Editing Propranolol (section)

==Medical uses==
[[Image:Propranolol 80mg.png|thumb|right|An 80&nbsp;mg capsule of [[Time release technology|extended-release]] propranolol]]
[[Image:Propranolol tablets.png|thumb|right|A mixture of 20&nbsp;mg and 10&nbsp;mg extended-release propranolol tablets]]
[[File:Propranolol hci sandoz 10mg.jpg|thumb|Propranolol blister pack]]
Propranolol is used for treating various conditions, including:

===Cardiovascular===
* [[Hypertension]]
* [[Angina pectoris]] (with the exception of [[Prinzmetal's angina|variant angina]])
* [[Myocardial infarction]]
* [[Tachycardia]] (and other [[sympathetic nervous system]] symptoms, such as [[muscle tremor]]) associated with various conditions, including [[anxiety]], [[panic]], [[hyperthyroidism]], and [[lithium pharmacology|lithium therapy]]
* [[Portal hypertension]], to lower [[Hepatic portal vein|portal vein]] pressure
* Prevention of [[esophageal varices|esophageal variceal]] bleeding and [[ascites]]
* [[Anxiety]]
* [[Hypertrophic cardiomyopathy]]

While once a first-line treatment for [[hypertension]], the role of beta blockers was downgraded in June 2006 in the [[United Kingdom]] to fourth-line, as they do not perform as well as other drugs, particularly in the elderly, and evidence is increasing that the most frequently used beta blockers at usual doses carry an unacceptable risk of provoking [[Diabetes mellitus type 2|type 2 diabetes]].<ref>{{cite web | vauthors = Ladva S | title=NICE and BHS launch updated hypertension guideline | url=http://www.nice.org.uk/download.aspx?o=335988 | date=28 June 2006 | publisher=[[National Institute for Health and Clinical Excellence]] | access-date=11 October 2009 | archive-url=https://web.archive.org/web/20060924003311/http://www.nice.org.uk/download.aspx?o=335988 | archive-date=24 September 2006 | df=dmy-all }}</ref>

Propranolol is not recommended for the treatment of [[high blood pressure]] by the Eighth Joint National Committee (JNC 8) because a higher rate of the primary composite outcome of cardiovascular death, [[myocardial infarction]], or [[stroke]] compared to an angiotensin receptor blocker was noted in one study.<ref>{{cite journal | vauthors = James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Narva AS, Ortiz E | title = 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) | journal = JAMA | volume = 311 | issue = 5 | pages = 507–520 | date = February 2014 | pmid = 24352797 | doi = 10.1001/jama.2013.284427 | df = dmy-all | doi-access = free }}</ref>

===Psychiatric===
Propranolol is occasionally used to treat [[performance anxiety]],<ref name=Dav2006/> although evidence to support its use in any [[anxiety disorder]]s is poor.<ref name="Steenenvan Wijk2015">{{cite journal | vauthors = Steenen SA, van Wijk AJ, van der Heijden GJ, van Westrhenen R, de Lange J, de Jongh A | title = Propranolol for the treatment of anxiety disorders: Systematic review and meta-analysis | journal = Journal of Psychopharmacology | volume = 30 | issue = 2 | pages = 128–139 | date = February 2016 | pmid = 26487439 | pmc = 4724794 | doi = 10.1177/0269881115612236 }}</ref> Its efficacy in managing [[panic disorder]] appears similar to [[benzodiazepine]]s, while carrying lower risks for addiction or abuse.<ref name="Steenenvan Wijk2015"/> Although beta-blockers such as propranolol have been suggested to be beneficial in managing [[Sympathetic nervous system|physical symptoms]] of anxiety, its [[efficacy#Medicine|efficacy]] in treating [[generalized anxiety disorder]] and panic disorder remain unestablished.<ref>{{cite journal | title = Beta-blockers in anxiety disorders | vauthors = Peggy H, Charles S | doi = 10.1016/0165-0327(87)90017-6 | url = https://www.sciencedirect.com/science/article/abs/pii/0165032787900176 | journal = Journal of Affective Disorders | volume = 13 | issue = 2 | date = October 1987 | pages = 119–130| pmid = 2890677 | url-access = subscription }}</ref> Some experimentation has been conducted in other psychiatric areas:<ref name="pmid17200914">{{cite journal | vauthors = Kornischka J, Cordes J, Agelink MW | title = 40 years beta-adrenoceptor blockers in psychiatry | language = de | journal = Fortschritte der Neurologie-Psychiatrie | volume = 75 | issue = 4 | pages = 199–210 | date = April 2007 | pmid = 17200914 | doi = 10.1055/s-2006-944295 | s2cid = 260156607 | url = https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-2006-944295| url-access = subscription }}</ref>
* [[Post-traumatic stress disorder]] (PTSD) and [[specific phobia]]s
* [[Aggressive behavior]] of patients with [[acquired brain injury|brain injuries]]<ref name="pmid7903928">{{cite journal | vauthors = Thibaut F, Colonna L | title = [Anti-aggressive effect of beta-blockers] | language = fr | journal = L'Encephale | volume = 19 | issue = 3 | pages = 263–267 | year = 1993 | pmid = 7903928 }}</ref>
* Treating the excessive drinking of fluids in [[psychogenic polydipsia]]<ref name="pmid7737786">{{cite journal | vauthors = Vieweg V, Pandurangi A, Levenson J, Silverman J | title = The consulting psychiatrist and the polydipsia-hyponatremia syndrome in schizophrenia | journal = International Journal of Psychiatry in Medicine | volume = 24 | issue = 4 | pages = 275–303 | year = 1994 | pmid = 7737786 | doi = 10.2190/5WG5-VV1V-BXAD-805K | s2cid = 22703210 }}</ref><ref name="pmid9844835">{{cite journal | vauthors = Kishi Y, Kurosawa H, Endo S | title = Is propranolol effective in primary polydipsia? | journal = International Journal of Psychiatry in Medicine | volume = 28 | issue = 3 | pages = 315–325 | year = 1998 | pmid = 9844835 | doi = 10.2190/QPWL-14H7-HPGG-A29D | s2cid = 25222454 }}</ref>

