PROPRANOLOL HYDROCHLORIDE

Indications & Dose:

Thyrotoxicosis (adjunct) l

• BY MOUTH

Adult: 10–40 mg 3–4 times a day

Thyrotoxic crisis l

• 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 course

Hypertension l

• 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 MOUTH

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 alphablocker) in preparation for surgery l

• BY MOUTH

Adult: 60 mg daily for 3 days before surgery

Phaeochromocytoma (only with an alphablocker) in patients unsuitable for surgery l

• BY MOUTH

Adult: 30 mg daily

Angina l

• BY MOUTH

Adult: Initially 40 mg 2–3 times a day; maintenance 120–240 mg daily

Hypertrophic cardiomyopathy Anxiety tachycardia l

• BY MOUTH

Adult: 10–40 mg 3–4 times a day

Anxiety with symptoms such as palpitation, sweating and tremor l

• 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 l

• BY MOUTH

Adult: Initially 40 mg 2–3 times a day; maintenance 80–160 mg daily

Migraine prophylaxis

• BY MOUTH

Adult: 80–240 mg daily in divided doses

Arrhythmias  

• BY MOUTH

Adult: 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 (sweatingexcepted)
RESP: Bronchospasm, dyspnea, wheezing
SKIN: Alopecia, pruritus, rash

Cautions:

Precautions:

nesthesia/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 (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 of propranolol

Beta-agonists: Antagonistic effects

Calcium channel Mockers: Increased concentrations of propranolol; increased bioBrands Available with Cost of nifedipine
Chlorpromazine: 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 Cost

Cimetidine, etintidine, fluoxetine, propoxyphene, 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 bioBrands 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

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: