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Propranolol (Inderal, Inderal LA)

Category:

  • Nervous system

Description:

  • Antihypertensive, antianginal, antimigraine agent, antidysrhythmic; beta blocker

Indications:

  • Hypertension, cardiac dysrhythmias, MI, hypertrophic subaortic stenosis

  • Adjunctive therapy of pheochromocytoma, migraine prophylaxis, angina pectoris

  • Essential tremor

Contraindications:

  • Cardiogenic shock, 2nd or 3rd degree heart block, sinus bradycardia, CHF unless secondary to a tachydysrhythmia treatable with beta-blockers

  • Bronchial asthma or bronchospasm, severe COPD, cardiac failure

Precautions:

  • Pregnancy category C

  • Major surgery, diabetes mellitus, renal disease, hepatic disease, thyroid disease

  • Well compensated heart failure, peripheral vascular disease, bradycardia

  • Down’s syndrome

Adverse Reactions (Side Effects):

  • CNS: depression, dizziness, drowsiness, fatigue, lethargy, hallucinations

  • CV: bradycardia, CHF, cold extremities, postural hypotension, 2nd or 3rd degree heart block, profound hypotension

  • EENT: dry burning eyes, sore throat, visual disturbances

  • GI: diarrhea, dry mouth, elevated LFT’s, ischemic colitis, mesenteric arterial thrombosis, nausea, vomiting

  • GU: impotence, sexual dysfunction

  • HEME: agranulocytosis, thrombocytopenia

  • RESP: Bronchospasm, dyspnea, wheezing

  • SKIN: alopecia, pruritis, rash

Dosage:

Administered orally, intravenously

  • Adult:            

    • Hypertension: 

      • PO 40mg twice daily (LA 80mg once daily) initially, usual range 120-240mg daily divided 2-3 times (LA 120-160 once daily), max 640mg daily

    • Dysrhythmias: 

      • PO 10-30mg 3-4 times daily

      • IV (reserve for life threatening situations or dysrhythmias) 0.5-3mg, a 2nd dose may be administered after 2 minutes as needed, additional doses at intervals no less than 4 hours until desired response obtained

    • Angina pectoris: 

      • PO 10-20mg 3-4 times daily (LA 80mg once daily) initially, usual range 160-240mg daily divided 3-4 times, maximum 320mg daily

    • Hypertrophic subaortic stenosis: 

      • PO 20-40mg 3-4 times daily (LA 80-160mg once daily)

    • Pheochromocytoma: 

      • PO 30mg daily in divided doses (in conjunction with an a-adrenergic blocking agent)

    • Migraine prophylaxis: 

      • PO 80mg daily in divided doses (LA 80mg once daily) initially, increase to optional prophylaxis, usual range 160-240mg daily

    • MI: 

      • PO 180-240mg daily divided 2-4 times daily beginning 5-21 days after MI

    • Essential tremor: 

      • PO 40mg twice daily initially, usual range 120-320mg daily divided 3 times daily

  • Child:            

    • Dysrhythmias: 

      • PO 0.5-1 mg/kg/day divided every 6-8 hours, increase dose at 3-7 day intervals, usual range 2-4 mg/kg/day, max 16 mg/kg/day or 60mg daily

      • IV 0.01-0.1 mg/kg slowly over 10 minutes, max 1mg

    • Hypertension: 

      • PO 0.5-1 mg/kg/day divided every 6-12 hours, increase dose at 3-7 day intervals, usual range 1-5 mg/kg/day

    • Migraine prophylaxis: 

      • PO 0.6-1.5 mg/kg/day

Special Consideration:

  • Do not discontinue abruptly, may precipitate angina, sudden death; reduce over 1-2 weeks

 


The information contained here is an abbreviated summary. For more detailed and complete information, consult the manufacturer's product information sheets or standard textbooks

Source: Operational Medicine 2001,  Health Care in Military Settings, NAVMED P-5139, May 1, 2001, Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This information is provided by The Brookside Associates.  The Brookside Associates, LLC. is a private organization, not affiliated with any governmental agency. The opinions presented here are those of the author and do not necessarily represent the opinions of the Brookside Associates or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the US Department of Defense or the Brookside Associates. All material presented here is unclassified.

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