What Is Propranolol?

Propranolol is a non-selective beta-adrenergic blocker (beta-blocker) that has been used for decades to treat a wide range of cardiovascular and neurological conditions. It is FDA-approved for hypertension, angina, atrial fibrillation (rate control), secondary prevention after heart attack, migraine prophylaxis, essential tremor, and hypertrophic subaortic stenosis. It is also approved as Hemangeol for proliferating infantile hemangioma in infants.

Propranolol is frequently prescribed off-label for performance anxiety (stage fright), generalized anxiety symptoms, thyroid storm symptom management, akathisia, and portal hypertension. All brand-name versions (Inderal, Inderal LA, InnoPran XL) have been discontinued, but the generic is widely available and affordable.

How does Propranolol work?

Propranolol works by competitively blocking both beta-1 and beta-2 adrenergic receptors throughout the body. By blocking beta-1 receptors in the heart, it decreases heart rate, contractility, and cardiac output — reducing the heart's workload and oxygen demand. This is why it is effective for hypertension, angina, and arrhythmias.

Because it also blocks beta-2 receptors, Propranolol reduces the physical symptoms of the body's "fight or flight" response — such as racing heart, trembling, and sweating — which is why it is commonly used for performance anxiety and essential tremor. However, this non-selectivity also means it can constrict airways, which is why it is contraindicated in patients with asthma or severe COPD.

What doses are available for Propranolol?

• Immediate-release tablets: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg
• Extended-release capsules: 60 mg, 80 mg, 120 mg, 160 mg
• Oral solution: 20 mg/5 mL, 40 mg/5 mL
• Injectable solution: 1 mg/mL (for IV use in hospital settings)

How hard is it to find Propranolol in stock?

Propranolol scores a 72 out of 100 on our findability scale, meaning it is generally available at most pharmacies with minor gaps. Immediate-release tablets and extended-release capsules are widely stocked by generic manufacturers. However, the oral solution (20 mg/5 mL and 40 mg/5 mL) is currently on the ASHP drug shortage list as of 2025, with manufacturer Hikma placing it on allocation. The injectable form (1 mg/mL) is also on back order. If you need the tablet or capsule form, you should be able to find it without much difficulty. If you need the oral solution, use Medfinder to locate pharmacies that have it in stock.

Who Can Prescribe Propranolol?

Propranolol can be prescribed by a wide range of healthcare providers, including:

• Primary Care / Family Medicine — most common prescribers for hypertension, anxiety symptoms, and migraine prevention
• Cardiologists — for arrhythmias, angina, and post-MI management
• Neurologists — for migraine prophylaxis and essential tremor
• Psychiatrists — for performance anxiety and PTSD-related symptoms
• Endocrinologists — for thyroid storm symptom management
• Pediatricians — for infantile hemangioma (Hemangeol)
• Emergency Medicine physicians — for acute rate control

Since Propranolol is not a controlled substance, it can also be prescribed via telehealth platforms, making it easy to get a prescription without an in-person visit.

Is Propranolol a controlled substance?

No. Propranolol is not a controlled substance and has no DEA scheduling. It does not have abuse potential and is not subject to the prescribing restrictions that apply to controlled medications. This means it can be prescribed via telehealth, called in to a pharmacy by phone, and refilled without the limitations that apply to Schedule II–V drugs.

Common Side Effects of Propranolol

• Fatigue and drowsiness
• Cold hands and feet
• Dizziness or lightheadedness
• Nausea and diarrhea
• Bradycardia (slow heart rate)
• Weight gain
• Sleep disturbances and vivid dreams
• Dry eyes
• Erectile dysfunction

Serious but less common side effects include severe bradycardia or heart block, bronchospasm (especially in asthma or COPD patients), worsening heart failure, severe hypotension, and masking of hypoglycemia symptoms in diabetics. Do not stop Propranolol abruptly — always taper gradually over 1–2 weeks under your doctor's guidance to avoid rebound effects including worsened angina or arrhythmias.

Alternative Medications to Propranolol

If you cannot find Propranolol in stock or experience side effects, your doctor may consider these alternatives:

• Metoprolol — A selective beta-1 blocker available as Metoprolol Tartrate (IR) or Metoprolol Succinate (ER/Toprol XL). Better suited for patients with mild asthma or COPD due to its beta-1 selectivity.
• Atenolol — A selective beta-1 blocker with once-daily dosing that crosses the blood-brain barrier less readily, meaning fewer CNS side effects like vivid dreams. Less effective for migraine and tremor.
• Nadolol — A non-selective beta-blocker like Propranolol but with a longer half-life allowing once-daily dosing. Not metabolized by the liver, making it a better option for patients with hepatic impairment.
• Timolol — Another non-selective beta-blocker also used for migraine prophylaxis, though more commonly known in its ophthalmic form for glaucoma.

Drug Interactions with Propranolol

Propranolol has several important drug interactions to be aware of:

• Calcium channel blockers (Verapamil, Diltiazem) — additive bradycardia, hypotension, and risk of heart block
• Other antiarrhythmics (Amiodarone, Digoxin) — additive cardiac depression
• MAO inhibitors — risk of severe hypertension
• Insulin and oral diabetes medications — Propranolol can mask hypoglycemia symptoms and prolong low blood sugar episodes
• CYP2D6/CYP1A2 inhibitors (Fluoxetine, Fluvoxamine, Cimetidine) — increased Propranolol blood levels
• Clonidine — risk of rebound hypertension if Clonidine is stopped while on Propranolol
• NSAIDs (Ibuprofen, Naproxen) — may reduce the blood-pressure-lowering effect
• Epinephrine — reduced effectiveness, risk of hypertensive crisis

Always tell your doctor and pharmacist about all medications, supplements, and over-the-counter drugs you are taking before starting Propranolol.

Final Thoughts on Propranolol

Propranolol is one of the most widely used and affordable beta-blockers on the market, with a long track record of safety and effectiveness across numerous conditions — from hypertension and migraine prevention to performance anxiety and essential tremor. The generic tablet and capsule forms are readily available at most pharmacies, often for as little as $4–$10 with a discount coupon.

The main supply concern in 2026 is the oral solution shortage, which primarily affects pediatric patients and those who cannot swallow pills. If you're having trouble finding any form of Propranolol, try Medfinder to search pharmacies near you that have it in stock. And as always, never stop taking Propranolol abruptly — work with your prescriber to adjust your treatment plan safely.