Propranolol is one among the different medication options for treating migraines, apart from being prescribed for heart conditions and anxiety disorders. The beta blocker is known to be highly effective and a medication of choice among other drug formulations. By reducing the heart rate, the medication helps in the pumping of blood in the body, and helps deal with various physical manifestations of anxiety disorders. Following subsections offer a detailed look at the drug, including information about propranolol for migraines, side effects and possible drug interactions. This is intended to help individuals identify, prevent and deal with any possible undesirable effects.

Overview of propranolol

In use since FDA approval more than five decades ago, the medication belongs to the category of drugs known as non-selective beta-adrenergic antagonist, and is prescribed for the following conditions:

The prescription only drug is available in oral formulations that include tablets, and liquids. The tablets are also available in slow-release formulations for treating specific conditions, with an extended onset of action.  It is important to note that the drug is not to be stopped abruptly as this could cause aggravation of existing conditions including angina and other heart conditions including myocardial infarctions.

How does propranolol work?

It is necessary to understand the mechanism of action of medications to know about the possible effects and the contraindications of drugs. As outlined above, the drug is a racemic mixture, and belongs to the category of nonselective β-adrenergic receptor antagonist. The blocking of the receptors results in various actions, including vasoconstriction, apart from other outcomes. The consequence of this blocking action and regulation results in the effects on various conditions offering results. For instance, this impacts the chronotropic, the inotropic and vasodilator responses that are attributed to the stimulation. It also reduces renin secretion, and this in turn is known to bring down peripheral resistance. In addition to the above, its effect on T3 levels, helps treat hyperthyroidism and thyroid storm.

How much propranolol for migraine?

It is necessary to stick diligently to the recommended dosage of medications. A large number of patients report side effects mainly as a result of incorrect dosage and schedule. Many are known to take an excessive dosage in an effort to experience faster results, especially for conditions such as migraine, due to the discomfort and pain of the condition. The drug is available in formulations of 10mg, 40mg, 80mg or 160mg. As outline earlier, the medication is also available in slow-release formulations, and these are available in strengths of 80mg or 160mg. Propranolol in liquid form is available in strengths of 5mg, 10mg, 40mg or 50mg in every 5ml volume. Ideally, the dosage depends on the condition of the patient and other factors such as age. Dosage considerations also take into account, the presence of other ailments and medications in use. Adult patients with migraine are typically recommended a dosage of 40 mg daily, split into two doses. Depending on the condition, this dose may also be increase to a maximum of 240 mg per day, but higher dosages are rare for migraine, and more likely for angina.

How to take propranolol?

Here are simple instructions on how to take the drug easily, so as to stick to a schedule. The medication can be taken either with food or without food, as it is not known to cause an upset stomach. The doses, either taken in a single dose, or split into different doses are to be taken at the same time each day. This will give the best results from the medication as the extended onset of action will work till the next dose, without any overlap. Capsules are not to be crushed, but to be swallowed whole. Individuals prescribed the liquid form of the medication are to use either a clean, sterile spoon or syringe for measuring the volume. It is necessary to use a spoon that will help measure out the desired volume, rather than using a spoon intended for other purposes.

What are the side effects of propranolol when used for treating migraine?

All medications come with the possibility of undesirable effects and propranolol is no exception. Effects may be mild in nature, or could be adverse in nature. The mild effects are known to resolve naturally without the need for any medical intervention, while the strong effects require some kind of treatment. The mild effects are known to occur more frequently, while the serious effects are known to occur rarely. Some of the adverse effects may require urgent medical attention to prevent it from turning into a serious condition. It is also necessary to bear in mind that not all users of the drug will experience undesirable effects. Some are known to be free from all effects whatsoever.