====PTSD and phobias====
Propranolol is being investigated as a potential treatment for PTSD.<ref>{{cite web |url=http://www.nbcnews.com/id/10806799 |archive-url=https://web.archive.org/web/20131112233001/http://www.nbcnews.com/id/10806799/ |url-status=dead |archive-date=12 November 2013 |title=Doctors test a drug to ease traumatic memories - Mental Health - NBC News |website=[[NBC News]] |access-date=30 June 2007 }}</ref><ref>{{cite journal | vauthors = Brunet A, Orr SP, Tremblay J, Robertson K, Nader K, Pitman RK | title = Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder | journal = Journal of Psychiatric Research | volume = 42 | issue = 6 | pages = 503–506 | date = May 2008 | pmid = 17588604 | doi = 10.1016/j.jpsychires.2007.05.006 }}</ref><ref>{{Cite book | vauthors = Young C, Butcher R |url=http://www.ncbi.nlm.nih.gov/books/NBK562942/ |title=Propranolol for Post-Traumatic Stress Disorder: A Review of Clinical Effectiveness  |date=2020 |publisher=Canadian Agency for Drugs and Technologies in Health |series=CADTH Rapid Response Reports |location=Ottawa (ON) |pmid=33074615}}</ref> Propranolol works to inhibit the actions of [[norepinephrine]] (noradrenaline), a [[neurotransmitter]] that enhances [[memory consolidation]].<ref>{{Cite web |title=DocFilm – DW |url=https://www.dw.com/en/docfilm/program-294010 |access-date=2 August 2023 |website=dw.com |language=en}}</ref> In one small study, individuals given propranolol immediately after trauma experienced fewer stress-related symptoms and lower rates of PTSD than respective control groups who did not receive the drug.<ref>{{cite journal | vauthors = Vaiva G, Ducrocq F, Jezequel K, Averland B, Lestavel P, Brunet A, Marmar CR | title = Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma | journal = Biological Psychiatry | volume = 54 | issue = 9 | pages = 947–949 | date = November 2003 | pmid = 14573324 | doi = 10.1016/s0006-3223(03)00412-8 | s2cid = 3064619 }}</ref> Due to the fact that memories and their emotional content are reconsolidated in the hours after they are recalled/re-experienced, propranolol can also diminish the emotional impact of already formed memories; for this reason, it is also being studied in the treatment of [[specific phobia]]s, such as [[arachnophobia]], [[dental fear]], and [[social phobia]].<ref name="Steenenvan Wijk2015" />  It has also been found to be helpful for some individuals with [[misophonia]].<ref>{{cite journal | vauthors = Webb J | title = β-Blockers for the Treatment of Misophonia and Misokinesia | journal = Clinical Neuropharmacology | volume = 45 | issue = 1 | pages = 13–14 | date = Jan–Feb 2022 | pmid = 35029865 | doi = 10.1097/WNF.0000000000000492 | s2cid = 245932937 }}</ref>

