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Propranolol can, in certain patients, be used alone or as an initial agent in patients in whom, in the judgment of the physician, treatment should be started with a beta-blocker rather than a diuretic. Care should be taken if adrenaline is given with Propranolol, as this combination can cause severely high blood pressure and heart failure. Inderal is usually used in combination with clonidine to lower blood pressure, and the velocity and extent of myocardial contraction. Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and the velocity and extent of myocardial contraction.
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