QUESTO HUB
QUESTO HEALTHCARE ECOSYSTEM Clinical Pharmacology & Maternal-Fetal Drug Safety Center
Document ID: Q-PREG-7408D852
Date Issued: October 07, 2026
Regulatory Base: US FDA (PLLR 8.1/8.2) & NIH LactMed®
Verified Portal: questocomm.com/pregnancy-safety/propranolol
OFFICIAL CLINICAL MONOGRAPH

PROPRANOLOL

Evidence-Based Medication Safety Profile for Maternal & Lactation Practice
Pregnancy & Lactation Center
Clinical Monograph Prescription / OTC (Propranolol Hydrochloride)
Evidence Available

Propranolol

UNII Code F8A3652H1V
RxNorm CUI 856448
Prescribing & Clinical Reference: Compiled from official regulatory labeling (US FDA PLLR, NIH LactMed®, EMA). Clinical decisions during pregnancy and lactation require individualized patient assessment and physician consultation.

1. Pregnancy Evidence & Regulatory Labeling

FDA Pregnancy and Lactation Labeling Rule (PLLR 8.1) & EMA SmPC Section 4.6

Clinical Risk Summary

Pregnancy In a series of reproductive and developmental toxicology studies, propranolol hydrochloride was given to rats by gavage or in the diet throughout pregnancy and lactation. At doses of 150 mg/kg/day, but not at doses of 80 mg/kg/day (equivalent to the MRHD on a body surface area basis), treatment was associated with embryotoxicity (reduced litter size and increased resorption rates) as well as neonatal toxicity (deaths). Propranolol hydrochloride also was administered (in the feed) to rabbits (throughout pregnancy and lactation) at doses as high as 150 mg/kg/day (about 5 times the maximum recommended human oral daily dose). No evidence of embryo or neonatal toxicity was noted. There are no adequate and well-controlled studies in pregnant women. Intrauterine growth retardation, small placentas, and congenital abnormalities have been reported in neonates whose mothers received propranolol during pregnancy. Neonates whose mothers received propranolol at parturition have exhibited bradycardia, hypoglycemia, and/or respiratory depression. Adequate facilities for monitoring such infants at birth should be available. Propranolol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

2. Lactation & Breastfeeding Safety

NIH / NLM LactMed® Database & FDA Labeling Section 8.2

Summary of Use during Lactation

Nursing Mothers Propranolol is excreted in human milk. Caution should be exercised when propranolol is administered to a nursing woman.

Drug Levels in Breast Milk & Relative Infant Dose

Relative Infant Dose (RID) Indexed in Clinical Studies RID <10% is generally considered low by clinical guidelines.
Milk Concentration & Transport

Evaluated in human/animal pharmacokinetic models.

3. Females & Males of Reproductive Potential

FDA Labeling Section 8.3 — Pregnancy Testing, Contraception & Infertility

Pregnancy Testing

Standard pre-treatment clinical assessment as indicated.

Contraception & Washout

Review contraception duration based on drug elimination half-life.

Infertility Considerations

No significant drug-induced impairment reported in standard models.

4. Regulatory Source Provenance & Comparison

Direct attribution to official regulatory documents without synthesized consensus

Regulatory Organization Jurisdiction Document / Framework Effective Date Official Source Link
U.S. Food and Drug Administration (FDA)
FDA Prescribing Information (PLLR)
United States regulatory_label 2024-08-09 Official Record
European Medicines Agency (EMA)
EMA Summary of Product Characteristics (SmPC 4.6)
European Union regulatory_label Recent Official Record
U.S. Food and Drug Administration (FDA) FDA Prescribing Information (PLLR)
United States
Framework: regulatory_label
Effective Date: 2024-08-09
View Official Regulatory Record
European Medicines Agency (EMA) EMA Summary of Product Characteristics (SmPC 4.6)
European Union
Framework: regulatory_label
Effective Date: Recent
View Official Regulatory Record

System Notice

Confirm Action