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Modified release formulations of propranolol

Drugs List

  • BEDRANOL SR 160mg capsules
  • BEDRANOL SR 160mg modified release capsules
  • BEDRANOL SR 80mg capsules
  • BEDRANOL SR 80mg modified release capsules
  • BETA-PROGRANE 160mg sustained release capsules
  • BETA-PROGRANE 160mg sustained release capsules
  • BETA-PROGRANE 160mg sustained release capsules
  • HALF BETA-PROGRANE 80mg sustained release capsules
  • HALF BETA-PROGRANE 80mg sustained release capsules
  • HALF BETA-PROGRANE 80mg sustained release capsules
  • propranolol 160mg modified release capsules
  • propranolol 80mg modified release capsules
  • Therapeutic Indications


    Adjunctive therapy in thyrotoxicosis (short term)
    Anxiety state
    Management of essential tremor
    Migraine (prophylaxis)
    Prophylaxis of upper GI bleeding in patients with oesophageal varices
    Prophylaxis of upper GI bleeding in patients with portal hypertension



    Initial dose: 160mg once daily, taken in the morning or evening.
    Maintenance dose: If necessary, the dose may be increased in 80mg increments.
    Maximum dose: 320mg once daily.
    A further reduction in blood pressure can be obtained if a diuretic or other antihypertensive agent is given in addition to propranolol.

    Angina; Essential tremor; Thyrotoxicosis; Prophylaxis of migraine
    Initial dose: 80mg once daily, taken in the morning or evening.
    Maintenance dose: If necessary, the dose may be increased in 80mg increments.
    Maximum dose: 240mg once daily.

    Situational and generalised anxiety
    Situational anxiety: 80mg once daily, taken in the morning or evening, should be sufficient to provide short-term relief.
    Generalised anxiety: Usually responds adequately 80mg once daily, taken in the morning or evening. In individual cases, the dosage may be increased to 160mg once daily. Treatment should be continued according to response. Patients should be reviewed after six to twelve months treatment.

    Portal hypertension
    Initial dose: 80mg once daily, taken in the morning or evening.
    Maintenance dose: If necessary, the dose may be increased in 80mg increments.
    Maximum dose: 320mg once daily to achieve an approximate 25% reduction in resting heart rate.


    Initial dose: 80mg once daily, taken in the morning or evening, regardless of indication.
    (See Dosage; Adult).


    Hypertension (unlicensed)
    The modified release preparation may be used for hypertension in children aged 12 to 18 years previously established on propranolol.

    Children aged 12 to 18 years
    Initial dose: 80mg twice daily. Increase at weekly intervals as necessary.
    Maintenance dose: 160mg to 320mg. Modified release preparations may be used for once daily administration.

    Patients with Renal Impairment

    Reduce initial dose in patients with significant renal impairment and monitor patient closely since the half-life may be increased in patients with renal impairment.

    Patients with Hepatic Impairment

    Reduce initial dose in patients with significant hepatic impairment and monitor patient closely since the half-life may be increased in patients with hepatic impairment.

    Additional Dosage Information

    Patients who are already established on propranolol standard release preparations can be transferred to the same total daily dose of propranolol modified release capsules once daily, taken in the morning or evening.


    Children under 12 years
    Predisposition to hypoglycaemia
    Prolonged fasting
    Cardiogenic shock
    Hereditary fructose intolerance
    History of asthma
    History of bronchospasm
    Metabolic acidosis
    Non-paced sinus node dysfunction
    Prinzmetal's angina
    Reversible obstructive pulmonary disease
    Second degree atrioventricular block
    Severe peripheral circulatory disorder
    Third degree atrioventricular block
    Uncontrolled cardiac failure
    Uncontrolled phaeochromocytoma

    Precautions and Warnings

    Children aged 12 to 18 years
    History of allergies including anaphylaxis
    Chronic hepatic disorder
    Decompensated liver disease
    Diabetes mellitus
    First degree atrioventricular block
    Glucose-galactose malabsorption syndrome
    Hepatic impairment
    History of obstructive pulmonary disease
    Myasthenia gravis
    Peripheral vascular disease
    Poor cardiac reserve
    Portal hypertension
    Renal impairment

    Advise diabetic patients that hypoglycaemic symptoms may be reduced/altered
    Anaesthetist should be made aware patient is taking this medication
    Give in conjunction with alpha blocker in patients with phaeochromocytoma
    May cause hepatic encephalopathy in patients with hepatic disease
    May mask symptoms of thyrotoxicosis
    May unmask the symptoms of myasthenia gravis
    Advise patient dizziness may affect ability to drive or operate machinery
    Some formulations contain sucrose
    Monitor blood glucose closely in patients with diabetes mellitus
    Monitor patients during drug withdrawal esp. in ischaemic heart disease
    Reduce dose if bradycardia develops
    Beta blockers may reduce the response to adrenaline in anaphylaxis
    May increase sensitivity to allergens
    May affect results of some laboratory tests
    Withdraw drug gradually, especially in patients with cardiac ischaemia
    Discontinue if persistent or symptomatic hypotension occurs
    Consider reducing initial dose in the elderly
    Hypotensive effects may be potentiated by alcohol

    Concurrent calcium channel blockers with negative inotropic effects: Avoid concurrent use, particularly in patients with impaired ventricular function or conduction abnormalities due to risk of severe hypotension, bradycardia and cardiac failure.

