Propranolol for SVT

Posted by mitchellynn @mitchellynn, Apr 11 6:53pm

I have SVT once or twice a year. I have been unable to reset my heart rate when I enter an episode (180-240) without emergency medical assistance. We have some flights coming up and I'm having anxiety over having an episode on the airplane. My primary care physician prescribed Propranolol in case of an episode on the plane. It appears from the leaflet that she could be accurate that it will reduce my heart rate. Has anyone used this? My cardiology appointment is after my first flight so I'm hoping she's right.

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kaka50 | @kaka50 | Apr 11 10:03pm

Works well to slow heart rate. Dose and frequency dependent.

gloaming | @gloaming | Apr 11 10:44pm

It's a beta-blocker like metoprolol. It blocks the effects of adrenalin in myocytes and adrenalin's effects on the two signaling nodes, but also in the kidneys:
https://cvpharmacology.com/cardioinhibitory/beta-blockers
"...Beta-blockers bind to beta-adrenoceptors in cardiac nodal tissue, the conducting system, and contracting myocytes. The heart has both β1 and β2 adrenoceptors, although the predominant receptor type in number and function is β1. These receptors primarily bind norepinephrine that is released from sympathetic adrenergic nerves. Additionally, they bind to norepinephrine and epinephrine that circulate in the blood. Beta-blockers prevent the normal ligand (norepinephrine or epinephrine) from binding to the beta-adrenoceptor by competing for the binding site...'

For whatever reason unique to you and your cardiologist's experience and teaching, you have been issued propranolol. The prescribing person feels that you need only take it when the need is urgent or acute, and feels that you can make the decision safely on your own account. I would run with that. Just be sure that, if you have travel insurance on which to draw, that the insurer knows this is a pre-existing condition. They will reject claims for a pre-existing condition if you fall ill with it while they are responsible for insuring you.

psyche | @psyche | Apr 12 10:05am

You might want to look into the recently approved nasal spray for stopping an SVT episode. The drug is Etripamil (Cardamyst). I’m not sure of availability and insurance coverage. It was approved December 2025 I believe. Some cardiologists haven’t heard of it but you can look it up online.

RN | @doclarrea | Apr 12 11:49am

Hello. I have SVT. Had a couple of episodes and had to go to emergencies and was given amiofarone IV successfully. This happened while I was on propafenone 150 mg twice daily taken 12 hours apart and bisoprolol 2.5 mg daily. I’m now on bisoprolol 5 mg daily, and propafenone 150mg twice daily. Propanolol and bisoprolol are for blood pressure control, but bisoprolol is mostly indicated for heart rate control. Now this two medications are in a class of drug called Beta blockers which are indicated for hypertension and rate control. As a general rule Beta blockers names end in “lol” such as propanolol, atenolol, bisoprolol, among others. Now for me the combination of propafenone and bisoprolol have been effective in controlling episodes of SVT for me. It has been 2 years since I had a SVT episode. Good luck and Godspeed.