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Peds Calc

Safety Information

Propranolol Contraindications & InteractionsWhen Not to Use & Important Drug Interactions

Assess respiratory and cardiac history before propranolol.

Clinical Utility: 7/10
1 Clinical Sources
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Absolute: severe asthma, bradycardia, heart block, uncompensated heart failure. Relative: diabetes (hypoglycemia masking), depression, peripheral vascular disease.

Contraindications

Absolute Contraindications (Never Use)

History of severe bronchospasm or asthma precipitated by beta-blockers

Nonselective beta blockade can provoke life-threatening bronchoconstriction; reserve therapy for alternative agents in reactive airway disease.

Marked bradycardia, sick sinus syndrome, or second/third-degree AV block without a pacemaker

Propranolol slows AV nodal conduction and can precipitate symptomatic heart block in susceptible patients.

Cardiogenic shock or overt decompensated heart failure

Negative inotropic effects worsen low-output states; stabilise circulation before considering beta-blockade.

Relative Contraindications (Use With Caution)

Diabetes mellitus or frequent hypoglycemic episodes

Propranolol masks adrenergic warning signs of hypoglycemia and prolongs recovery; emphasise glucose monitoring and caregiver education.

Peripheral vascular disease or Raynaud phenomenon

Beta-blockade may exacerbate peripheral ischemia; monitor for cold extremities or choose a vasodilatory alternative.

Hepatic impairment

Extensive hepatic metabolism raises drug exposure in liver disease; initiate lower doses and titrate cautiously.

Concomitant calcium channel blockers or antiarrhythmics that depress conduction

Additive AV nodal blockade increases bradyarrhythmia risk; adjust dosing and monitor ECG when combinations are unavoidable.

Clinical References

Propranolol•MedlinePlus (2024)