Ethical and legal questions have been raised surrounding the use of propranolol-based medications for use as a "memory damper", including altering memory-recalled evidence during an investigation, modifying the behavioral response to past (albeit traumatic) experiences, the regulation of these drugs, and others.<ref>{{cite journal| vauthors = Kolber AJ | title=Therapeutic Forgetting: The Legal and Ethical Implications of Memory Dampening |journal=Vanderbilt Law Review, San Diego Legal Studies Paper No. 07-37. |volume=59 |page=1561 |year=2006}}</ref> However, Hall and Carter have argued that many such objections are "based on wildly exaggerated and unrealistic scenarios that ignore the limited action of propranolol in affecting memory, underplay the debilitating impact that PTSD has on those who suffer from it, and fail to acknowledge the extent to which drugs like [[alcohol (drug)|alcohol]] are already used for this purpose".<ref>{{cite journal | vauthors = Hall W, Carter A | title = Debunking alarmist objections to the pharmacological prevention of PTSD | journal = The American Journal of Bioethics | volume = 7 | issue = 9 | pages = 23–25 | date = September 2007 | pmid = 17849333 | doi = 10.1080/15265160701551244 | s2cid = 27063524 }}</ref>

===Other uses===
* [[Essential tremor]]. Evidence for use for [[akathisia]] however is insufficient<ref>{{cite journal | vauthors = Lima AR, Bacalcthuk J, Barnes TR, Soares-Weiser K | title = Central action beta-blockers versus placebo for neuroleptic-induced acute akathisia | journal = The Cochrane Database of Systematic Reviews | issue = 4 | pages = CD001946 | date = October 2004 | volume = 2004 | pmid = 15495022 | pmc = 6599862 | doi = 10.1002/14651858.CD001946.pub2 }}</ref>
* [[Migraine]] and [[cluster headache]] prevention<ref>{{cite journal | vauthors = Shields KG, Goadsby PJ | title = Propranolol modulates trigeminovascular responses in thalamic ventroposteromedial nucleus: a role in migraine? | journal = Brain | volume = 128 | issue = Pt 1 | pages = 86–97 | date = January 2005 | pmid = 15574468 | doi = 10.1093/brain/awh298 | doi-access = free }}</ref><ref>{{cite book |title=The Biochemistry of Migraine | vauthors = Eadie M, Tyrer JH |year=1985 |publisher=Springer |location=New York |isbn=9780852007310 |page=148 |oclc=11726870 |url= https://books.google.com/books?id=JYeyCc9M6acC&q=Propranolol+migraine+mechanism%2C&pg=PA148 |url-status=live |archive-url=https://web.archive.org/web/20170324030406/https://books.google.com/books?id=JYeyCc9M6acC&pg=PA148&lpg=PA148&dq=Propranolol+migraine+mechanism,&source=bl&ots=Ep2oSjxpAo&sig=7H_KHF3xoIP0nBKJJaqsDl_IhAs&hl=en&ei=TXVPTuu6DKHE4gT6gLnXBw&sa=X&oi=book_result&ct=result&resnum=4&ved=0CCoQ6AEwAzgK#v=onepage&q=Propranolol%20migraine%20mechanism%2C&f=false |archive-date=24 March 2017 }}</ref> and in primary exertional headache<ref name=AHFS2015/><ref>{{cite web | vauthors = Chan C, Goadsby PJ | veditors = Silberstein SD | date = 26 September 1996 | title = Primary exercise headache | work = MedLink | url = https://www.medlink.com/articles/primary-exercise-headache }}</ref>
* [[Hyperhidrosis]] (excessive sweating){{cn|date=June 2023}}
* [[Infantile hemangioma]]<ref>{{cite journal | vauthors = Chen T, Gudipudi R, Nguyen SA, Carroll W, Clemmens C | title = Should Propranolol Remain the Gold Standard for Treatment of Infantile Hemangioma? A Systematic Review and Meta-Analysis of Propranolol Versus Atenolol | journal = The Annals of Otology, Rhinology, and Laryngology | pages = 332–340 | date = April 2022 | volume = 132 | issue = 3 | pmid = 35466712 | doi = 10.1177/00034894221089758 | s2cid = 248375711 }}</ref>
* [[Glaucoma]]{{cn|date=June 2023}}
* [[Thyrotoxicosis]] by [[deiodinase]] inhibition{{cn|date=June 2023}}

Propranolol may be used to treat severe [[infantile hemangioma]]s (IHs). This treatment shows promise as being superior to [[corticosteroid]]s when treating IHs. Extensive clinical case evidence and a small controlled trial support its efficacy.<ref>{{cite journal |journal= Current Dermatology Reports |year= 2012 |doi= 10.1007/s13671-012-0026-6 |title= Propranolol for Infantile Hemangiomas: A Review | vauthors = Hogeling M |page= Online-first |volume=1|issue= 4 |doi-access= free }}</ref>