Dangerous Drug: Propranolol Hydrochloride(proe pran’ oh lol)
Apo-Propranolol (CAN), Inderal, Inderal LA, InnoPran XL
PREGNANCY CATEGORY C
Drug Classes
Antianginal
Antiarrhythmic
Antihypertensive
Beta-adrenergic blocker (nonselective)
Therapeutic Actions
Competitively blocks beta-adrenergic receptors in the heart and juxtoglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues, the excitability of the heart, cardiac workload and oxygen consumption, and the release of renin and lowering BP; has membrane-stabilizing
(local anesthetic) effects that contribute to its antiarrhythmic action; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone. The mechanism by which it prevents migraine headaches is unknown.
(local anesthetic) effects that contribute to its antiarrhythmic action; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone. The mechanism by which it prevents migraine headaches is unknown.
Indications
Hypertension alone or with other drugs, especially diuretics
Angina pectoris caused by coronary atherosclerosis (not ER products)
Idiopathic hypertrophic subaortic stenosis to manage associated stress-induced angina, palpitations, and syncope
Atrial fibrillation; to control rapid ventricular rate (not ER products)
To reduce CV mortality in clinically stable patients 5–21 days after MI (not ER products)
Pheochromocytoma, an adjunctive therapy after treatment with an alpha-adrenergic blocker to manage tachycardia before or during surgery or if the pheochromocytoma is inoperable (not ER products)
Prophylaxis for migraine headache
Treatment of essential tremor, familial or hereditary (not ER products)
Unlabeled uses: Migraine prevention in children and adolescents; smoking cessation; traumatic brain injury
Contraindications and Cautions
Contraindicated with allergy to beta-blocking agents, sinus bradycardia, second- or third-degree heart block, cardiogenic shock, HF, bronchial asthma, bronchospasm, COPD, pregnancy (neonatal bradycardia, hypoglycemia, and apnea, and low birth weight with long-term use during pregnancy), lactation.
Use cautiously with hypoglycemia and diabetes, thyrotoxicosis, hepatic impairment, Raynaud disease.
Available Forms
ER capsules—60, 80, 120, 160 mg; tablets—10, 20, 40, 60, 80 mg; injection—1 mg/mL; oral solution—4, 8 mg/mL
Dosages
Adults
Oral
Hypertension: 40 mg regular propranolol bid PO or 80 mg PO SR or ER daily initially; usual maintenance dose, 120–240 mg/day PO given bid or tid or 120–160 mg PO SR or ER daily (maximum dose, 640 mg/day).
Angina: 80–320 mg/day PO divided bid, tid, or qid or 80 mg PO SR or ER daily initially; gradually increase SR or ER dosage at 3- to 7-day intervals; usual maintenance dose, 160 mg/day PO (maximum dose, 320 mg/day).
IHSS: 20–40 mg PO tid or qid or 80–160 mg PO SR or ER daily.
Arrhythmias: 10–30 mg PO tid or qid.
Post-MI: 120 mg/day PO divided tid. After 1 mo, may titrate to 180–240 mg/day tid or qid (maximum dose, 240 mg/day).
Pheochromocytoma: Preoperatively, 60 mg/day PO for 3 days in divided doses; inoperable tumor, 30 mg/day in divided doses.
Migraine: 80 mg/day PO daily (SR or ER) or in divided doses; usual maintenance dose, 160–240 mg/day.
Essential tremor: 40 mg PO bid; usual maintenance dose, 120 mg/day (maximum dose, 320 mg/day).
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