Trade Names:Inderal- Injection 1 mg/mL
Trade Names:Inderal LA- Capsules, ER 60 mg- Capsules, ER 80 mg- Capsules, ER 120 mg- Capsules, ER 160 mg
Trade Names:InnoPran XL- Capsules, ER 80 mg- Capsules, ER 120 mg
Trade Names:Propranolol Hydrochloride- Tablets 10 mg- Tablets 20 mg- Tablets 40 mg- Tablets 60 mg- Tablets 80 mg
Trade Names:Propranolol- Solution, oral 4 mg/mL- Solution, oral 8 mg/mLApo-Propranolol (Canada)
Nonselective, beta-adrenergic receptor blocking agent, primarily affecting the CV system (eg, decreased heart rate, decreased cardiac contractility, decreased BP) and lungs (promotes bronchospasm).
Well absorbed from the GI tract. Extent of absorption is less than 90%. Bioavailability is approximately 25% (immediate-release). Food enhances bioavailability for immediate-release and increases T max from 11.5 to 15.4 h for InnoPran XL . T max is 1 to 4 h (immediate-release) and 6 h (ER).
Protein binding is 90%. Readily enters the CNS. Crosses the placenta; distributed into breast-milk.
Significant first-pass hepatic metabolism through 3 primary routes and produces 4 major metabolites.
Urine is less than 1% excreted unchanged. Plasma half-life is 3 to 6 h (immediate-release) and about 10 h (ER). Most metabolites appear in the urine
Angina pectoris caused by coronary atherosclerosis (excluding InnoPran XL ); cardiac arrhythmias (excluding ER); essential tremor (excluding ER); hypertension; hypertrophic subaortic stenosis (excluding InnoPran XL ); migraine prophylaxis (excluding InnoPran XL ); MI (excluding ER); pheochromocytoma (excluding ER).IV
Hypersensitivity to propranolol; greater than first-degree heart block; sinus bradycardia; cardiogenic shock; bronchial asthma.
PO 80 to 320 mg/day in 2 to 4 divided doses or 80 mg/day of sustained-release medication (max, 320 mg/day).ArrythmiasAdults
PO 10 to 30 mg (immediate-release) 3 to 4 times daily before meals and at bedtime.Adults
IV 1 to 3 mg at rate of 1 mg/min; may repeat after 2 min; give subsequent doses every 4 h.Essential TremorAdults
PO The initial dosage is 40 mg of immediate-release twice daily; titrate to response. Max dosage is 320 mg/day in divided doses.HypertensionAdults
PO The initial dosage is 40 mg twice daily initially (or 80 mg/day of ER); titrate to response. The usual maintenance dosage is 120 to 240 mg/day in 2 to 3 divided doses or 120 to 160 mg/day of ER. For InnoPran XL , initial dosage is 80 mg once daily at bedtime (approximately 10 pm); titrate 120 mg/day. Do not exceed 640 mg/day.Children
PO 0.5 mg/kg twice daily; titrate every 3 to 5 days to max dose of 16 mg/kg/day.Hypertrophic Subaortic StenosisAdults
PO 20 to 40 mg 3 to 4 times daily before meals and at bedtime or 80 to 160 mg of sustained-release once daily.Migraine PreventionAdults
PO 80 mg in divided doses daily or once daily (sustained-release); titrate to response (max dosage, 240 mg/day); discontinue after 6 wk if no response.MIAdults
PO 40 mg (immediate-release) 3 times per day as initial dose; after 1 mo, titrate to 60 mg to 80 mg 3 times daily as tolerated. Maintenance dosage is 180 to 240 mg/day in divided doses.PheochromocytomaAdults
PO 60 mg/day in divided doses for 3 days prior to surgery, given with alpha-blocker. 30 mg/day in divided doses, given with alpha-blocker for management of inoperable tumor.
Immediate-release and ER doseforms may not be interchangeable on a mg to mg basis. Be prepared to retitrate dose to maintain desired therapeutic effect.
Store at 68° to 77°F. Protect from light, freezing, moisture, or excessive heat.
