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The usual dose of propranolol is 40 mg twice daily, although the lowest dose needed to reduce symptoms is generally prescribed for patients with thyrotoxicosis. Often, beta blockers are prescribed PRN or to be taken as needed. In patients who are anti-thyroid drugs, the dose of beta-blockers is generally reduced after 4-8 weeks when euthyroidism is achieved. The usual dose of atenolol (Tenormin) and metoprolol (lopressor) is generally 25-50 mg given once daily.
There are no well controlled studies in pregnant women. Intrauterine growth retardation has been noted in neonates whose mothers received propranolol during pregnancy. Neonates whose mothers are receiving propranolol at parturition have exhibited bradycardia, hypoglycemia and respiratory depression. Propranolol is excreted in human milk. Caution should be exercised when using beta blockers in nursing women.
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