PROPRANOLOLHYDROCHLORIDE

Indications & Dose:

Thyrotoxicosis (adjunct)BY MOUTH

Adult: 10–40 mg 3–4 times a day Thyrotoxic crisis BY INTRAVENOUS INJECTION Adult: 1 mg, to be given over 1 minute, dose may be repeated if necessary at intervals of 2 minutes, maximum total dose is 5mg in anaesthesia;maximum 10 mg per cours Hypertension BY MOUTH Adult: Initially 80 mg twice daily, dose should be increased at weekly intervals as required; maintenance 160–320 mg daily Prophylaxis of variceal bleeding in portal hypertension BY MOUT Adult: Initially 40 mg twice daily, then increased to 80 mg twice daily (max. per dose 160 mg twice daily), dose to be adjusted according to heart rate Phaeochromocytoma (only with an alpha-blocker) in preparation for surgery BY MOUTH Adult: 60 mg daily for 3 days before surgery Phaeochromocytoma (only with an alpha-blocker) in patients unsuitable for surger BY MOUTh Adult: 30 mg dail Angina BY MOUTHnAdult: Initially 40 mg 2–3 times a day; maintenance 120–240 mg daily Hypertrophic cardiomyopathyAnxiety tachycardia BY MOUTH Adult: 10–40 mg 3–4 times a day Anxiety with symptoms such as palpitation, sweating and tremor BY MOUTH Adult: 40 mg once daily, then increased if necessary to 40 mg 3 times a day Prophylaxis after myocardial infarction l BY MOUTH Adult: Initially 40 mg 4 times a day for 2–3 days, then 80 mg twice daily, start treatment 5 to 21 days after infarction Essential tremor BY MOUT Adult: Initially 40 mg 2–3 times a day; maintenance 80–160 mg dailyMigraine prophylaxis BY MOUTH Adult: 80–240 mg daily in divided doses Arrhythmias BY MOUTHAdult: 10–40 mg 3–4 times a day BY INTRAVENOUS INJECTION Adult: 1 mg, to be given over 1 minute, dose may be repeated if necessary at intervals of 2 minutes, maximum 10 mg per course (5mg in anaesthesia

Contraindications:

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

Cautions:

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.

Interaction:

Drugs

alfa-1 adrenergic blockers: Potential enhanced first dose response (marked initial drop in blood pressure), particularly on standing (especiallyprazocin)Amiodarone: Bradycardia, cardiac arrest, ventriculardysrhythmia shortly after initiation of beta-blockerAntidiabetic: Masked symptoms of hypoglycemia,prolonged recovery of normoglycemiaAntipyrine: Increased antipyrine concentrationsBarbiturates, rifampin: Reduced concentrations of propranololBeta-agonists: Antagonistic effects Calcium channel Mockers: Increased concentrations of propranolol; increased bioBrands Available with Cost of nifedipineChlorpromazine: Additive hypotensive effects and grand mal seizures; chlorpromazine decreases the clearance of oral propranolol by 25% to 32%, resulting in increased propranolol bioBrands Available with CostCimetidine, etintidine, fluoxetine, propoxyphene, propafenone, quinidine, quinolones: Increased propranolol concentrationsClonidine, guanahenz, guanfacine: Exacerbation of hypertension upon withdrawal of clonidine Cocaine: Potentiation of cocaine induced coronary vasospasContrast media: Increased risk anaphylaxisDigitalis glycosides: Increased digoxin concentrationsDihydroergotamine, ergotamine: May result in excessive vasoconstrictionFluvoxamine: Increased propranolol serum concentrations; increased risk of bradycardia and hypotensionEpinephrine: Enhanced pressor response to epinephrineFlecainide: Increased propranolol and flecainide concentrations; additive negative inotropic effects Hydralazine: Increases oral bioBrands Available with Cost of propranolol (high clearance and lipophilic PB-blockers) increasing risk of adverse effects Hydrochlorothiazide: Exaggerated hyperglycemic response Lidocaine: Increased lidocaine concentrationsLocal anesthetics: Enhanced sympathomimetic side effects of epinephrine-containing local anesthetics Neostigmine, physostigmine, tacrine: Additive bradycardia Neuroleptics: Increased plasma concentrations of both drugsNSAIDs: Reduced hypotensive effect of propranolol Phenylephrine: Predisposition to acute hypertensive episodes Theophylline: Increased theophylline concentrations; antagonistic pharmacodynamic effects

Warnings:

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Counselling:

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