Can You Drink on Propranolol?

You’re at a dinner party, and the host passes around a bottle of wine. Normally, you’d pour a glass, but tonight you hesitate — you just started taking a new medication, and you're not sure if it's safe to mix with alcohol.

Almost all of us have taken medication at one point or another, but it may not have occurred to us that alcohol could cause an interaction. Today we’re looking at a common heart medication called propranolol. It’s prescribed for a number of reasons, but it acts on the heart — and so does alcohol.

So do these two substances work together to keep your ticker ticking, or do they make a dangerous cocktail? Let’s take a look at the science and learn how to stay safe!

What Is Propranolol, and What Is It Used For?

Propranolol is a class of medication known as a beta-blocker. It works by slowing your heart rate and reducing how hard your heart has to work. Beta blockers work by blocking beta receptors in the heart — hence the name!

Beta receptors are responsible for receiving natural excitatory chemicals in our body, like adrenaline (also known as epinephrine) and norepinephrine. These chemicals are part of our body’s “fight or flight” response, which increases our heart rate, makes our heart pump harder, and raises our blood pressure. When beta receptors are blocked, our heart stays calmer and doesn’t get as excited by these chemicals.

Uses of Propranolol

Propranolol is not an emergency heart rate medication. Instead, it’s typically used in long-term management of disorders that affect the heart.

• High blood pressure. One of the main uses of propranolol is treating hypertension (a.k.a., high blood pressure) in tandem with other medications and lifestyle changes. 
• Arrhythmias. Due to its ability to regulate heart rate, propranolol is used to treat some arrhythmia (heart rhythm) conditions, such as atrial fibrillation (AFib).
• Chronic chest pain. Known as angina, chest pain can happen when the heart doesn't get enough blood. This is common after heart attacks or in people with other risk factors for narrowed arteries.
• Anxiety. Sometimes, propranolol is used to help with physical symptoms of anxiety, like a racing heart or shaking. It is typically fast-acting and does not have significant sedative effects.
• Other uses. It’s also sometimes used for preventing migraines or treating certain types of tremors.

Is Propranolol a Blood Thinner?

Because it’s commonly prescribed for those with heart conditions, it’s a common misconception that propranolol is a blood thinner when, in fact, it is not. 

Blood thinners reduce the risk of blood clots, while propranolol works on the heart's rhythm and pressure. Many people with heart conditions or hypertension are at risk of blood clots, and they may also be on blood thinners to manage this condition. However, propranolol is in a class of its own.

Chemistry of Alcohol

Much like propranolol, alcohol is a chemical that affects the body. While propranolol is used to treat medical conditions, alcohol is a chemical we choose for its temporary sedative and mood-boosting effects. Let’s look at a quick overview of alcohol’s chemical process.

Alcohol is a central nervous system depressant: it slows our body’s nerve impulses. This doesn’t just mean that everything slows down. In fact, some of these slow-downs cause other things to speed up — such as the heart.

Alcohol can cause an increase in heart rate by stimulating the release of adrenaline in the body — yes, the same thing propranolol blocks! It also increases heart rate by lowering blood pressure and interfering with the electrical signals in our heart directly.

You may be thinking, “Wow, it sounds like alcohol can help lower my blood pressure!” Not so fast. Moderate alcohol temporarily lowers blood pressure for up to 12 hours after drinking, but then raises it after that for at least 24 hours. Heart rate is also consistently increased for at least 24 hours after drinking. Binge drinking and chronic alcohol use are both associated with high blood pressure. So don’t think you can replace your alcohol with propranolol just yet.

Interactions Between Propranolol and Alcohol

When alcohol and propranolol are used together, they can interact in ways that may be harmful to your health. The interactions have different implications based on your reason for taking propranolol, and understanding each one is important for making the most informed health decisions.

