Propranolol hydrochloride
Propranolol hydrochloride (Inderal)
Propranolol Hydrochloride
(proh- PRAN-oh-lohl)
Pregnancy Category: C Apo-Propranolol Detensol Dom-Propranolol Inderal Inderal 10, 20, 40, 60, 80, and 90 Inderal LA Novo-Pranol Nu-Propranolol PMS Propranolol Propranolol Intensol (Rx)

Classification: Beta-adrenergic blocking agent; antiarrhythmic (type II)

See Also: See also Beta-Adrenergic Blocking Agents .

Action/Kinetics: Manifests both beta-1- and beta-2-adrenergic blocking activity. Antiarrhythmic action is due to both beta-adrenergic receptor blockade and a direct membrane-stabilizing action on the cardiac cell. Has no intrinsic sympathomimetic activity and has high lipid solubility. Onset, PO: 30 min; IV: immediate. Maximum effect: 1-1.5 hr. Duration: 3-5 hr. t 1/2: 2-3 hr (8-11 hr for long-acting). Therapeutic serum level, antiarrhythmic: 0.05-0.1 mcg/mL. Completely metabolized by liver and excreted in urine. Although food increases bioavailability, absorption may be decreased.

Uses: Hypertension (alone or in combination with other antihypertensive agents). Angina pectoris, hypertrophic subaortic stenosis, prophylaxis of MI, pheochromocytoma, prophylaxis of migraine, essential tremor. Cardiac arrhythmias including ventricular tachycardias and arrhythmias, tachycardias due to digitalis intoxication, supraventricular arrhythmias, PVCs, resistant tachyarrhythmias due to anesthesia/catecholamines.
Investigational: Schizophrenia, tremors due to parkinsonism, aggressive behavior, antipsychotic-induced akathisia, rebleeding due to esophageal varices, situational anxiety, acute panic attacks, gastric bleeding in portal hypertension, vaginal contraceptive, anxiety, alcohol withdrawal syndrome, winter depression.

Contraindications: Bronchial asthma, bronchospasms including severe COPD.

Special Concerns: It is dangerous to use propranolol for pheochromocytoma unless an alpha-adrenergic blocking agent is already in use.

Additional Side Effects: Psoriasis-like eruptions, skin necrosis, SLE (rare).

Laboratory Test Alterations: Blood urea, serum transaminase, alkaline phosphatase, LDH. Interference with glaucoma screening test.

Additional Drug Interactions: Haloperidol / Severe hypotension Hydralazine / Effect of both agents Methimazole / May effects of propranolol Phenobarbital / Effect of propranolol due to breakdown by liver Propylthiouracil / May the effects of propranolol Rifampin / Effect of propranolol due to breakdown by liver Smoking / Serum levels and clearance of propranolol

How Supplied: Capsule, extended release: 60 mg, 80 mg, 120 mg, 160 mg; Concentrate: 80 mg/mL; Injection: 1 mg/mL; Solution: 20 mg/5 mL, 40 mg/5 mL; Tablet: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg

Dosage
?Tablets, Sustained-Release Capsules, Oral Solution, Concentrate Hypertension.
Initial: 40 mg b.i.d. or 80 mg of sustained-release/day; then, increase dose to maintenance level of 120-240 mg/day given in two to three divided doses or 120-160 mg of sustained-release medication once daily. Do not exceed 640 mg/day. Pediatric, initial: 0.5 mg/kg b.i.d.; dose may be increased at 3- to 5-day intervals to a maximum of 1 mg/kg b.i.d. Calculate the dosage range by weight and not by body surface area.
Angina.
Initial: 80-320 mg b.i.d., t.i.d., or q.i.d.; or, 80 mg of sustained-release once daily; then, increase dose gradually to maintenance level of 160 mg/day of sustained-release capsule. Do not exceed 320 mg/day.
Arrhythmias.
10-30 mg t.i.d.-q.i.d. given after meals and at bedtime.
Hypertrophic subaortic stenosis.
20-40 mg t.i.d.-q.i.d. before meals and at bedtime or 80-160 mg of sustained-release medication given once daily.
MI prophylaxis.
180-240 mg/day given in three to four divided doses. Do not exceed 240 mg/day.
Pheochromocytoma, preoperatively.
60 mg/day for 3 days before surgery, given concomitantly with an alpha-adrenergic blocking agent.
Inoperable tumors.
30 mg/day in divided doses.
Migraine.
Initial: 80 mg sustained-release medication given once daily; then, increase dose gradually to maintenance of 160-240 mg/day in divided doses. If a satisfactory response has not been observed after 4-6 weeks, discontinue the drug and withdraw gradually.
Essential tremor.
Initial: 40 mg b.i.d.; then, 120 mg/day up to a maximum of 320 mg/day.
Aggressive behavior.
80-300 mg/day.
Antipsychotic-induced akathisia.
20-80 mg/day.
Tremors associated with Parkinson's disease.
160 mg/day.
Rebleeding from esophageal varices.
20-180 mg b.i.d.
Schizophrenia.
300-5,000 mg/day.
Acute panic symptoms.
40-320 mg/day.
Anxiety.
80-320 mg/day.
Intermittent explosive disorder.
50-1,600 mg/day.
Nonvariceal gastric bleeding in portal hypertension.
24-480 mg/day.
?IV Life-threatening arrhythmias or those occurring under anesthesia.
1-3 mg not to exceed 1 mg/min; a second dose may be given after 2 min, with subsequent doses q 4 hr. Begin PO therapy as soon as possible. Although use in pediatrics is not recommended, investigational doses of 0.01-0.1 mg/kg/dose, up to a maximum of 1 mg/dose (by slow push), have been used for arrhythmias.