switch to Nadolol 40 mg once daily")
• A taper schedule in case supply is interrupted
• Instructions for the patient on what to do if they can't fill their prescription (e.g., contact the clinic, try Medfinder, do not stop abruptly)

This proactive documentation reduces the urgency of shortage-related calls and empowers patients to act quickly.

Step 5: Consider 90-Day Prescriptions via Mail Order

Mail-order pharmacies (including insurance-based mail order, Amazon Pharmacy, and Cost Plus Drugs) generally have more stable supply chains than local retail pharmacies. Prescribing 90-day supplies reduces refill frequency and the chance of a stock-out disrupting the patient's therapy.

This approach also typically saves patients money — a 90-day supply often costs the same or less than three separate 30-day fills.

Therapeutic Alternatives

When Propranolol is genuinely unavailable in any form, the following alternatives are most commonly used. Selection depends on the indication:

• Nadolol: Non-selective beta-blocker. Closest pharmacological match. Effective for migraine prophylaxis, essential tremor, and hypertension. Once-daily dosing. Renally eliminated — dose-adjust for renal impairment.
• Metoprolol (Tartrate or Succinate): Selective beta-1 blocker. Good for hypertension, rate control, heart failure, post-MI. Less effective for migraine and tremor. Very affordable ($4 to $8 generic).
• Atenolol: Selective beta-1 blocker. Once daily. Fewer CNS effects. Limited utility for migraine/anxiety. Affordable ($4 to $10 generic).
• Timolol (oral): Non-selective. FDA-approved for migraine prophylaxis. Less commonly prescribed but available.

For a patient-friendly version, share this alternatives guide with your patients.

Workflow Tips

Incorporate these practices to handle shortage-related disruptions more smoothly:

• Proactive patient communication: When you prescribe Propranolol, mention that some formulations are in limited supply and provide Medfinder as a backup resource.
• EHR templates: Create a smart phrase or template for shortage-related messaging that includes Medfinder, compounding pharmacy referrals, and backup medication instructions.
• Staff training: Brief your clinical staff on the current shortage so they can field patient calls and provide initial guidance without requiring a provider callback.
• Monitor ASHP updates: Check the ASHP drug shortage list periodically (ashp.org/drug-shortages) for status changes.

Final Thoughts

The Propranolol shortage is disruptive but manageable with the right preparation. The tablet and capsule supply remains stable, and the drug's low cost means even uninsured patients can generally afford it. Your most impactful intervention is simply directing patients to Medfinder so they can quickly locate a pharmacy with stock — reducing their stress and your office's phone volume.

For the full shortage picture, see our Propranolol shortage briefing for prescribers. For cost-saving strategies to share with patients, see our provider's guide to helping patients save on Propranolol.