Propranolol
Betablocking Agent · Non-cardioselective beta-blocker
Indications
Management of hypertension, angina pectoris. Prophylaxis after myocardial infarction, cardiac dysrhythmias, migraine prophylaxis, essential tremor, anxiety, prophylaxis of upper gastrointestinal bleeding in patients with portal hypertension and oesophageal varices.
Dosage
Adults: ORAL: Adjust dosage according to response in divided daily doses. Hypertension: Usually 160-320 mg daily. Arrhythmias: 10-40 mg three to four times daily. Angina pectoris: Usually 120-240 mg daily. Anxiety, migraine, essential tremor: Usually 80-160 mg daily. Prophylaxis of variceal bleeding in portal hypertension: Titrate to 25% reduction in resting heart rate, 80-320 mg daily. Post myocardial infarction: Begin 5-21 days post infarct, 40 mg four times daily for 2-3 days, then 80 mg twice daily or 160 mg once daily. Children: Not recommended. Adults: INJECTION: By IV: Arrhythmias and thyrotoxic crises: 1 mg over 1 min, if necessary repeat at 2 min intervals; max total dose 10 mg (5 mg in anaesthesia). Children: Not recommended.
Administration
IV administration should not exceed 1 mg/min. IV dose is much smaller than oral dose. Compatibility: Stable in NS, D5W, ½ NS, LR. Y-site administration: Drug to Drug IV Incompatibility: Amphotericin B cholesteryl sulphate complex, diazoxide. In syringe: Incompatible with HCO3. When admixed: Incompatible with HCO3. Stability: Store at approximately 25°C (77°F). Protect from light, freezing and excessive heat. Discard unused portion. Retain in carton until time of use.
Adverse Effects
Cardiovascular effects including bradycardia, postural hypotension. Rarely, heart failure, increased AV block, cardiac arrhythmias. Raynaud's phenomenon cold extremities, sexual dysfunction. GI, sleep and CNS disturbances. Dyspnoea rarely, bronchospasm. Skin reactions, withdraw if unexplained dry eyes or rash. Fatigue, paraesthesia, peripheral neuropathy, arthralgia, myopathy, altered blood sugar, haematology and lipid levels.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Caution advised or effect undetermined. Contraindications: 2nd or 3rd degree AV block (without pacemaker), severe bradycardia, sick sinus syndrome, uncontrolled heart failure, cardiogenic shock, severe peripheral arterial disease, hypotension, metabolic acidosis, untreated pheochromocytoma, severe asthma or COPD, patients at risk of hypoglycaemia, Prinzmetal's angina, history of bronchospasm. Precautions: 1st degree AV block. Heart failure (avoid if uncontrolled). Peripheral arterial circulatory disorders (avoid if severe), Myasthaenia gravis. Ischaemic heart disease, withdraw gradually. History of bronchospasm. Diabetes, hyperthyroidism, renal or hepatic impairment, psoriasis. Elderly. Consider withdrawal before elective surgery. Anaphylaxis risk due to increased sensitivity to allergens. Always withdraw gradually over period of 1-2 weeks.
Interactions
Ca++ antagonists. Antihypertensives including centrally acting agents (e.g. clonidine), antiarrhythmics, antipsychotics. TCADs, MAOIs, fluvoxamine, barbiturates, cardiac glycosides, sympathomimetics, cimetidine, hydralazine, rifampicin, NSAIDs, ergot derivatives, erythromycin, anaesthetics, diuretics, digoxin, xanthines, insulin/oral hypoglycaemics, antimalarials, moxisylyte, iodinated contrast media, baclofen, levothyroxine, alcohol, corticosteroids, rizatriptan, muscle relaxants, contraceptives, parasympathomimetics, fingolimod, ampicillin.
Advice to Patient
Take with or without meals, as advised. Do not skip medication, stop medication abruptly or change dosage without consulting prescriber. Tablets may be crushed and taken with liquid. Swallow whole, do not chew or crush long-acting forms. Take at the same time each day. Contact prescriber if there is unusual swelling of extremities, difficulty in respiration, unrelieved cough, unusual weight gain, shortness of breath, cold extremities, constant diarrhoea, confusion, hallucinations, headache, nervousness or lack of improvement. If you stop smoking, inform prescriber because dosage may need adjustments. Change position slowly. If you have diabetes, regularly get checked blood glucose level and urine.
Pharmacokinetics
Onset of action: Beta-blockade: Oral: 1-2 hrs. Peak effect: Hypertension: A few days to several wks. Duration: Immediate release: 6-12 hrs. Extended release formulations: Approx. 24-27 hrs. Absorption: Oral: Rapid and complete. Metabolism: Extensive first-pass effect, hepatically metabolized. Bioavailability: Approx. 25% reaches systemic circulation due to high first-pass metabolism. Half-life elimination: Neonates: Possible increased half-life. Infants (age 35-150 days): Median 3.5 hrs. Children: 3.9-6.4 hrs. Adults: Immediate release formulation: 3-6 hrs. Extended-release formulations: 8-10 hrs. Time to peak: Immediate release: Adults: 1-4 hrs. Infants: =2 hrs. Extended release cap: 12-14 hrs. Long acting cap: 6 hrs. Excretion: Primarily urine.
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
Always consult a pharmacist or doctor.