Parenteral Manual

Propranolol

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
INDERAL®
Classification: 
Antihypertensive, antiarrhythmic, antianginal
Original Date: 
August 2005
Revised Date: 
January 2010
Indications: 
  • Treatment of hypertension, cardiac arrhythmias, tetralogy of Fallot spells
Reconstitution and Stability: 
  • Stable at room temperature                                                                
  • Protect from light
  • Diluted solution stable 24 hours at room temperature in compatible IV solution 
Compatibility: 

- Solutions Compatible: D5W, NS, dextrose-saline combinations, ringer's lactate

- Additive/buretrol Compatible: no information

- Y-site Compatible: alteplase, heparin, meperidine, milrinone, morphine, KCl (up to 40 mEq/L), propofol, tacrolimus  

- Incompatible: bicarbonate, diazoxide

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM

NO
IV Direct

NO
IV Intermittent Infusion

YES:
Usual dilution: 0.1 mg/mL
Infusion time: 10 minutes
Infusion rate: do not exceed 1 mg/minute

IV Continuous Infusion NO
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:      
- Arrhythmias:       

  • 0.01-0.15 mg/kg/dose IV Q 6-8 hours PRN
  • Maximum: 1 mg/dose (infants) and 3 mg/dose (children)

-Tetralogy spells:   

  • 0.05-0.1 mg/kg/dose IV     

Adult:
- Arrhythmias:

  • 1 mg/dose IV; repeat Q 5 minutes up to a total of 5 mg           
Potential hazards of parenteral administration: 
  • May precipitate or potentiate heart failure                                                  
  • Hypotension, circulatory collapse, asystole, bradycardia, partial heart block (antidote:  atropine)
  • Bronchospasm            
  • Hypoglycemia, hyperglycemia, hyperkalemia
  • Elevated liver enzymes
  • Lightheadedness, drowsiness   
  • Diarrhea, GI upset
Notes: 
  • Monitor ECG and blood pressure                                       
  • Contraindicated in patients with sinus bradycardia, heart failure, cardiogenic shock, asthma, chronic obstructive pulmonary disease, uncompensated CHF, 2nd and 3rd degree heart block
  • May mask signs of hypoglycemia
  • IV dose is much smaller than oral dose
  • When administering propranolol, nurses first take the heart rate.  If the heart rate is lower than indicated below, the medication is held and the physician is notified:

Age

Heart Rate

Birth-6 months

95 beats/minute

6-18 months

80 beats/minute

>18 months

65 beats/minute
References: 

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