Inderal LA
Inderal LA is propranolol hydrochloride 40 mg long-acting (LA / SR) capsules from AstraZeneca — once-daily dosing with smoother 24-hour plasma levels. For migraine prevention: 80-160 mg once daily. Classic first-line preventive; safe in pregnancy (preferred in women of childbearing potential). Contraindicated in asthma, severe bradycardia, second/third degree heart block.
✓ Medisch beoordeeld door Morgan Ellis — Apotheekonderzoeker · 8 jaar ervaring · Laatst beoordeeld: mei 2026
⚡ Quick Answer — What is Inderal LA?
Inderal LA is een 40 mg propranolol long-acting (LA / SR) capsule from AstraZeneca — a non-selective beta-blocker and the classic first-line preventive medication for episodic migraine, FDA-approved for this indication since 1979. Also used for hypertension, angina, atrial fibrillation rate control, thyrotoxicosis, essential tremor, infantile haemangioma, performance anxiety, and portal-hypertensive varices prophylaxis. Typical migraine-prevention dose: 80-160 mg once daily. Full effect at 8-12 weeks. Reduces migraine frequency by ~50% in roughly half of treated patients. Safe in pregnancy (Category C but extensive reassuring data) — making propranolol the preferred preventive in women of childbearing potential. Contraindicated in asthma, severe bradycardia, second/third degree heart block, and acute heart failure. Key side effects: fatigue, cold extremities, bradycardia, postural dizziness, sleep disturbance with vivid dreams, exercise intolerance.
What Is Inderal LA?
Inderal LA is an oral long-acting (LA / SR) capsule of propranolol hydrochloride 40 mg from AstraZeneca, supplied in 30-180 tablets. Propranolol was the first beta-blocker introduced into clinical practice (Sir James Black, 1964; Nobel Prize 1988) and remains the benchmark non-selective beta-blocker — widely used across multiple indications and arguably the most important cardiovascular drug ever developed.
The LA (long-acting) / SR (sustained-release) formulation allows once-daily dosing with smoother 24-hour plasma levels than the immediate-release form — better tolerability, better adherence, and particularly useful for migraine prevention and hypertension where steady-state plasma levels matter.
How Propranolol Prevents Migraine
The precise mechanism in migraine prophylaxis remains debated (this was actually serendipitously discovered when propranolol-treated angina patients noticed their migraines improved). Current theories include:
- Beta-1 blockade — may reduce sympathetic-nervous-system-mediated cranial arterial reactivity
- Beta-2 blockade — may block cortical noradrenaline release and lower cortical excitability
- 5-HT antagonism — propranolol has modest serotonin-receptor binding at clinical doses; possible cortical spreading depression suppression
- Membrane-stabilising action — may reduce neuronal excitability in trigeminal nucleus caudalis
Only lipophilic non-selective beta-blockers (propranolol, metoprolol, nadolol, timolol) work for migraine prevention — water-soluble atenolol and selective agents like bisoprolol do not. The CNS-penetrating non-selective profile is the active ingredient.
Goedgekeurde Toepassingen
- Migraineprofylaxe (FDA-approved 1979)
- Hypertensie
- Angina pectoris
- Frequentiecontrole bij atriumfibrilleren
- Essentiële tremor
- Thyreotoxicose — symptom control during hyperthyroid phase
- Infantiel hemangioom — eerste keus sinds 2008
- Portal hypertension variceal prophylaxis
- Prestatieangst (off-label; reduces tremor and palpitations)
- Feochromocytoom — ONLY after alpha-blockade; never as monotherapy
Inderal LA Dosage for Migraine Prevention
- Week 1-2: 80 mg eenmaal daags
- Week 3-4: 120 mg once daily if tolerated
- Doel: 80-160 mg once daily (most patients respond at 80-120 mg)
- Innemen met of zonder voedsel.
- Assess benefit at 8-12 weeks with a migraine diary.
- If <50% reduction at 12 weeks with target dose, switch agent.
Monitoring: check pulse (<50 bpm = dose reduction), blood pressure (hypotension caution), and clinical response. Routine blood work is not needed.
Stopzetting: Taper over 1-2 weeks. Abrupt discontinuation of a beta-blocker can precipitate rebound tachycardia, angina, or myocardial infarction in patients with cardiovascular disease — even in migraineurs without heart disease, taper slowly.
Bijwerkingen
Zeer vaak voorkomend:
- Fatigue, lethargy (often adapts over 2-4 weeks)
- Koude handen en voeten
- Bradycardia (check pulse — stop if <50 bpm)
- Exercise intolerance (heart-rate response to exercise is blunted)
- Duizeligheid, orthostatische hypotensie
Common (1-10%):
- Sleep disturbance — vivid dreams or nightmares (lipophilic beta-blocker effect crossing the blood-brain barrier)
- Depression, mood changes (mostly at higher doses)
- Reduced libido, erectile dysfunction
- Gastrointestinal upset
- Raynaud-like cold intolerance in the hands
Important but less common:
- Bronchospasme — can be severe in asthmatics and COPD patients (beta-2 blockade). Absolute contraindication in asthma.
