Most overdoses of propranolol are mild and respond to supportive care.

Propranolol is not significantly dialyzable. In the event of overdose or exaggerated response, the following measures should be employed.

Hypotension and bradycardia have been reported following propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a propranolol overdose.

Glucagon should be administered as 50-150 meg/kg intravenously followed by continuous drip of 1-5 mg/hour for positive chronotropic effect. Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine, however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing.

The electrocardiogram, pulse, blood pressure, neurobehavioral status and intake and output balance must be monitored. Isoproterenol and aminophylline may be used for bronchospasm.

Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia, sick sinus syndrome, and greater than first-degree block unless a permanent pacemaker is in place; 3) bronchial asthma; and 4) in patients with known hypersensitivity to propranolol hydrochloride.

Last reviewed on RxList: 2/3/2011
This monograph has been modified to include the generic and brand name in many instances.