Pregnancy Risk Category C
How supplied
Tablets: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg, 90 mg
Capsules (extended-release): 60 mg, 80 mg, 120 mg, 160 mg
Oral solution: 4 mg/ml, 8 mg/ml, 80 mg/ml (concentrate)
Injection: 1 mg/ml
Action
A nonselective beta blocker that reduces cardiac oxygen demand by blocking catecholamine-induced increases in heart rate, blood pressure, and force of myocardial contraction. Depresses renin secretion and prevents vasodilation of cerebral arteries.
Indications & dosage
Angina pectoris--
Adults: total daily doses of 80 to 320 mg P.O. when given b.i.d., t.i.d., or q.i.d. Or, one 80-mg extended-release capsule daily. Dosage increased at 3- to 7-day intervals.
Mortality reduction after MI--
Adults: 180 to 240 mg P.O. daily in divided doses beginning 5 to 21 days after MI has occurred. Usually administered t.i.d. or q.i.d.
Supraventricular, ventricular, and atrial arrhythmias; tachyarrhythmias caused by excessive catecholamine action during anesthesia, hyperthyroidism, or pheochromocytoma--
Adults: 0.5 to 3 mg by slow I.V. push, not to exceed 1 mg/minute. After 3 mg have been given, another dose may be given in 2 minutes; subsequent doses, no sooner than q 4 hours. May be diluted and infused slowly. Usual maintenance dose is 10 to 30 mg P.O. t.i.d. or q.i.d.
Hypertension--
Adults: initially, 80 mg P.O. daily in two to four divided doses or extended-release form once daily. Increased at 3- to 7-day intervals to maximum daily dose of 640 mg. Usual maintenance dose is 160 to 480 mg daily.
Prevention of frequent, severe, uncontrollable, or disabling migraine or vascular headache--
Adults: initially, 80 mg P.O. daily in divided doses or one extended-release capsule daily. Usual maintenance dose is 160 to 240 mg daily, t.i.d. or q.i.d.
Essential tremor--
Adults: 40 mg (tablets, oral solution) P.O. b.i.d. Usual maintenance dose is 120 to 320 mg daily in three divided doses.
Hypertrophic subaortic stenosis--
Adults: 20 to 40 mg P.O. t.i.d. or q.i.d.; or 80 to 160 mg extended-release capsules once daily.
Adjunct therapy in pheochromocytoma--
Adults: 60 mg P.O. daily in divided doses with an alpha blocker 3 days before surgery.
Adverse reactions
CNS: fatigue, lethargy, vivid dreams, hallucinations, mental depression, light-headedness, insomnia.
CV: bradycardia, hypotension, heart failure, intermittent claudication, intensification of AV block.
GI: abdominal cramping, constipation, diarrhea, nausea, vomiting.
GU: elevated BUN levels.
Hematologic: agranulocytosis.
Hepatic: elevated serum transaminase, alkaline phosphatase, and LDH levels.
Respiratory: bronchospasm.
Skin: rash.
Other: fever.
Interactions
Drug-drug. Aminophylline: antagonized beta-blocking effects of propranolol. Use together cautiously.
Cardiac glycosides, diltiazem, verapamil: hypotension, bradycardia, and increased depressant effect on myocardium. Use together cautiously.
Cimetidine: inhibited metabolism of propranolol. Monitor for increased beta-blocking effect.
Epinephrine: severe vasoconstriction. Monitor blood pressure and observe patient carefully.
Glucagon, isoproterenol: antagonized propranolol effect. May be used therapeutically and in emergencies.
Haloperidol: cardiac arrest has occurred with concomitant therapy. Avoid use together.
Insulin, oral antidiabetics: can alter requirements for these drugs in previously stabilized diabetics. Monitor for hypoglycemia.
Phenothiazines, reserpine: additive effect. Use cautiously.
Drug-herb. Betel palm: decreased temperature-elevating effects and enhanced CNS effects. Avoid concomitant use.
Drug-lifestyle. Cocaine use: increased angina-inducing potential of cocaine. Monitor patient carefully.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with bronchial asthma, sinus bradycardia and heart block greater than first-degree, cardiogenic shock, and heart failure (unless failure is secondary to a tachyarrhythmia that can be treated with propranolol).
Nursing considerations
I.V. administration
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING