The prescribing information for propranolol hydrochloride tablets has an Alcohol interaction entry and names a range of medicines. For alcohol, it says that alcohol, when used concomitantly with propranolol, may increase plasma levels of propranolol. This guide reports each statement as written and is not a complete list of interactions.
Alcohol in a general NIH page
The National Institute on Alcohol Abuse and Alcoholism, in its page on mixing alcohol with medicines, says that to learn more about a medicine and whether it will interact with alcohol, you should talk to your pharmacist or other health care provider. The passage used here is general and does not name propranolol. The label sentence in the opening paragraph is the source used here for propranolol and alcohol.
Medicines named in the label
The table gives the label's wording. Where the label says "such as", the names that follow are its examples.
| Medicine or group | What the label says |
|---|---|
| CYP2D6, 1A2 or 2C19 pathways | Caution should be exercised when propranolol is administered with drugs that have an effect on CYP2D6, 1A2, or 2C19 metabolic pathways. |
| CYP2D6 pathway | 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 (spelled "delavudin" in the label). |
| CYP1A2 pathway | Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP1A2, such as imipramine, cimetidine, ciprofloxacin, fluvoxamine, isoniazid, ritonavir, theophylline, zileuton, zolmitriptan, and rizatriptan. |
| CYP2C19 pathway | Blood levels and/or toxicity of propranolol may be increased by co-administration with substrates or inhibitors of CYP2C19, such as fluconazole, cimetidine, fluoxetine, fluvoxamine, teniposide, and tolbutamide. |
| Verapamil | There have been reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers. |
| Clonidine | The antihypertensive effects of clonidine may be antagonized by beta-blockers. Propranolol should be administered cautiously to patients withdrawing from clonidine. |
| Epinephrine | Patients on long-term therapy with propranolol may experience uncontrolled hypertension if administered epinephrine as a consequence of unopposed alpha-receptor stimulation. |
| NSAIDs, including indomethacin | Nonsteroidal anti-inflammatory drugs (NSAIDS) have been reported to blunt the antihypertensive effect of beta-adrenoreceptor blocking agents. Administration of indomethacin with propranolol may reduce the efficacy of propranolol in reducing blood pressure and heart rate. |
| Methoxyflurane and trichloroethylene | Methoxyflurane and trichloroethylene may depress myocardial contractility when administered with propranolol. |
| Warfarin | Propranolol when administered with warfarin increases the concentration of warfarin. Prothrombin time, therefore, should be monitored. |
| Zolmitriptan and rizatriptan | Administration of zolmitriptan or rizatriptan with propranolol resulted in increased concentrations of zolmitriptan (AUC increased by 56% and C max by 37%) or rizatriptan (the AUC and C max were increased by 67% and 75%, respectively). |
Anti-ulcer medicines and keeping a list
The label's Anti-Ulcer Drugs entry says co-administration of propranolol with cimetidine, a non-specific CYP450 inhibitor, increased propranolol AUC and C max by 46% and 35%, respectively. It also says co-administration with aluminum hydroxide gel (1200 mg) may result in a decrease in propranolol concentrations. A general FDA consumer page on managing the benefits and risks of medicines, which is not about propranolol, says to keep an up-to-date, written list of all the medicines (prescription and over-the-counter) and dietary supplements, including vitamins and herbals, that you use, even those you only use occasionally, and to share this list with all of your health care professionals.
Alcohol and propranolol in healthy volunteers
A 1995 abstract of studies in normal healthy volunteers covers diazepam, propranolol and alcohol given alone or in combination. The abstract does not state the doses, randomization or blinding. It reported impaired psychomotor performance persisting up to 4-5 h when diazepam, propranolol or alcohol were given singly, tested on simple reaction time, multiple choice reaction time and critical flicker fusion frequency tasks. It also reported an additive impairment of critical flicker fusion frequency with the alcohol-propranolol combination only. The number of volunteers is not given in the passages used here.
What this does not tell you
Some label entries name who they are about, such as patients on long-term therapy with propranolol (epinephrine) and patients withdrawing from clonidine. This guide does not say whether any entry applies to another person or to any pattern of use. The zolmitriptan, rizatriptan and cimetidine figures are percentage changes in AUC and C max as the label states them, and the passages do not say what follows from them. The alcohol abstract gives no doses, so it cannot tell you at what amounts the reported impairment occurs.
The NIAAA page says to talk to a pharmacist or other health care provider about whether a medicine will interact with alcohol, and a licensed provider who knows the medicines a person takes decides what matters for them. This guide does not tell you to start, stop or change anything.