11 Propranolol Interactions You Should Know About

If you have a heart condition, you might be taking propranolol. Propranolol is a beta blocker with many approved uses, including high blood pressure and tremors. It’s also used off-label for performance anxiety and migraines. It works by lowering your blood pressure and heart rate.

During treatment, it’s important to keep in mind that propranolol can interact with other medications and substances. Alcohol, Adderall, and ibuprofen are a few examples. Below, we cover 11 potential propranolol interactions and how to manage them.

1. Alcohol

Alcohol can interact with propranolol, potentially raising propranolol levels in your body. As a result, this combination may cause your blood pressure to drop too low (hypotension). So, it’s typically recommended to avoid alcohol if you’re taking propranolol.

Talk to your healthcare provider about whether an occasional drink is OK. Since everyone responds to medications and alcohol differently, they can give you guidance for your specific situation.

2. Stimulants like Adderall

Propranolol and stimulants like Adderall (amphetamine salts) have effects in the body that can potentially counteract each other.

Propranolol helps lower your blood pressure and slows down your heart rate. Stimulants like Adderall can have the opposite effect — raising your blood pressure and increasing your heart rate. In other words, propranolol may not be able to do its job as well with this combination.

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If you're taking a beta blocker like propranolol, your healthcare provider may suggest a non-stimulant medication instead of Adderall for ADHD (attention-deficit/hyperactivity disorder). Or, they may have you monitor your blood pressure at home if you take this combination.

3. NSAIDs like ibuprofen

Nonsteroidal anti-inflammatory drugs (NSAIDs) can also counteract propranolol’s effects. NSAIDs such as ibuprofen (Advil, Motrin) have been shown to increase your blood pressure if you take them long term. In this case, propranolol may not be able to lower your blood pressure as well.

Before taking an NSAID, it’s a good idea to check with your healthcare provider first. They may say that taking an NSAID every now and then is OK. However, they may recommend safer alternatives if you need to take a pain reliever for a longer period of time.

4. Antihistamines

Propranolol and antihistamines can cause some similar side effects, such as drowsiness, dizziness, and constipation. If you take them together, you may be more likely to experience these side effects.

A few examples of antihistamines that can interact with propranolol in this way include hydroxyzine (Vistaril) and diphenhydramine (Benadryl). This combination may be riskier if you’re an older adult since you may be more sensitive to these side effects.

If you need to take an antihistamine for allergy symptoms, your healthcare provider may suggest a non-drowsy option — or topical product if it’s for itching. These types of antihistamines are less likely to worsen propranolol’s side effects. 

5. Migraine medications

Some migraine medications can interact with propranolol. This can be a common interaction because propranolol is sometimes taken to prevent migraines. So, you may need to be careful about which migraine medications you’re combining with propranolol. 

Migraine medications that can interact with propranolol include rizatriptan (Maxalt) and zolmitriptan (Zomig). These medications are taken to treat a migraine after it has started.

With this interaction, propranolol can raise the levels of rizatriptan and zolmitriptan in your blood. Your healthcare provider may have you take a lower rizatriptan dose if you’re also taking propranolol.

6. Heart rhythm medications

Heart rhythm medications (antiarrhythmics) are used to treat an irregular heartbeat. Because of its effects, propranolol can be considered an antiarrhythmic medication and it can be used off-label to treat heart rhythm conditions like atrial fibrillation. 

Propranolol can interact with other heart rhythm medications because they each slow down the heart rate. Combining them could cause your heart rate to drop too low (bradycardia). Some of the heart rhythm medications that propranolol interacts with include:

• Amiodarone (Pacerone)

• Propafenone

• Quinidine

• Digoxin (Lanoxin)

• Verapamil

Propranolol can interact with different heart rhythm medications in different ways. For example, propranolol can raise the levels of propafenone in the body. And amiodarone and quinidine can raise the levels of propranolol in your body.

Even though interactions are possible, your healthcare provider may intentionally prescribe propranolol with a heart rhythm medication. This depends on which conditions you’re being treated for.

7. Certain antidepressant medications

Antidepressants can interact with propranolol. These medications treat mental health conditions, like depression or anxiety. There are two ways that antidepressants can interact with propranolol:

• Some antidepressants block enzymes (proteins) in the liver that break down propranolol. This can result in higher blood levels of propranolol. 

• Some antidepressants may increase the risk of your blood pressure dropping too low.

Examples of antidepressants that can interact with propranolol include:

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Fluvoxamine (Luvox)

• Imipramine 

• Escitalopram (Lexapro)

• Bupropion (Wellbutrin)

• Sertraline (Zoloft)

• Trazodone

In some cases, your healthcare provider may adjust your propranolol dosage if you’re taking it with one of these antidepressants. Or, they may consider a different antidepressant that’s less likely to interact with propranolol.

8. Xanax

Xanax (alprazolam) is a benzodiazepine used to treat anxiety. Propranolol is also sometimes used off-label for certain anxiety disorders, such as performance anxiety. 

Xanax and propranolol have a few similar side effects, such as drowsiness. Both can also lower your blood pressure. Taking them together may make these side effects worse.

If your healthcare provider thinks taking Xanax and propranolol together is necessary, they may adjust your dosage or monitor you more closely for side effects. Let them know if you feel dizzy or lightheaded, or if you’re experiencing increased drowsiness.

9. Warfarin

Warfarin (Coumadin) is a blood thinner used to prevent blood clots. If you take warfarin and propranolol, the interaction can increase warfarin levels in the body. This could cause your blood to be “thinner” than if you weren’t taking propranolol. This can raise the risk of bleeding.

If you’ve been taking propranolol and warfarin for a longer time, this interaction may not be a problem. Your healthcare provider changes your warfarin dose based on blood tests. These tests reflect any medications or foods you’ve had recently. 

If you start or stop propranolol while taking warfarin, you should let your healthcare provider know. It could affect your warfarin level and blood tests.

10. Cimetidine

Cimetidine (Tagamet HB) is a histamine-2 antagonist (H2 blocker) medication. It can be used to treat gastroesophageal reflux disease (GERD) and help with heartburn. 

The interaction between cimetidine and propranolol causes higher levels of propranolol. Similar to antidepressants, cimetidine blocks liver enzymes that break down propranolol. 

The good news is that you have other options to treat GERD or prevent heartburn. Your pharmacist or healthcare provider can recommend one that doesn’t interact with propranolol.

11. Cigarettes

If you take propranolol and smoke, it can affect how your body breaks down propranolol. 

Cigarette smoking causes the liver to break down a larger amount of propranolol than normal. Propranolol is cleared from your body more quickly, resulting in lower medication levels. This means it may not work as well as it should.

When should you contact my healthcare provider about a propranolol interaction?

You should contact your healthcare provider if you're concerned about a propranolol interaction. They can review your current medication list to determine if there are any major interactions. 

Sometimes, medications are still prescribed even if there’s a possible interaction. The interaction may be mild, or the benefit of taking these medications could outweigh the risks.

If you’ve been taking propranolol and your other routine medications for a long time, you may not need to check with your healthcare provider if you’re not experiencing any symptoms of an interaction. But you should contact them if you’re having symptoms like low blood pressure or low heart rate.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

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