20/05/2026
Propranolol: Non-selective beta-blocker that blocks beta-1 and beta-2 receptors. It is used for conditions such as hypertension, angina, tremor, migraine prophylaxis, arrhythmias, and thyrotoxicosis, but its non-selective action explains key adverse effects like bradycardia, hypotension, bronchospasm, cold extremities, CNS effects, and masking of hypoglycemia symptoms.
πΉ Drug class clue
β Propranolol = non-selective beta-blocker
β Blocks beta-1 and beta-2 receptors
β High-yield pharmacology drug
β Important because beta-2 blockade increases bronchospasm risk.
πΉ Common side-effects
β Fatigue
β Dizziness / lightheadedness
β Reduced exercise tolerance
β These are common and often dose-related, especially when starting treatment.
πΉ Cardiovascular effects
β Bradycardia
β Hypotension
β May worsen AV conduction block
β Important hemodynamic toxicity pattern.
πΉ Respiratory risk
β Bronchospasm may occur
β Wheeze / dyspnea can occur
β Avoid or use great caution in asthma; caution is also needed in some COPD patients
β This happens because of beta-2 blockade.
πΉ CNS and peripheral effects
β Sleep disturbance / vivid dreams / nightmares may occur
β Low mood or depressed mood may occur in some patients
β Cold hands and feet / cold extremities are classic
β Propranolol is relatively lipophilic, which helps explain CNS effects.
πΉ Metabolic / special caution
β Can mask hypoglycemia symptoms, especially tachycardia and tremor
β Important in patients with diabetes, especially those using insulin or sulfonylureas
β May delay recognition of low blood sugar.
πΉ Practical management
β Check pulse and blood pressure
β Start low and titrate carefully
β Do not stop abruptly
β Reduce dose or stop and review if there is marked bradycardia, hypotension, wheeze, or symptomatic intolerance.
πΉ Important caution clues
β Higher risk in patients with asthma, baseline bradycardia, AV block, or marked hypotension
β Abrupt withdrawal can be harmful in some cardiac patients
β Consider a more beta-1 selective blocker if bronchospasm or intolerance is an issue.
πΉ High-Yield Points
β Propranolol is a non-selective beta-blocker
β Common adverse effects: fatigue, dizziness, bradycardia, hypotension
β Classic cautions: bronchospasm, cold extremities, sleep disturbance, masked hypoglycemia
β Best practical rule: monitor pulse/BP, titrate carefully, and avoid abrupt stopping.
Medical disclaimer: This note is for education only and is not a substitute for professional medical advice, diagnosis, or treatment.