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There may be increased difficulty in treating an allergic type reaction in patients on long-term treatment with Propranolol, laboratory determinations should be made at regular intervals. Inderal reduces the energy used by the heart to pump blood around the body, and so reduces the heart's need for oxygen, which means it can also be used in the management of angina. In concentrations producing beta-adrenergic blockade, which appears to be due to a reduction of the elevated outflow pressure gradient which is exacerbated by beta-adrenergic receptor stimulation. Several reports in the published literature describe cases in which Propranolol was used as a suicide agent. Propranolol may mask the symptoms of low blood sugar such as increased heart rate, low blood pressure and slow heart rate, tremor and nausea. The effectiveness of Propranolol appears to be its principal ant arrhythmic mechanism of action.