.
Combination drugs: Inderetic®, Inderex®, Inderide®
Propranolol is a beta-blocker drug. Propranolol is used to treat or prevent some heart conditions, reduce the symptoms of angina pectoris (chest pain), lower blood pressure in people with hypertension, and improve survival after a heart attack. Propranolol is sometimes used to prevent migraine headaches, to reduce movement associated with essential tremor, and to reduce performance anxiety.
Interactions with Dietary Supplements
Coenzyme Q10
Propranolol inhibits enzymes dependent on coenzyme Q10 (CoQ10). In one trial,
propranolol-induced symptoms were reduced in people given 60 mg of CoQ10 per
day.1
Potassium
Some beta-adrenergic blockers (called “nonselective” beta blockers) decrease the
uptake of potassium from the blood into the cells,2 leading to excess potassium in
the blood, a potentially dangerous condition known as hyperkalemia.3 People taking
beta-blockers should therefore avoid taking potassium supplements, or eating large quantities
of fruit (e.g.,
bananas), unless directed to do so by their doctor.
Interactions with Herbs
Pepper (Piper nigrum, Piper longum)
In a single-dose human study, piperine, a chemical found in black pepper and long pepper, was
reported to increase blood levels of propranolol,4 which could increase the
activity and risk of side effects of the drug.
Pleurisy root
As pleurisy root and other plants in the Aesclepius genus contain cardiac glycosides,
it is best to avoid use of pleurisy root with heart medications such as
beta-blockers.5
Interactions with Foods and Other Compounds
Food
Food increases the absorption of propranolol.6 Propranolol should be taken at the
same time every day, always with or always without food. High-protein foods may interfere with
propranolol metabolism, increasing propranolol blood levels and activity.7
Alcohol
Propranolol may cause drowsiness or dizziness.8 Alcohol may intensify this action.
To prevent accidental injury, people taking propranolol should avoid alcohol.
Tobacco
In a double-blind study of ten cigarette smokers with
angina treated with propranolol for one week, angina episodes were significantly reduced
during the nonsmoking phase compared with the smoking phase.9 People with angina
taking propranolol who do not smoke should avoid starting. Those who smoke should consult with
their prescribing doctor about quitting.
Summary of Interactions for Propranolol
| Depletion or interference | Coenzyme Q10* |
|---|---|
| Adverse interaction | High-potassium foods* Pleurisy root* Potassium supplements* Tobacco |
| Side effect reduction/prevention | Coenzyme Q10* |
| Supportive interaction | None known |
| Reduced drug absorption/bioavailability | None known |
| Other (see text) | Pepper |
For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
References:
1. Hamada M, Kazatain Y, Ochi T, et al. Correlation between serum CoQ10 level and myocardial contractility in hypertensive patients. In Biomedical and Clinical Aspects of Coenzyme Q, vol 4, ed. K Folkers, Y Yamamura. Amsterdam: Elsevier, 1984, 263–70.
2. Rosa RM, Silva P, Young JB, et al. Adrenergic modulation of extrarenal potassium disposal. N Engl J Med 1980;302:431–4.
3. Lundborg P. The effect of adrenergic blockade on potassium concentrations in different conditions. Acta Med Scand Suppl 1983;672:121–6 [review].
4. Bano G, Raina RK, Zutshi U, et al. Effect of piperine on bioavailability and pharmacokinetics of propranolol and theophylline in healthy volunteers. Eur J Clin Pharmacol 1991;41:615–7.
5. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press, 1996, 213–4.
6. Threlkeld DS, ed. Diuretics and Cardiovasculars, Beta-Adrenergic Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1993, 159a–9c.
7. Holt GA. Food & Drug Interactions. Chicago: Precept Press, 1998, 225.
8. Threlkeld DS, ed. Diuretics and Cardiovasculars, Beta-Adrenergic Blocking Agents. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Feb 1993, 159a–9c.
9. Deanfield J, Wright C, Krikler S, et al. Cigarette smoking and the treatment of angina with propranolol, atenolol, and nifedipine. N Engl J Med 1984;310:951–4.
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