Drug interactions
Epinephrine + Propranolol
Severity: Major
Epinephrine and Propranolol: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
With nonselective beta blockade, epinephrine's beta-2 mediated vasodilation is blocked while alpha-mediated vasoconstriction continues unopposed. This can cause marked hypertension with reflex bradycardia, and epinephrine may also be less effective in anaphylaxis.
What this interaction means in plain words
Epinephrine and Propranolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Epinephrine belongs to Endocrine; Propranolol belongs to Cardiovascular.
Why it happens
Nonselective beta blockade leaves epinephrine's alpha-adrenergic vasoconstriction unopposed and antagonizes its beta effects.
What to do
Monitor blood pressure and heart rate closely when epinephrine must be given, and prefer a cardioselective beta blocker where a beta blocker is needed. In anaphylaxis refractory to epinephrine in a patient on a beta blocker, consider glucagon.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Epinephrine and Propranolol, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Propranolol
- Propranolol + Thioridazine Contraindicated
- Acebutolol + Propranolol Major
- Adrenaline-articaine + Propranolol Major
- Amifostine + Propranolol Major
- Amiodarone + Propranolol Major
- Arformoterol + Propranolol Major
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Epinephrine with Propranolol?
MediHelp rates the interaction as major. Epinephrine and Propranolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. With nonselective beta blockade, epinephrine's beta-2 mediated vasodilation is blocked while alpha-mediated vasoconstriction continues unopposed. This can cause marked hypertension with reflex bradycardia, and epinephrine may also be less effective in anaphylaxis.
How serious is the interaction between Epinephrine and Propranolol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor blood pressure and heart rate closely when epinephrine must be given, and prefer a cardioselective beta blocker where a beta blocker is needed. In anaphylaxis refractory to epinephrine in a patient on a beta blocker, consider glucagon.
What other medicines interact with Propranolol?
MediHelp also lists interactions of Propranolol with, for example, Thioridazine, Acebutolol, Adrenaline-articaine. The full list is on the Propranolol page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
