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ACE inhibitors (eg, captopril)
Increased risk of hypotension, especially in patients with acute MI; bronchial hyper-reactivity may be increased.
Aluminum hydroxide gel
Greatly reduces GI absorption of propranolol.
Amiodarone
Has additive antiarrhythmic and negative chronotropic properties with propranolol.
Anesthetic agents (eg, methoxyflurane, trichloroethylene)
Depression in myocardial contractility may occur.
Barbiturates
Decreased bioavailability of propranolol.
Cimetidine
Increased propranolol levels.
Clonidine
Attenuation or reversal of antihypertensive effect; potentially life-threatening increases in BP, especially on withdrawal.
Disopyramide
Has been associated with severe bradycardia, asystole, and heart failure, when given with propranolol.
Dobutamine, isoproterenol
May reverse effects of propranolol.
Epinephrine
Initial hypertensive episode followed by bradycardia.
Ergot derivatives
Peripheral ischemia, manifested by cold extremities and possible gangrene.
Ethanol
Slows rate of propranolol absorption.
Hydantoins, rifabutin, rifampin
Decreased effects of propranolol.
Hydralazine
Increased serum levels of both drugs.
Insulin
Prolonged hypoglycemia with masking of symptoms.
Lidocaine
Increased lidocaine levels, leading to toxicity.
Methimazole, propafenone, propylthiouracil, quinidine
Increased effects of propranolol.
NSAIDs
Some agents may impair antihypertensive effect.
Phenothiazines
Increased effects of either drug.
Prazosin
Increased orthostatic hypotension.
Reserpine
Hypotension, marked bradycardia, vertigo, syncopal attacks, and orthostatic hypotension may result from excessive reduction of resting sympathetic nervous activity caused by reserpine-induced catecholamine-depletion.
Theophylline
Reduces elimination of theophylline; pharmacologic antagonism.
Thyroxine
May result in decreased T 3 concentration when coadministered with propranolol.
Verapamil
Increased effects of both drugs.
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