PROPRANOLOL (INDERAL)

PROPRANOLOL

Chemical Class: Beta adrenergic blocker, nonselective

Therapeutic Class: Antianginal; antiarrthythmic, class II ; antiglaucoma agent; antihypertensive; antimigraine agent

BRNAD NAMES	MANUFACTURER	DOSES FORM	GENERIC
Betablock	PPP	Tab 10mg, 40mg	Propranolol
Betanol	Rakaposhi	Tab 10mg, 40mg	Propranolol
Cardioset	Lisko	Tab 10mg, 40mg	Propranolol
Cara prop	Caraway pharma	Tab 10mg, 40mg	Propranolol
Cardinol	Icon pharma	Tab 10mg, 40mg	Propranolol
Hyporide	Usawaq	Tab 10mg,	Propranolol
Hyporide LA	Usawa	Tab 40mg	Propranolol
Hyprol	Munawar	Tab 10mg, 40mg	Propranolol
Inderal	ICI Pakistan	Tab 10mg, 40mg	Propranolol
Neprolol	Nawabsons	Tab 40mg	Propranolol
Oprinol	Abbott	Tab 10mg, 40mg	Propranolol
Prodral	Regent	Tab 10mg, 40mg	Propranolol

 

INDICATIONS: Migraine headache, hypertension, postmyocardial infarction, supraventricular  arrhythmias (atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia), ventricular arrhythmias, aggressive behavior," angina pectoris, anxiety,* cataract extraction prophylaxis,* congestive heart failure,* hyperthyroidism,* neuroleptic-induced akathisia,* retinal detachment,* tremor, hypertrophic obstructive cardiomyopathy, hypertrophic subaortic stenosis, pheochromocytoma, portal hypertension, Wolff-Parkinson-White syndrome, Alzheimer's disease,* ascites,* carcinoid syndrome,* resistant giardiasis,* menopausal symptoms,* mitral valve prolapse,* priapism secondary to chronic antipsychotic medications, restless leg syndrome, schizophrenia,* tardive dyskinesia,* tetanus,* Tourette's syndrome,* withdrawal syndromes* & Glaucoma,

CONTRAINDICATIONS: Bronchial asthma, cardiogenic shock, overt cardiac failure, 2nd and 3rd degree AV block, severe sinus bradycardia

DOSE

Oral: Adults

Initially:40mg twice daily or 80mg. once daily. Usual Range: 120-320mg per day given 2-3 times daily. Max: 640mg daily SR-120-160mg. once daily. Hypertention: 160mg daily, increasing if necessary in 80mg increaments untill adequate response is achieved.

Thyrotoxicosis: 80mg or 160mg daily, max: 240mg daily

Angina: 80-160mg in 2-4 div. doses max;240mg daily, or 80mg S.R. once daily. Range 160mg S.R. once daily.

M.I.: 180-240mg daily in 3-4 div. doses.

Arrhythmias/ cardiomyopathy: 10-40mg 3-4 times daily before meals and at bed time.

Migraine: Initially 40mg 2-3 times daily, increasing at weekly intervals to 80-160mg daily.. Prophylaxis after myocardial infarction: 40mg 4 times daily for 2-3 days followed by 80mg 2 times daily, beginning 5-21 days after infarction.

Anxiolytics: Situational; 40-80mg daily, Generalised: 40-160mg daily.

Hypertrophic subaortic stenosis: PO 20-40 mg tid-qid (L-A 80-160 mg qd)

Pheochromocytoma: PO 30 mg/day in divided doses (in conjunction with cc-adrenergic blocking agent)

Migraine prophylaxis: PO 80 mg/day in divided doses (L-A 80 mg qd) initially, increase to optimal

prophylaxis, usual range 160-240 mg/day Essential tremor: PO 40 mg bid initially, usual range120-320 mg/day divided tid

Gastrointestinal bleeding: PO 40 to 360 mg qd titrated to reduce the resting heart rate by 25% Thyroid storm: IV I mg/min to max 10 mg; repeat in 4-f hr, PO 40 to 80 mg of h, following IV

By intravenous injection: arrhythmias and thyroxtoxic crisis, 1mg over 1 minute; if necessary repeat at 2 minute intervals; max. 10mg (5mg in anaesthesia).