Increased risk of hypotension, especially in patients with acute MI; bronchial hyperreactivity may be increased.Alcohol
Pharmacologic and therapeutic effects are difficult to predict. Reported increased plasma concentrations, and increased and decreased clearance of propranolol.Aluminum salts (eg, aluminum carbonate, aluminum hydroxide)
Greatly reduces GI absorption of propranolol.Antiarrhythmic agents (eg, amiodarone, propafenone, quinidine)
Inhibition of propranolol metabolism; may increase pharmacologic and toxic effects. Amiodarone has additive negative chronotropic properties to those of propranolol.Barbiturates (eg, pentobarbital, phenobarbital, primidone), levothyroxine, phenytoin, rifampin
May result in decreased effects of propranolol.Bile acid sequestrants (eg, cholestyramine, colestipol)
GI absorption of propranolol may be decreased.Calcium channel blockers (eg, diltiazem, nicardipine, nifedipine, verapamil), flecainide, haloperidol, phenothiazines (eg, chlorpromazine, thioridazine), selective 5-HT 1 receptor antagonists (eg, rizatriptan, zolmitriptan), sulfonylureas (eg, chlorpropamide, tolbutamide)
Increased serum levels and effects of both drugs.Cigarette smoking
Increases clearance of propranolol by as much as 100%.Cimetidine, ciprofloxacin, diphenhydramine, fluconazole, hydralazine, imipramine, isoniazid, methimazole, propafenone, propylthiouracil, ritonavir, SSRIs (eg, fluoxetine, fluvoxamine, paroxetine), teniposide, terbinafine, zileuton
Increased effects of propranolol.Clonidine
Attenuation or reversal of antihypertensive effect; potentially life-threatening increases in BP, especially on withdrawal.Diazepam
Inhibition of diazepam metabolism.Digoxin
Progressive bradycardia may occur.Dobutamine, isoproterenol
May reverse effects of propranolol.Epinephrine
Initial hypertensive episode followed by bradycardia.Ergot derivatives (eg, dihydroergotamine, ergotamine)
Peripheral ischemia, manifested by cold extremities and possible gangrene.HMG-CoA reductase inhibitors (eg, lovastatin, pravastatin)
Plasma concentrations may be increased.Insulin
Prolonged hypoglycemia with masking of symptoms.Lidocaine (IV)
Increased lidocaine levels, leading to toxicity.MAOIs, tricyclic antidepressants
Coadministration may exacerbate the hypotensive effects of MAOIs.NSAIDs (eg, ibuprofen, indomethacin, naproxen), salicylates (eg, aspirin)
Some agents may impair antihypertensive effect.Prazosin
Increased orthostatic hypotension.Reserpine
Hypotension, marked bradycardia, vertigo, syncopal attacks, and orthostatic hypotension may result from excessive reduction of resting sympathetic nervous activity caused by reserpine-induced catecholamine depletion.Sympathomimetics (eg, albuterol, formoterol)
Pharmacologic effects may be antagonized by propranolol resulting in bronchospasm.Theophylline
Reduced elimination of theophylline; propranolol concentrations may be increased.Warfarin
The anticoagulant effect of warfarin may be increased.
May interfere with glaucoma screening tests.
Arterial insufficiency usually of the Raynaud type, bradycardia, CHF, edema, hypotension, intensification of AV block.
Dizziness, fatigue (7%); decreased performance on neuropsychometric tests, disorientation, emotional lability, hallucinations, insomnia, lassitude, lethargy, light-headedness, mental depression progressing to catatonia, paraesthesia of the hands, short-term memory loss, slightly clouded sensorium, vivid dreams, weakness.
Alopecia, erythema multiforme, exfoliative dermatitis, psoriasiform rashes, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria.
Dry eyes, visual disturbances.
Abdominal cramping, constipation, diarrhea, epigastric distress, ischemic colitis, mesenteric arterial thrombosis, nausea, vomiting.
Agranulocytosis, nonthrombocytopenic and thrombocytopenic purpura.
Agranulocytosis, anaphylactic/anaphylactoid reactions, erythematous rash, fever combined with aching and sore throat, laryngospasm, pharyngitis, respiratory distress.
Elevated levels of serum potassium, transaminases, and alkaline phosphatase.
Bronchospasm, difficulty breathing, dyspnea, wheezing.
Peyronie disease, SLE-like reactions, systemic lupus erythematosus.
In patients with angina pectoris or coronary artery disease (CAD), abrupt withdrawal may cause exacerbation of angina, occurrence of MI, and ventricular arrhythmias. Monitor patients closely. Because CAD is common and unrecognized, it may be prudent not to discontinue beta-blocker therapy abruptly in patients treated only for hypertension. When discontinuance is planned, the dosage should be gradually reduced over at least a few weeks.
Category C (first trimester); Category D (second and third trimesters).
Excreted in breast milk.
Safety and efficacy not established.
Use with caution because of the greater frequency of decreased hepatic, renal, or cardiac function, and concomitant diseases or other drug therapy.
Use with caution.
A beta-blocker withdrawal syndrome (eg, hypertension, tachycardia, anxiety, angina, MI) may occur 1 to 2 wk after sudden discontinuation of systemic beta-blockers. If possible, gradually withdraw therapy over 1 to 2 wk.
Deaths have occurred; aggressive therapy may be required.
Avoid in patients with overt CHF; administer cautiously in patients whose CHF is controlled by digitalis and diuretics.
May mask symptoms of hypoglycemia (eg, tachycardia, BP changes). May potentiate insulin-induced hypoglycemia.
Not indicated for treatment of hypertensive emergencies.
May cause reduction of IOP.
Withdrawal of treatment prior to surgery is controversial; it is thought that continued treatment may augment the risk of general anesthesia and surgical procedures.
Give drug with caution in patients with bronchospastic diseases.
May precipitate or aggravate symptoms of arterial insufficiency.
May mask clinical signs (eg, tachycardia) of developing or continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm.
In several cases, tachycardia was replaced by severe bradycardia requiring treatment with a pacemaker.
Bradycardia, depressed myocardial function, hypotension.
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