Propranolol for headaches

Propranolol belongs to a group of drugs called beta blockers. It is used in patients with heart problems to control high blood pressure or irregular heart beats. It is also used to treat certain types of vascular birthmarks. It is also used to prevent migraines and headaches.

How is it given?

It is usually given three times a day. An oral liquid is available for children who cannot swallow tablets. The strength we use at GOSH is 50mg in 5mL but other strengths are available. Following incidents where propranolol 50mg/5ml has been dispensed by pharmacists instead of 5mg/5ml, parents are asked to check the dose with the pharmacist before giving it to your child. Ideally any strength other than 5mg/5ml should be avoided to minimize any risk of the wrong dose being given to your child.

  • Small doses can be given using the oral syringe provided.
  • For older children and teenagers, tablets are available in the following strengths: 10mg, 40mg, 80mg and 160mg.
  • Your child should not stop taking propranolol suddenly.

What monitoring will my child need?

When the medication is started, your family doctor (GP) or paediatrician will have to monitor your blood pressure and heart rate regularly until the dose is stabilised. 

Who should not take propranolol (contraindications)?

People with the following conditions should discuss taking propranolol with their doctor 

  • Pregnant, could be pregnant, planning to become pregnant or breast-feeding 
  • asthma
  • diabetes or low blood glucose
  • uncontrolled heart failure or heart block
  • Raynaud’s disease

What are the side effects?

Propranolol is usually well tolerated, but possible side effects are:

  • „„Low blood pressure or slow heart rate (bradycardia): This may make your child feel dizzy or faint. If this occurs please tell us, so that we can adjust the dose if necessary.
  • „„Difficult breathing (bronchospasm) or shortness of breath: if this worsens while taking propranolol, please tell us. Some people have shortness of breath because of their condition.
  • „„Cold hands and feet
  • „„Nausea (feeling sick), vomiting, diarrhoea or constipation
  • „„Difficulty sleeping and bad dreams
  • „„Feeling tired and lethargic
  • „„High or low blood sugar

Propranolol and other medicines

Some medicines can interact with Propranolol. Always check with your doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines. The following medicines are known to react with propranolol

  • Other medicines that slow the heart rate such as digoxin, amiodarone, verapamil and diltiazem. These are sometimes prescribed alongside propranolol but will need careful monitoring.
  • Other medicines that reduce blood pressure such as diuretics, ACE inhibitors and calcium channel blockers. These are sometimes prescribed alongside propranolol but will need careful monitoring.
  • Selective serotonin inhibitor antidepressants: These medicines may increase the effect of propranolol
  • Phenothiazine type anti-psychotic medicines: Fluoxetine may have an additional effect on lowering the blood pressure.

Please discuss with your doctor or pharmacist before giving them to your child.

Important information

  • „„Keep medicines in a safe place where children cannot reach them.
  • „„Keep medicines in a cool, dry place out of direct sunlight and away from heat. 
  • „„ If your doctor decides to stop treatment with Propranolol, return any unused medicine to the pharmacist. Do not flush down the toilet or throw it away.
  • „„ If you forget to give your child a dose, give it as soon as you remember.
  • Do not give a double dose. 
  • „„ If you child vomits after taking the medicine, do not give a double dose.
  • „„Your family doctor (GP) will need to give you a repeat prescription for propranolol. Some medicines will need to be ordered by your community pharmacy (chemist) so arrange this in plenty of time.
Compiled by: 
Compiled by the Neurology and Pharmacy departments in collaboration with the Child and Family Information Group
Last review date: 
May 2016
Ref: 
2016F1690

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.