Propranolol dosage
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Propranolol Dosage for Angina, Heart Rate Control, and Beta Blockade
For adults with angina pectoris, propranolol is effective at daily doses of 160 mg and 320 mg, with both doses significantly reducing the frequency of angina episodes and the need for nitroglycerin. Exercise tolerance also improves, especially at the 320 mg dose. Clinical benefits are linked to serum propranolol levels of at least 30 ng/ml, typically achieved with these dosages. A daily dose slightly above 160 mg is generally needed to maintain plasma levels above 20 ng/ml, which is associated with significant beta blockade, as measured by a reduction in exercise heart rate. The degree of beta blockade is related to the total daily dose rather than how often the dose is given throughout the day 13.
Propranolol Dosage in Pediatric Conditions
Infantile Hemangioma
For problematic infantile hemangioma, propranolol is usually started at a low dose (0.25 mg/kg twice daily), then gradually increased. The effective and safe dose is typically 1.5–2.0 mg/kg/day, divided into two doses. Treatment is continued until the lesion is fully involuted or the child reaches 12 months of age. Lower doses (1–1.5 mg/kg/day) are also effective for most patients, and increasing the dose above this range does not benefit those who do not respond initially 27.
Retinopathy of Prematurity
In retinopathy of prematurity, oral propranolol at 1.5–2 mg/kg/day is most effective, especially when given at later stages of disease progression. Lower doses (0.5–1.0 mg/kg/day) also show efficacy, and topical propranolol (0.2% eye drops) can be as effective as oral dosing. Higher oral doses (2 mg/kg/day) are linked to a slightly increased risk of adverse events, while lower doses and topical administration have a safer profile .
Severe Burns in Children
For children with severe burns, propranolol is started at 1 mg/kg/day and increased up to 4 mg/kg/day to achieve and maintain a 15% reduction in heart rate. This higher dose is effective in reducing cardiac workload without causing low blood pressure .
Propranolol Dosage in Other Clinical Settings
Breast Cancer (Adjunct to Chemotherapy)
In patients with breast cancer undergoing chemotherapy, propranolol is started at 20 mg twice daily and increased to 80 mg extended-release daily as tolerated. Most patients can reach and maintain the 80 mg daily dose with high adherence and minimal side effects .
Acute Heart Failure (Animal Model)
In animal studies of catecholamine-induced acute heart failure, low-dose propranolol (1 mg/kg) improved survival and heart function, while higher doses (10–15 mg/kg) did not provide additional benefit and were associated with lower survival rates .
Propranolol Overdose: Toxicity Thresholds
Severe toxicity from propranolol overdose in adults is most likely when a single dose of 2,000 mg or more is ingested. The lowest doses associated with hypotension and bradycardia are 400 mg and 800 mg, respectively. Fatal overdoses often involve doses above 3,200 mg, especially when combined with other drugs. Rapid medical intervention is critical in overdose situations 510.
Conclusion
Propranolol dosing varies widely depending on the condition being treated, patient age, and clinical goals. For adults with angina, 160–320 mg/day is effective, while pediatric dosing for hemangioma and retinopathy of prematurity typically ranges from 1–2 mg/kg/day. Higher doses may be needed in severe burns, and careful titration is essential to balance efficacy and safety. Overdose risks increase sharply at doses above 2,000 mg, highlighting the importance of careful prescribing and monitoring.
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