Meta Information
ID:propranolol
Name:Propranolol
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-07-02T06:42:50Z
Model
phase-b-newfiles-claude-opus-4.8
Interactions
Target id:
/condition/asthma
Target name:
Asthma / bronchospastic lung disease
Severity:
major
Interaction type:
contraindication
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Propranolol is non-selective and blocks the beta-receptors that keep airways open, which can trigger a severe asthma attack.
Actionable advice:
Propranolol should be avoided with asthma or bronchospastic lung disease.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Propranolol is contraindicated in... bronchial asthma.
Label source:
fda_label
Action type:
avoid
Target id:
/class/calcium-channel-blockers
Target name:
Verapamil / diltiazem
Severity:
major
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combining propranolol with verapamil or diltiazem can cause serious slowing of the heart, heart block, heart failure, or circulatory collapse.
Actionable advice:
This combination should be avoided in heart disease; if used, it requires close cardiac monitoring.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
There have been reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers.
Label source:
fda_label
Action type:
avoid
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Both propranolol and digoxin slow AV conduction and heart rate; together they increase the risk of bradycardia.
Actionable advice:
Heart rate should be monitored closely, and it is important to report dizziness, fainting, or a very slow pulse.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.
Label source:
fda_label
Action type:
monitor
Target id:
/class/cyp2d6-inhibitors
Target name:
CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine, ritonavir)
Severity:
moderate
Interaction type:
pharmacokinetic
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
These drugs raise propranolol blood levels, increasing beta-blockade and the risk of low blood pressure on standing.
Actionable advice:
It is worth watching for dizziness or excessive heart-rate/BP lowering; the dose may need adjustment.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP2D6, such as amiodarone, cimetidine, delavudin, fluoxetine, paroxetine, quinidine, and ritonavir.
Label source:
fda_label
Action type:
monitor
Target id:
/intervention/theophylline
Target name:
Theophylline
Severity:
moderate
Interaction type:
pharmacokinetic
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Propranolol reduces theophylline clearance (raising its levels), and it can also oppose theophylline's bronchodilation.
Actionable advice:
Theophylline levels should be monitored, and a non-selective beta-blocker is generally best avoided in those needing theophylline.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Co-administration of theophylline with propranolol decreases theophylline oral clearance by 30% to 52%.
Label source:
fda_label
Action type:
monitor
Target id:
/condition/diabetes-mellitus
Target name:
Diabetes / hypoglycemia
Severity:
moderate
Interaction type:
adverse
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Propranolol masks the warning signs of low blood sugar and can itself cause hypoglycemia, especially during fasting.
Actionable advice:
Blood glucose is best monitored closely, and it is worth staying alert for hypoglycemia that lacks the usual racing-heart warning.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Propranolol therapy, particularly when given to infants and children, diabetic or not, has been associated with hypoglycemia, especially during fasting.
Label source:
fda_label
Action type:
monitor
Target id:
/class/nsaids
Target name:
NSAIDs (e.g., indomethacin, ibuprofen)
Severity:
moderate
Interaction type:
diminishing
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
NSAIDs blunt the blood-pressure-lowering effect of beta-blockers.
Actionable advice:
Blood pressure should be monitored if NSAIDs are used regularly with propranolol.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Nonsteroidal anti-inflammatory drugs (NSAIDS) have been reported to blunt the antihypertensive effect of beta-adrenoreceptor blocking agents.
Label source:
fda_label
Action type:
monitor
Target id:
/intervention/warfarin
Target name:
Warfarin
Severity:
moderate
Interaction type:
pharmacokinetic
Nature:
relative
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Propranolol raises warfarin concentrations, which can increase bleeding risk.
Actionable advice:
INR/prothrombin time is best monitored when starting or stopping propranolol.
Validation status:
validated_via_fda_label
Evidence tier:
tier_a
Evidence basis:
fda_label_verbatim
Evidence anchors:
Source url:
Exact phrase from label:
Propranolol when administered with warfarin increases the concentration of warfarin. Prothrombin time, therefore, should be monitored.
Label source:
fda_label
Action type:
monitor