The actual type or intensity of effects depends on various reasons, such as the condition being treated, the age of the patient, the overall health condition, other existing ailments, and use of other drugs or medications. Here is a list of commonly reported side effects of propranolol; this is not a complete or exhaustive list and is intended to serve as a broad reference only. Patients are frequently known to experience headaches, and may also experience overall fatigue. Feelings of dizziness are also commonly reported, while some are known to have the sensation of cold extremities in the limbs, such as the fingers and the toes. Other effects that may be experienced include possible vomiting sensations and feelings of nausea. Bouts of diarrhea is also a possibility, while some are known to experience pain in the stomach.

What are the serious side effects of propranolol?

The medication is known to trigger serious effects among patients, although this is known to afflict only a very small percentage of patients. For instance, the individual may experience a distinct change of color in the eyes, with the whites of the eyes turning yellowish. The color of the skin may also turn pale or yellowish, especially noticeably among individuals with white skin complexion. Discoloration of urine or feces is an indication of effects on the liver. Patients are also known to have nosebleeds, and may also end up bruised more frequently, indicating low platelet count, medically known as Thrombocytopenia.  Other serious conditions include shortness of breath, and possible bouts of coughing especially with any strenuous physical activity such as exercise, indicating possible impact on the lungs. The ankles may end up swollen without any other possible reason, and some are known to experience a change in heartbeat rate, apart from pain – all indicative of effects on the heart.

Does propranolol make allergies worse?

The possibility of aggravation of allergies cannot be ruled out among patients on propranolol. For instance, individuals with a history of allergic reactions to the medication may experience adverse allergic reactions that include anaphylaxis. There are tell-tale indications of allergies; for instance, the individual may end up with a rash on the skin, or other visible changes such as peeling of the skin or formation of blisters. Wheezing is also a possible indication of allergic reactions, while some are known to experience a distinct tightening of the chest. Other manifestations of allergies include difficulty breathing, and swelling in the face – especially on the lips, the tongue and the throat.

How to deal with effects of propranolol?

Here is some useful information on how to deal with the commonly reported effects of the drug. For instance, individuals experiencing headaches are advised to take adequate rest and ensure that there is sufficient liquid intake. Alcohol is to be avoided when headaches are experienced, and this will help to reduce the intensity.  Individuals who experience tiredness are not to consume alcohol, to prevent it from worsening. Fatigue and dizzy feelings typically resolve naturally, with use of the drug, as the body gets used to the medication.

Patients suffering from bouts of diarrhea are to check for indications such as discoloration of the urine or unusual smell in urine. It is important to avoid taking OTC medications for treating diarrhea; and patients are advised to seek medical advice regarding diarrhea medications. A note of caution for women on contraceptive pills; bouts of diarrhea may have an impact on the efficacy of the pills and this may not offer protection from pregnancy. It is necessary to look at additional methods of protection.

Contraindications of propranolol

In addition to side effects of medications, there is also the possibility of drug interactions when two or more medications are taken together, either for the same condition, or different conditions. The effects could result in an increased potency of one of the drugs, or it could result in reduced efficacy in the drugs. Another possible outcome of contraindication is aggravation of side effects of the drugs taken together. The best way to deal with contraindications is to either discontinue or temporarily suspend one of the medications that are causing the interactions. In the event that all medications are equally important, the next best method is to lower the dosage and stagger the intake so as to minimize the possible interactions.

Medications that are known to interact with propranolol include drugs prescribed for hypertension. As propranolol causes a reduction in blood pressure, it may result in lowered blood pressure, if taken with other drugs for hypertension.  Medications for treating irregular heart beat may also interact with propranolol as the drug has similar outcome. Drugs that are prescribed for treating depression are known to lower blood pressure, and when patients take propranolol for treating migraines, along with antidepressants, this could reduce in hypotension. Other drugs that may interact include medications for asthma and COPD (chronic obstructive pulmonary disease.

A note of caution for patients on insulin medications; propranolol is known to mask effects that are typically used to identify lowered blood sugar levels. This may therefore have an impact on diabetics who taken propranolol. Periodic checks of blood sugar levels are required to ensure that the levels are maintained.

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