Propranolol

Indications
 Oral
Hypertension
Adult: As conventional tablet or oral solution: Initially, 40-80 mg bid. Usual range: 160-320 mg daily. As extended release tablet: Initially, 80 mg once daily. Usual range: 120-160 mg once daily. Max: 640 mg daily.
Child: Initially, 1 mg/kg daily in divided doses, may increase to 2-4 mg/kg daily in 2 divided doses.
Oral
Phaeochromocytoma
Adult: 60 mg daily given on the 3 days before the operation with α-blockade. Prolonged treatment of 30 mg daily may be given if tumour is inoperable.
Child: 250-500 mcg/kg 3-4 times daily.
Oral
Myocardial infarction
Adult: 40 mg 4 times daily for 2-3 days followed by 80 mg bid. Alternatively, 180-240 mg daily in divided doses. Doses to be given within 5-21 days of MI.
Oral
Cardiac arrhythmias
Adult: 30-160 mg daily in divided doses.
Child: 250-500 mcg/kg 3-4 times daily.
Oral
Prophylaxis of migraine
Adult: Initially, 40 mg bid-tid increased to 160 mg daily. Up to 240 mg daily may be necessary. Discontinue therapy if satisfactory response not obtained within 4-6 wk after reaching max dose.
Child: <12 yr: 20 mg bid-tid.
Oral
Portal hypertension
Adult: Initially, 40 mg bid increased up to 160 mg bid.
Oral
Angina pectoris
Adult: As conventional tablet or oral solution: 40 mg bid-tid, may increase to 120-240 mg daily, up to 320 mg daily may be required in some patients. As extended release tablet: 80 mg once daily, increased as needed every 3-7 days, average dose 160 mg once daily, max: 320 mg daily.
Oral
Hypertrophic cardiomyopathy
Adult: 10-40 mg, given 3-4 times daily.
Oral
Hyperthyroidism
Adult: 10-40 mg, given 3-4 times daily.
Oral
Anxiety
Adult: 40 mg once daily, may increase to bid-tid.
Oral
Essential tremor
Adult: 40 mg bid-tid. May increase at wkly intervals to 160 mg daily. Up to 320 mg daily may be necessary.
Intravenous
Emergency treatment of cardiac arrhythmias
Adult: 1 mg injected over a period of 1 minute, repeated every 2 minutes, if needed. Max: 10 mg in conscious patients and 5 mg in patients under anaesthesia.
Child: 25-50 mcg/kg via slow inj, may be repeated 3-4 times daily.
Intravenous
Hyperthyroidism
Adult: 1 mg, given over 1 minute, may repeat at 2-minute intervals until response is observed or a max of 10 mg is used in conscious patients or 5 mg in patients who are under anaesthesia.
Contraindications
 Sinus bradycardia, cardiogenic shock, pulmonary oedema, severe hyperactive airway disease, compensated cardiac failure, Raynaud's disease, hypoglycaemia, severe haemorrhage, metabolic acidosis, severe peripheral arterial disease, 2nd or 3rd degree heart block. Pregnancy (2nd and 3rd trimesters).
Warnings / Precautions
 Compensated heart failure, peripheral vascular disease, diabetes. Switching from conventional to sustained-release preparations, elderly. Ischaemic heart disease, congestive cardiac failure, renal or hepatic dysfunction. Increased risk of bradycardia and hypotension in patients with underlying cardiac disorders. 1st degree heart block. May mask symptoms of hyperthyroidism and hypoglycaemia. May unmask myasthenia gravis. Abrupt withdrawal may lead to angina, MI, ventricular arrhythmias and death. Lactation.
Adverse Reactions
 Cold extremities, insomnia, fatigue, dizziness, vivid dreams, lassitude, nausea, constipation or diarrhoea, vomiting, anorexia, stomach discomfort, impotence. Weakness, paraesthesia, wheezing, pharyngitis, bronchospasm. CNS disturbances at higher doses and mood alterations. Thrombocytopenic purpura, agranulocytosis, nonthrombocytopenic purpura, thrombocytopenia. Depression, confusion, cognitive dysfunction, emotional lability, fatigue, hallucinations.
Potentially Fatal: Heart failure, heart block and bronchospasm.
Overdose Reactions
 Severe and occasionally fatal CV depression.
Drug Interactions
 Decreased effect with aluminum and calcium salts, NSAIDs, ampicillin, rifampicin. Concurrent use with chlorpromazine results in raised blood levels of both drugs and additive hypotensive effect. Hypotensive effect reduced by indometacin. Additive effect with other antihypertensives and diuretics. May reduce the clearance of bupivacaine. Plasma levels may be increased by hydralazine and propafenone. Increased serum levels of thioridazine when used with propranolol.
Potentially Fatal: Marked hypertension and bradycardia with adrenaline. Rebound hypertension due to abrupt withdrawal of clonidine is potentiated. Severe bradycardia may occur with digitalis.
See Below for More propranolol Drug Interactions
Lab Interactions
 Metabolite may interfere with bilirubin and metanephrine measurements.
Mechanism of Actions
 Propranolol competitively blocks β1- and β2-receptors resulting to decreased heart rate myocardial contractility, BP and myocardial oxygen demand. It only possesses membrane-stabilising properties.
Absorption: Almost completely absorbed from the GI tract (oral); peak plasma concentrations after 1 hr.
Distribution: Crosses the blood-brain barrier and placenta, enters breast milk. Protein-binding: 90%.
Metabolism: Hepatic; yields 4-hydroxypropranolol (biologically active).
Excretion: Via urine (as metabolites and small amounts of unchanged drug); 3-6 hr (elimination half-life). May be removed by dialysis.
Administration
 Tab: Should be taken on an empty stomach. (Take before meals.)
Cap: May be taken with or without food. (Take consistently either always w/ or always w/o meals.)
Storage Conditions
 Intravenous: Store at 20-25°C. Oral: Store at 20-25°C.
ATC Classification
 C07AA05 - propranolol ; Belongs to the class of non-selective beta-blocking agents. Used in the treatment of cardiovascular diseases.
Storage
 Intravenous: Store at 20-25°C. Oral: Store at 20-25°C.
Available As
  • Propranolol 1 mg
  • Propranolol 10 mg
  • Propranolol 120 mg
  • Propranolol 20 mg
  • Propranolol 40 mg
  • Propranolol 60 mg
  • Propranolol 80 mg

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