Inderal is usually well tolerated. In clinical studies the possible adverse reactions reported are usually attributable to the pharmacological actions of propranolol.
The following possible adverse reactions, listed by body system, have been reported.
Common (1-9.9%): General: Fatigue and/or lassitude (often transient).
Cardiovascular: Bradycardia, cold extremities, Raynaud's phenomenon.
CNS: Sleep disturbances, nightmares.
Uncommon (0.1-0.9%): GI: Gastrointestinal disturbance, such as nausea, vomiting, diarrhoea.
Rare (0.01-0.09%): General: Dizziness.
Cardiovascular: Heart failure deterioration, precipitation of heart block, postural hypotension, which may be associated with syncope, exacerbation of intermittent claudication.
CNS: Hallucinations, psychoses, mood changes, confusion, memory loss.
Skin: Purpura, alopecia, psoriasiform skin reactions, exacerbation of psoriasis, skin rashes.
Eyes: Dry eyes, visual disturbances.
Respiratory: Bronchospasm may occur in patients with bronchial asthma or a history of asthmatic complaints, sometimes with fatal outcome.
Very rare (<0.01%): Endocrine system: Hypoglycaemia in neonates, infants, children, elderly patients, patients on haemodialysis, patients on concomitant antidiabetic therapy, patients with prolonged fasting and patients with chronic liver disease has been reported.
Investigations: an increase in ANA (Antinuclear Antibodies) has been observed, however the clinical relevance of this is not clear.
Nervous system: Isolated reports of myasthenia gravis like syndrome or exacerbation of myasthenia gravis have been reported.
Discontinuance of the drug should be considered if, according to clinical judgement, the well-being of the patient is adversely affected by any of the previously mentioned reactions. Cessation of therapy with a beta-blocker should be gradual. In the rare event of intolerance, manifested as bradycardia and hypotension, the drug should be withdrawn and, if necessary, treatment for overdosage instituted.