Note: Excessive bradycardia can be countered with intra-venous injection of atrophine sulphate 0.6 2.4mg in divided doses of 600 micrograms for overdosage

Children

Initially 1mg/kg/24 hrs. divided every 6 hrs. Increase gradually upto 5mg/kg/24 hrs every 6 hrs. Arrhythmias:0.25-0.5-/kg/24 hrs. divided every 6-8 hours.

Migraine: 1mg/kg/24 initially div. every 6 hours and progressively increase if needed to 5mg/kg/24 hours.

Note: Combinations with diuretic or hydrallazine are indicated because propranolol blocks physiologic compensatory mechanisms such as adrenergic inotropic and chronotropic responses, as well as renin activity.

PRECAUTIONS: Anesthesia/surgery (myocardial depression), avoid abrupt withdrawal, bronchospastic airways, congestive heart failure, diabetes mellitus, hyperthyroidism/ thyrotoxicosis (atenolol, unlike propranolol, does not decrease T3 levels), concurrent clonidine (discontinue atenolol several days prior to withdrawal of clonidine), peripheral vascular disease, renal disease.

Pregnancy & breast-feeding: Use with caution.

Old age: May be used.

SIDE EFFECTS:

CNS: Depression, dizziness, drowsiness, fatigue, hallucinations, insomnia, lethargy, memory loss, mental changes, strange dreams

CV: Bradycardia, CHF, cold extremities, postural hypotension, profound hypotension, 2nd or 3rd degree heart block

EENT: Dry, burning eyes; sore throat; visual disturbances

GI: Diarrhea, dry mouth, elevated LFTS, ischemic colitis, mesenteric arterial thrombosis, nausea, vomiting

GU: Impotence, sexual dysfunction HEME: Agranulocytosis, thrombocytopenia

METAB: Hyperglycemia, hyperlipidemia (increase TG, total cholesterol, LDL; decrease HDL), masked hypoglycemic response to insulin (sweating excepted)

RESP: Bronchospasm, dyspnea, wheezing

SKIN: Alopecia, pruritus, rash

INTERACTIONS

Drugs

alfa-1 adrenergic blockers: Potential enhanced first dose response (marked initial drop in blood pressure), particularly on standing (especially prazocin)

Amiodarone: Bradycardia, cardiac arrest, ventricular dysrhythmia shortly after initiation of beta-blocker Antidiabetic: Masked symptoms of hypoglycemia, prolonged recovery of normoglycemia Antipyrine: Increased antipyrine concentrations Barbiturates, rifampin: Reduced concentrations propranolol Beta-agonists: Antagonistic effects of Calcium channel. Mockers: Increased concentrations of propranolol; increased bioBrands Available with Cost of nifedipine effects and Chlorpromazine: Additive hypotensivegrand mal seizures; chlorpromazine decreases the clearance of oral propranolol by 25% to 32%, resulting in increased propranolol bio Brands etintidine, fluoxetine, propoxyphene,Available with Cost Cimetidine,propafenone, quinidine, quinolones: Increased propranolol concentrations Clonidine, guanahenz,

guanfacine: Exacerbation of hypertension upon withdrawal of clonidine Cocaine: Potentiation of cocaine induced coronary vasospasm

Contrast media: Increased risk anaphylaxis Digitalis glycosides: Increased digoxin concentrations Dihydroergotamine, ergotamine: May result in excessive vasoconstriction

Fluvoxamine: Increased propranolol serum concentrations; increased risk of bradycardia and hypotension Epinephrine: Enhanced pressor response to epinephrine

Flecainide: Increased propranolol and flecainide concentrations; additive negative inotropic effects

Hydralazine: Increases oral bio Brands Available with Cost of propranolol (high clearance and lipophilic PB-blockers) increasing risk of adverse effects Hydrochlorothiazide: Exaggerated hyperglycemic response Lidocaine: Increased lidocaine concentrations

Local anesthetics: Enhanced sympathomimetic side effects of epinephrine-containing local anesthetics Neostigmine, physostigmine, tacrine: Additive bradycardia

Neuroleptics: Increased plasma concentrations of both drugs

NSAIDs: Reduced hypotensive effect of propranolol Phenylephrine: Predisposition to acute hypertensive episodes

Theophylline: Increased theophylline concentrations; antagonistic pharmacodynamic effects

Labs

• False increase: Bilirubin