- Masked hypoglycaemia in diabetics on insulin — propranolol blocks the tachycardia/tremor warning signs of low blood sugar while delaying recovery.
- Hartblok or worsening heart failure in susceptible patients
Contra-indicaties
- Asthma, severe COPD, bronchospasm of any cause — absolute
- Second or third degree atrioventricular block
- Sinusbradycardie <50 bpm
- Cardiogenic shock, decompensated heart failure
- Severe peripheral arterial disease, Raynaud’s syndrome (relative)
- Phaeochromocytoma without prior alpha-blockade (never use beta-blocker first — paradoxical hypertensive crisis)
- Hypersensitivity to propranolol
Zwangerschap: FDA Category C but with extensive reassuring real-world data. Propranolol is the preferred migraine preventive in women planning or during pregnancy. Small risk of mild intrauterine growth restriction, neonatal bradycardia, and hypoglycaemia; these are monitored but rarely clinically significant.
Borstvoeding: compatible. Minimal amounts in breast milk; routine use during breastfeeding is considered safe.
Geneesmiddelinteracties
- Verapamil, diltiazem (non-dihydropyridine CCBs) — additive bradycardia and heart-block risk; avoid combination
- Andere bètablokkers — additive effect; do not combine
- Rizatriptan — propranolol increases rizatriptan plasma levels ~70%; reduce rizatriptan dose to 5 mg maximum
- NSAID's — may reduce the antihypertensive effect of propranolol (less relevant for migraine indication)
- Insulin / sulphonylureas — mask hypoglycaemia symptoms
- Alcohol — additive hypotension and CNS depression
- Fluvoxamine, fluoxetine — inhibit CYP2D6; can raise propranolol levels
Opslag
Bewaren onder 25°C. Buiten bereik van kinderen houden.
Veelgestelde vragen
How long until Inderal LA starts preventing migraines?
Allow 8-12 weeks at target dose. Keep a migraine diary. A clinically meaningful response is a 50% reduction in monthly migraine days. If no response after 12 weeks at 160 mg/day, switch preventive (topiramate, valproate ER, amitriptyline, flunarizine).
Can I take Inderal LA if I have asthma?
No — propranolol is non-selective and blocks beta-2 receptors in bronchial smooth muscle, which can precipitate severe bronchospasm in asthmatics. Absolute contraindication. For asthmatic migraineurs, topiramate, amitriptyline, or flunarizine are safer alternatives.
Is Inderal LA safe in pregnancy?
Ja — propranolol is the preferred migraine preventive in pregnancy and in women of childbearing potential. Extensive reassuring real-world data; small risk of mild intrauterine growth restriction, neonatal bradycardia, and hypoglycaemia (monitored but rarely problematic). Topiramate and valproate are contraindicated; propranolol is the go-to option.
Will Inderal LA affect my exercise performance?
Yes to some extent — beta blockade blunts the heart-rate response to exercise, so your maximum heart rate is lower and you fatigue faster at high intensities. For recreational exercise most people adapt; for competitive endurance athletes, propranolol can substantially impair performance and is banned in some sports (archery, shooting — where it reduces tremor). Discuss with your doctor if you train competitively.
Can I drink alcohol on Inderal LA?
Moderate alcohol is generally acceptable but alcohol potentiates the hypotensive and CNS-depressant effects. Stand up slowly after drinking. Alcohol is also a common migraine trigger, so reducing intake often improves migraine frequency independently.
How do I stop Inderal LA?
Taper over 1-2 weeks. Abrupt discontinuation of a beta-blocker can cause rebound tachycardia and — in patients with any cardiovascular disease — precipitate angina or MI. Migraine itself may also flare on abrupt stop.
Is Inderal LA better than Inderal IR?
Inderal LA (long-acting) gives once-daily dosing with smoother plasma levels — better tolerability and adherence. Preferred over IR for migraine prevention and hypertension in most cases. Inderal IR remains useful when dose flexibility matters (situational performance-anxiety use, thyrotoxicosis symptom control).
Can I take Inderal LA with a triptan?
Yes. Propranolol is a preventive, triptans are abortive. They work through different mechanisms. Special note: rizatriptan levels rise ~70% when combined with propranolol — use rizatriptan at 5 mg maximum (not 10 mg) when also on propranolol. Sumatriptan en zolmitriptan do not have this interaction.
Where can I buy Inderal LA online?
You can buy Inderal LA (propranolol 40 mg long-acting (LA / SR) capsule, 30-180 tablets) from MedsBase with discreet packaging and worldwide shipping.
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- Rizact — Rizatriptan (Cipla)
- Sumitop — Sumatriptan 25/50/100 mg
- Browse all Anti-Migraine Treatments
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| Sterkte | 40 mg |
|---|---|
| Hoeveelheid | 30 Tabletten, 60 Tabletten, 90 Tabletten, 180 Tabletten |
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