• Heart rate. Propranolol slows the heart rate, but alcohol has the opposite effect by temporarily increasing it. When combined, these opposite actions can cause irregular heart rhythms or palpitations.
• Blood pressure. Alcohol initially lowers blood pressure, but hangovers, binge drinking, and chronic alcohol misuse can increase blood pressure. This fluctuation can undermine propranolol's effectiveness in managing blood pressure consistently.
• Depressant effects. Both propranolol and alcohol are depressants. When taken together, they amplify each other’s effects. Depending on dosage and the amount of alcohol consumed, this can be anywhere from annoying to dangerous — especially when driving.
• Side effects. The side effects of propranolol, such as fatigue, dizziness, and lightheadedness, can be amplified by alcohol. This can increase our risk of falls or accidents.
• Anxiety and depression. For those who take propranolol for anxiety, it’s a quick way to alleviate the increased heart rate associated with anxiety attacks or increased stress. Alcohol consumption can increase overall anxiety and even lead to depression, counteracting the medication's benefits.
• Liver function. Alcohol and propranolol are both metabolized by the liver. Excessive alcohol consumption impairs liver function, affecting how propranolol is processed in the body and potentially leading to an accumulation of the medication. This can cause increased side effects or excessive sedation.

Can I Take Propranolol During a Hangover?

We’ve discussed the potential effects of mixing alcohol and propranolol, but it’s possible you’ve already mixed these two substances and now you’re in the aftermath — the dreaded hangover. We know that alcohol causes a chemical response in our body, and we know that hangovers are our body’s response to alcohol. So how does the chemistry of hangovers affect the chemistry of propranolol?

Morning After Blues

Hangovers occur after alcohol’s effects have worn off, and they typically involve symptoms like headache, dehydration, fatigue, and anxiety. They’re caused by the chemical rebounds of alcohol’s effects on our brain chemistry, and the aftereffects of our body’s physical response to alcohol, like excessive urination and poor sleep.

Taking propranolol during a hangover can be complex. The effects and aftereffects of alcohol continue to affect your heart rate and blood pressure for at least 24 hours. The liver is still working hard to process the leftovers of alcohol metabolism, and introducing propranolol may stress it.

Hangovers stress your body (especially your cardiovascular system), potentially making the symptoms that propranolol treats more pronounced. On the other hand, some hangover symptoms, like dehydration, can be worsened by propranolol. Propranolol’s ability to lower blood pressure and heart rate could intensify feelings of dizziness or lightheadedness during a hangover.

Other Considerations

If propranolol is a regular part of your medication routine, missing a dose can be risky, especially if you're taking it for heart-related conditions. However, the added physical stress of a hangover might require a different approach. Take it easy, stay hydrated, and replenish electrolytes during a hangover. Drinking water and consuming electrolyte-rich foods or drinks can mitigate some of the dehydrating effects of both substances.

It’s also important to be honest with your healthcare provider. Tell them how much you drink and seek their personalized advice about how to balance your propranolol use with your drinking habits. If you don’t really know how much you drink, consider using the Reframe app’s drink tracker to get a clear picture.

Your overall health plays a significant role in how both propranolol and alcohol affect you. For example, propranolol can mask the signs of low blood sugar or trigger asthma attacks. Alcohol can trigger episodes of atrial fibrillation (AFib), a common condition for which propranolol is prescribed.

Tips for Managing Propranolol and Alcohol Consumption

1. Reduce alcohol consumption. If you choose to drink while taking propranolol, set limits for yourself and choose lower-alcohol options. Start slow and pay attention to how your body reacts. Consider alternating with water or a mocktail to help with hydration and rate of consumption.
2. Stay hydrated. Alcohol and propranolol are both dehydrating. Be sure to drink plenty of water before, during, and after consuming alcohol.
3. Avoid heavy drinking. It's generally safer to avoid heavy or binge drinking while taking propranolol (of course, it’s always best to avoid binge drinking!).
4. Don't skip medication for alcohol. You shouldn’t skip a dose of propranolol to drink alcohol. Missing your medication can lead to instability in your condition and is not a safe trade-off for alcohol consumption. Remember: your doctor prescribed propranolol, not alcohol!
5. Consult your doctor. Before deciding to drink alcohol while on propranolol, have a discussion with your healthcare provider. They can provide tailored advice based on your health history and current condition.
6. Plan for safety. If you're going to drink, plan for your safety in advance. Expect that some side effects may get worse and make a plan for handling them. Ask for social support and consider informing someone you trust about your situation.

The Big Picture

Using alcohol and propranolol together isn’t necessarily dangerous. It depends on a lot of factors, such as amount used, underlying health issues, reasons for taking propranolol (and their severity), and other medications you use. Ultimately, only your doctor can assess all these factors and give you the most personalized advice.

But keep this in mind: most of the conditions treated by propranolol are negatively impacted by alcohol. If you’re concerned that alcohol is interfering with your ability to manage your health, consider using the Reframe app to develop a personalized plan to quit or cut back on alcohol consumption.