    Propranolol has occasionally caused hypoglycaemia in non-diabetic patients, e.g. children, elderly patients, patients on haemodialysis or patients suffering from chronic liver disease and patients suffering from overdose. Therefore, propranolol must be used with extreme caution and careful monitoring in patients susceptible to hypoglycaemia. An inadequate response to hypoglycaemia is likely to occur in patients with malnutrition, prolonged fasting, starvation, chronic liver disease or diabetes.

    Treatment with beta-blockers should not be stopped abruptly. The dosage should be withdrawn gradually over a period of 7 to 14 days. An equivalent dosage of another beta-blocker may be substituted during the withdrawal period to facilitate a reduction in dosage below propranolol modified release 80mg. Patients should be followed during withdrawal especially those with ischaemic heart disease. Patients should be advised not to stop taking propranolol modified release capsules except on medical advice.

    When a patient is scheduled for surgery and a decision is made to discontinue beta-blocker therapy, this should be done at least 24 hours prior to the procedure. The risk/benefit of stopping beta blockade should be made for each patient.

    Pregnancy and Lactation


    Use propranolol with caution in pregnancy.

    Propranolol should be used with caution in pregnancy. Beta blockers reduce placental perfusion, which may result in intrauterine foetal death, immature and premature deliveries. Intrauterine growth retardation (IUGR), and reduced placental weight may be caused by propranolol. The greatest weight reductions are seen when treatment begins in the second trimester (Briggs, 2011). Schaefer (2007) states that beta-receptor blockers such as propranolol, which have been in long term use, are among the first-line drugs of choice for treating hypertension in pregnancy. It is important to be aware of pharmacological effects such as decreased heart rate, hypoglycaemia, and respiratory problems, particularly in premature neonates, when treatment with beta blockers continues until birth.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Use propranolol with caution in breastfeeding.

    Most beta-blockers, particularly lipophilic compounds, will pass into breast milk therefore breastfeeding is not recommended. The peak concentrations is 2 to 3 hours after a dose (Briggs, 2011). Briggs and Hale (2014) consider the quantities excreted in breast milk, insufficient to cause adverse effects. Hale concludes not to be used in breastfeeding mothers of infants with reactive airways disease. Breastfed infants should be monitored for symptoms of beta blockade, e.g. respiratory depression, bradycardia and hypoglycaemia.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Aggravation of cardiac failure
    Cardiac failure
    Cold extremities
    Conduction disturbances
    Dry eyes
    Exacerbation of intermittent claudication
    Exacerbation of myasthenia gravis
    Exacerbation of psoriasis
    Exacerbation of Raynaud's disease
    Gastro-intestinal disturbances
    Hepatic encephalopathy
    Increase in antinuclear antibodies (ANA)
    Memory loss
    Mood changes
    Myasthenia gravis-like syndrome
    Peripheral vasoconstriction
    Possible alteration of laboratory tests
    Postural hypotension
    Precipitation of heart block
    Psoriasiform rash
    Sexual dysfunction
    Sleep disturbances
    Visual disturbances

    Effects on Laboratory Tests

    Propranolol has been reported to interfere with the estimation of serum bilirubin by the diazo method and with the determination of catecholamines by methods using fluorescence.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: March 2016

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Medications and Mothers' Milk, Sixteenth Edition (2014) Hale, T and Rowe, H, Hale Publishing, Plano, Texas.

    Summary of Product Characteristics Bedranol 80mg SR Capsules. Sandoz Ltd. March 2016.
    Summary of Product Characteristics Bedranol 160mg SR Capsules. Sandoz Ltd. December 2015.

    Summary of Product Characteristics Half Beta-Prograne SR Capsules 80mg. Tillomed Laboratories. December 2011.
    Summary of Product Characteristics Beta-Prograne SR Capsules 160mg. Tillomed Laboratories. December 2011.

    NICE Evidence Services Available at: Last accessed: 13 September 2017

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Propranolol Last revised: 7 September, 2013
    Last accessed: 22 March, 2016

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