Beta-Blocker Selection Guide
Find Your Best Beta-Blocker Match
Answer a few questions about your condition and health status to identify the most appropriate beta-blocker for you.
Recommended Beta-Blocker
Why this medication?
Key considerations
Important Safety Information
Quick Takeaways
- Inderal LA (propranolol) is a non‑selective beta‑blocker best for migraine prevention, essential tremor and certain heart rhythm issues.
- For pure hypertension or angina, cardio‑selective blockers such as atenolol or metoprolol often cause fewer side‑effects.
- Patients with asthma, severe COPD or diabetes may prefer agents with less impact on beta‑2 receptors (e.g., bisoprolol).
- Switching between beta‑blockers requires a tapering plan to avoid rebound tachycardia.
- Always discuss dosage changes with a prescriber; abrupt stops can trigger serious heart problems.
What is Inderal LA (Propranolol)?
Propranolol is a non‑selective beta‑adrenergic antagonist that blocks both beta‑1 and beta‑2 receptors throughout the body. The "LA" stands for long‑acting, meaning the tablet releases the drug slowly over 24hours, allowing once‑daily dosing.
First approved in the 1960s, propranolol became the prototype beta‑blocker and remains a workhorse for many cardiovascular and neurologic conditions.
How Propranolol Works
Beta receptors respond to adrenaline. When propranolol blocks them, the heart beats slower, the force of contraction drops, and blood vessels relax. This reduces heart‑rate, lowers blood pressure, and dampens the sympathetic surge that triggers migraines or tremors.
Typical Uses for Inderal LA
- Prevention of migraine headaches
- Essential tremor control
- Management of certain cardiac arrhythmias (e.g., atrial fibrillation)
- Post‑myocardial‑infarction (heart‑attack) secondary prevention
- Control of hypertension when combined with other drugs

Key Attributes of Inderal LA
Attribute | Typical Value |
---|---|
Dosage forms | 80mg, 160mg tablets (once daily) |
Half‑life (extended‑release) | ≈10hours (steady‑state) |
Bioavailability | ≈25% (first‑pass metabolism) |
Common side effects | Fatigue, cold hands/feet, mild depression, sleep disturbances |
Contraindications | Severe asthma, second‑/third‑degree AV block, untreated pheochromocytoma |
Alternative Beta‑Blockers to Consider
Below are the most frequently prescribed alternatives. Each entry includes a short definition with schema markup.
Atenolol is a cardio‑selective beta‑1 blocker that primarily affects the heart while sparing beta‑2 receptors in the lungs.
Metoprolol is another beta‑1 selective antagonist, available in immediate‑release (tartrate) and extended‑release (succinate) forms.
Carvedilol combines non‑selective beta‑blockade with alpha‑1 antagonism, offering additional vasodilation.
Labetalol is a mixed alpha‑ and beta‑blocker often used in hypertensive emergencies.
Bisoprolol is a highly beta‑1 selective blocker with a long half‑life, making it convenient for daily dosing.
Nebivolol is a newer beta‑1 selective agent that also releases nitric oxide, improving endothelial function.
Side‑by‑Side Comparison
Drug | Receptor Selectivity | Typical Indication(s) | Favoured Patient Profile | Notable Contra‑indications |
---|---|---|---|---|
Propranolol (Inderal LA) | Non‑selective (β1&β2) | Migraine prophylaxis, essential tremor, arrhythmia | Patients without asthma, needing neuro‑protective effects | Severe asthma, bradycardia, untreated pheochromocytoma |
Atenolol | β1‑selective | Hypertension, angina, post‑MI | Patients with mild‑to‑moderate lung disease | Severe bradycardia, AV block, cardiogenic shock |
Metoprolol | β1‑selective | Hypertension, heart failure, post‑MI | Older adults, heart‑failure patients | Severe asthma, overt heart block |
Carvedilol | Non‑selective β + α1 | Heart failure, hypertension | Patients needing after‑load reduction | Asthma, severe liver disease |
Labetalol | β1/β2 + α1 | Hypertensive emergencies, pregnancy‑related HTN | Pregnant patients, acute BP spikes | Severe asthma, heart block |
Bisoprolol | Highly β1‑selective | Hypertension, chronic heart failure | Elderly, diabetics (less glucose impact) | Severe asthma, bradycardia |
Nebivolol | β1‑selective+NO release | Hypertension, early heart failure | Patients needing vasodilation without α‑blockade | Severe liver disease, hypotension |
Choosing the Right Beta‑Blocker: Scenario‑Based Guidance
- Migraine prevention: Propranolol remains the gold standard because its non‑selective profile dampens the vascular surge that triggers migraines. Alternatives like metoprolol work for some patients, but evidence leans heavily toward propranolol.
