Propranolol

Also known by these names

  • Angilol
  • Ciplar
  • Inderal
  • Syprol
  • Hemangeol (special oral formulation for the treatment of infantile hemangioma)

Key Points

  • Propranolol is a drug approved by the FDA for several diseases and conditions.
  • It’s used off-label in cancer treatment.
  • BCCT sees propranolol as an interesting and promising drug and is impressed with the early evidence to support re-purposing its use in cancer.
  • Laboratory and clinical effects of propranolol in cancer treatment include inhibiting cancer cell proliferation, decreasing cancer cell migration and invasion, increasing cancer cell death, and inhibiting the growth of blood vessels to feed tumors.
  • Propranolol shows promise in enhancing the effectiveness of conventional treatments, boosting the immune system’s cancer-fighting mechanisms, reducing metastases, extending survival, and reducing symptoms.
  • Propranolol may also reduce stress and its cancer-promoting effects.
  • Propranolol is generally safe and usable long-term, although several cautions and interactions are noted.

Propranolol is a beta blocker (non-selective beta-adrenergic receptor antagonist) being used off-label for cancer treatment by some integrative oncologists. Off-label use is a drug’s application for a disease or condition that has not yet received FDA approval. Every US state allows for drugs to be used off-label as long as there is enough evidence to support its use.

Most of the human evidence in cancer to date is from case reports, but  a number of clinical trials for several cancers are in progress.

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Treating the Cancer

Working against cancer growth or spread, improving survival, or working with other treatments or therapies to improve their anticancer action

Clinical Evidence

An extensive review in 2016 found these effects:2

 

  • Exhibiting anti-metastatic effects in breast and ovarian cancers: evidence particularly indicates that propranolol works at multiple points in the metastatic cascade, especially in the setting of the post-surgical wound response (see more at right).
  • Propranolol may provide beneficial effects of beta blockade in reducing the effects of psychological stress on primary tumor growth.

 

Extended Survival

Studies Finding Extended Survival

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Studies Not Finding Extended Survival

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Lab and Animal Evidence

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Anticancer Activity

In lab, animal and human studies and in clinical data, evidence suggests that propranolol has potent anticancer effects. An extensive review in 2016 found these effects:17

  • Interfering with cancer cell growth and invasion, reducing proliferation and increasing apoptosis (programmed cell death)
  • Enhancing the immune system’s cancer-fighting mechanisms, such as increasing the macrophages’ ability to consume cancer cells (phagocytosis)
  • Reducing tumor angiogenesis (development of new blood vessels)

Propranolol in the Perioperative Setting

A very interesting and promising use of propranolol is its use in the perioperative setting. The wound-healing response after surgical incision starts a cascade of inflammatory events that suppress cell-mediated immunity and increase signals for angiogenesis.

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Enhancer of Conventional Treatments

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Managing Side Effects and Promoting Wellness

Managing or relieving side effects or symptoms, reducing treatment toxicity, supporting quality of life or promoting general well-being

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Reducing Risk

Reducing the risk of developing cancer or the risk of recurrence

Clinical Evidence

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Access

Propranolol is available with a prescription in both standard and extended-release tablets, as an oral solution and as an IV injection. It is now available globally in generic form. Estimated cash price for sixty 40-mg tablets ranges from about $40 to $75. Significant discounts are available using prescription drug discount apps such as GoodRX.

Cautions

Propranolol generally has low toxicity and can be used for many years in long-term treatment.28 However, some cautions should be heeded:

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Integrative Plans, Protocols and Medical Systems

For more information about plans and protocols, see our Integrative Plans and Protocols page.

Commentary

BCCT advisor Dwight McKee, MD, an integrative oncologist and co-author of After Cancer Care, February 20, 2017:

“I've advocated for propranolol (which seems to work the best compared with more 'modern' beta blockers), implemented as soon as possible after diagnosis, since a new diagnosis of cancer is a highly stressful event, and we have both experimental and clinical evidence that stress acts as a tumor promoter, although it doesn't appear to be involved in the initiation of malignancy.

I have recommended propranolol for anyone diagnosed with cancer who is experiencing high levels of stress.

Dwight McKee, MD

I have recommended propranolol for anyone diagnosed with cancer who is experiencing high levels of stress from their diagnosis, and all of the logistics involved in seeing different doctors, and making treatment decisions often with a sense of time pressure (the psychological emergency of a cancer diagnosis). It takes time for people to learn and become proficient with stress management techniques, so I see propranolol as “ training wheels” until they are in calmer waters and well on their way to practicing an “ anticancer lifestyle”, which includes learning and practicing stress management techniques.

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Non-cancer Uses of Propranolol

Propranolol is approved by the FDA and commonly used to treat the following:33

  • Heart disease: angina, cardiac arrhythmia, atrial fibrillation, survival of acute myocardial infarction (heart attack), hypertrophic subaortic stenosis, hypertension
  • Essential tremor in the head, arms and legs
  • Prevention of migraine or variceal bleeding

Propranolol is also used off-label for a number of conditions including these:34

  • Aggression associated with brain injury
  • Anxiety
  • Hemorrhage
  • Sepsis

BCCT has not reviewed the effectiveness of this therapy for non-cancer uses.

Written by Laura Pole, RN, MSN, OCNS, and Nancy Hepp, MS; most recent update January 14, 2019.

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