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Also indexed as: Betachron, Inderal
Combination drug: 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.
Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.
 May Be Beneficial: Depletion or interference—The medication may deplete or interfere with the absorption or function of the nutrient. Taking these nutrients may help replenish them. | Coenzyme Q10* |
| May Be Beneficial: Side effect reduction/prevention—Taking these supplements may help reduce the likelihood and/or severity of a potential side effect caused by the medication. | Coenzyme Q10* |
 Avoid: Adverse interaction—Avoid these supplements when taking this medication because taking them together may cause undesirable or dangerous results. | High-potassium foods* Pleurisy root* Potassium supplements* Tobacco |
 Check: Other—Before taking any of these supplements or eating any of these foods with your medication, read this article in full for details. | Pepper |
| Supportive interaction | None known |
| Reduced drug absorption/bioavailability | None known |
An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.
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.
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
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.
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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Learn more about the authors of Using Medicines with Vitamins and Herbs
The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.