- Hypertension without lung disease: Atenolol or bisoprolol provide similar BP control with fewer bronchospasm risks.
- Heart‑failure with reduced ejection fraction: Carvedilol or bisoprolol are preferred; they improve mortality rates more than non‑selective agents.
- Asthma or COPD: Choose a highly β1‑selective blocker (bisoprolol, nebivolol) or avoid beta‑blockers altogether if respiratory symptoms are severe.
- Pregnancy‑related hypertension: Labetalol’s mixed α/β action is often recommended by obstetric guidelines.

Pros and Cons of Inderal LA vs. Each Alternative
- Propranolol vs. Atenolol: Propranolol offers migraine benefit but has higher risk of bronchospasm; atenolol is gentler on lungs but lacks neurologic efficacy.
- Propranolol vs. Metoprolol: Metoprolol’s β1 selectivity reduces fatigue; however, propranolol’s longer half‑life provides steadier plasma levels for tremor control.
- Propranolol vs. Carvedilol: Carvedilol adds vasodilation, useful in heart failure, yet its α‑blockade may cause orthostatic hypotension more often than propranolol.
- Propranolol vs. Labetalol: Labetalol is faster‑acting for acute BP spikes, whereas propranolol is better for chronic migraine prophylaxis.
- Propranolol vs. Bisoprolol: Bisoprolol’s high cardio‑selectivity is safer for patients with reactive airway disease, but propranolol wins for essential tremor.
- Propranolol vs. Nebivolol: Nebivolol’s nitric‑oxide release improves endothelial health; propranolol lacks this benefit but is cheaper and more widely studied for migraine.
Switching Safely Between Beta‑Blockers
Because all beta‑blockers share a core mechanism, abrupt changes can cause rebound tachycardia, hypertension, or angina. Follow these steps:
- Consult your prescriber before any change.
- If moving to a longer‑acting drug (e.g., propranolol LA → metoprolol succinate), taper the current dose over 1‑2 weeks.
- Start the new agent at 50% of the calculated equivalent dose.
- Monitor heart rate, blood pressure, and symptom control at least every 48hours during the transition.
- Report any new chest pain, shortness of breath, or dizziness immediately.
Frequently Asked Questions
Frequently Asked Questions
Can I take Inderal LA if I have mild asthma?
Mild, well‑controlled asthma is a relative contraindication. Many clinicians start at a low dose and watch for wheezing. If symptoms appear, switch to a β1‑selective blocker like bisoprolol.
Why does propranolol cause cold hands?
Blocking β2 receptors reduces blood‑vessel dilation in peripheral tissues, so blood flow to the extremities drops, making them feel colder.
Is the long‑acting formulation better than immediate‑release?
Long‑acting tablets smooth out peaks and troughs, which improves adherence and reduces night‑time rebound symptoms. Immediate‑release may be chosen for rapid titration or short‑term needs.
Can I combine propranolol with another beta‑blocker?
Generally no. Combining two beta‑blockers increases the risk of bradycardia, severe hypotension, and heart block without added benefit.
How long does it take for migraine prevention to work?
Most patients notice a reduction in attack frequency after 2‑4 weeks of daily dosing, but full effect may require up to 12 weeks.
Choosing the right beta‑blocker hinges on your primary health goal, existing medical conditions, and how your body reacts to the medication. By weighing the pros and cons laid out here, you can have a focused conversation with your doctor and land on the option that fits your life best.
Helen Crowe
October 13, 2025 AT 19:06When evaluating beta‑blocker pharmacodynamics, consider the non‑selective beta‑adrenergic blockade of propranolol versus the cardio‑selective profile of agents like bisoprolol. The therapeutic index of Inderal LA is broadened by its extended‑release matrix, which smooths plasma concentrations over 24 hours. For migraine prophylaxis, the central nervous system penetration is a critical factor that the molecule’s lipophilicity facilitates. Ultimately, aligning the drug’s kinetic profile with patient comorbidities yields optimal outcomes.