Drug interactions
Epinephrine racemic + Propranolol
Severity: Major
Epinephrine racemic 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 non-selective beta blockade, epinephrine's beta-2 vasodilation is blocked and unopposed alpha stimulation can cause severe hypertension with reflex bradycardia. Epinephrine may also be less effective for bronchospasm or anaphylaxis in propranolol-treated patients.
What this interaction means in plain words
Epinephrine racemic 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.
Why it happens
Propranolol blocks beta-2 receptors, leaving epinephrine's alpha-adrenergic vasoconstriction unopposed.
What to do
Monitor blood pressure and heart rate closely when epinephrine is given and prefer a cardioselective beta-blocker if one is required. Be prepared to use glucagon for epinephrine-resistant anaphylaxis.
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?
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References
Other interactions of Propranolol
- Propranolol + Thioridazine Contraindicated
- Acebutolol + Propranolol Major
- Adrenaline-articaine + Propranolol Major
- Amifostine + Propranolol Major
- Amiodarone + Propranolol Major
- Arformoterol + Propranolol Major
Frequently asked questions
Can I take Epinephrine racemic with Propranolol?
MediHelp rates the interaction as major. Epinephrine racemic 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 non-selective beta blockade, epinephrine's beta-2 vasodilation is blocked and unopposed alpha stimulation can cause severe hypertension with reflex bradycardia. Epinephrine may also be less effective for bronchospasm or anaphylaxis in propranolol-treated patients.
How serious is the interaction between Epinephrine racemic 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 is given and prefer a cardioselective beta-blocker if one is required. Be prepared to use glucagon for epinephrine-resistant anaphylaxis.
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.
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