$Unique_ID{BRK03312} $Pretitle{} $Title{propranolol} $Subject{Inderal Wyeth-Ayerst LA Beta-adrenergic blocking agent propranolol high blood pressure angina pectoris chest pain irregular heartbeats migraine headaches heart attacks beta blockers nerve impulses pathways} $Volume{} $Log{ Inderal 10 mg*0331201.scf Inderal 20 mg*0331202.scf Inderal 40 mg*0331203.scf Inderal 80 mg*0331204.scf Inderal LA 80 mg*0331205.scf Inderal LA 120 mg*0331206.scf} Copyright (C) 1993 Publications International, Ltd. propranolol ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Inderal (Wyeth-Ayerst) Inderal LA (Wyeth-Ayerst) propranolol (various manufacturers) TYPE OF DRUG Beta-adrenergic blocking agent INGREDIENT propranolol DOSAGE FORMS Tablets (10 mg, 20 mg, 40 mg, 60 mg, 80 mg, and 90 mg) Extended-release capsules (60 mg, 80 mg, 120 mg, and 160 mg) Oral solution (4 mg and 8 mg per ml) Oral concentrated solution (80 mg per ml) STORAGE Store at room temperature in a tightly closed, light-resistant container. The solutions should never be frozen. USES Propranolol is used to treat high blood pressure, angina pectoris (chest pain), and irregular heartbeats. It is also useful in preventing migraine headaches and preventing additional heart attacks in heart attack patients. Propranolol belongs to a group of medicines known as beta-adrenergic blocking agents or, more commonly, beta blockers. These drugs work by controlling nerve impulses along certain nerve pathways. TREATMENT Propranolol can be taken with a glass of water, with meals, immediately following meals, or on an empty stomach (depending on your doctor's instructions). Try to take the medication at the same time(s) each day. The extended-release capsules should be swallowed whole. Do not chew or crush them. Breaking the capsule releases the medication all at once--defeating the purpose of extended-release capsules. The oral solution should be measured with a specially designed 5-ml measuring spoon. The oral concentrated solution must be mixed in four ounces (1/2 cup) of water, juice, or soda before drinking. The cup should be refilled with more of the liquid, which must be drunk to ensure that the entire dose is taken. This form may also be mixed with applesauce or pudding. It is important to remember that propranolol does not cure high blood pressure, but it will help control the condition as long as you continue to take it. Try not to miss any doses of this medicine. If you do miss a dose, take the missed dose as soon as possible, unless it is within eight hours (if you are taking this medicine only once a day) or within four hours (if you are taking this medicine more than once a day) of your next scheduled dose. In that case, do not take the missed dose at all; just return to your regular dosing schedule. Do not double the next dose of the medication. SIDE EFFECTS Minor. Anxiety; constipation; decreased sexual ability; diarrhea; difficulty in sleeping; drowsiness; dryness of the eyes, mouth, and skin; headache; nausea; nervousness; stomach discomfort; tiredness; or weakness. These side effects should disappear as your body adjusts to the medicine. To relieve constipation, increase the amount of fiber in your diet (fresh fruits and vegetables, salads, bran, and whole-grain breads) and drink more water (unless your doctor directs you to do otherwise). If you are extra-sensitive to the cold, be sure to dress warmly during cold weather. Plain, nonmedicated eye drops (artificial tears) may help to relieve eye dryness. Sucking on ice chips or chewing sugarless gum helps to relieve mouth and throat dryness. Major. Tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about breathing difficulty or wheezing, cold hands or feet (due to decreased blood circulation to skin, fingers, and toes), confusion, depression, dizziness, hair loss, hallucinations, light-headedness, nightmares, numbness or tingling of the fingers or toes, rapid weight gain (three to five pounds within a week), reduced alertness, swelling, sore throat and fever, skin rash, or unusual bleeding or bruising. INTERACTIONS Propranolol interacts with a number of other types of medications: 1. Indomethacin, aspirin, or other salicylates lessen the blood-pressure-lowering effects of beta blockers. 2. Concurrent use of beta blockers and calcium channel blockers (diltiazem, nifedipine, or verapamil) or disopyramide can lead to heart failure or very low blood pressure. 3. Cimetidine and oral contraceptives (birth control pills) can increase the blood concentrations of propranolol, which can result in greater side effects. 4. Side effects may also be increased when beta blockers are taken with clonidine, digoxin, epinephrine, phenylephrine, phenylpropanolamine, phenothiazine tranquilizers, prazosin, reserpine, or monoamine oxidase (MAO) inhibitors. At least 14 days should separate the use of a beta blocker and an MAO inhibitor. 5. Barbiturates, alcohol, and rifampin can increase the breakdown of propranolol in the body, which can lead to a decrease in its effectiveness. 6. Beta blockers may antagonize (work against) the effects of theophylline, aminophylline, albuterol, isoproterenol, metaproterenol, and terbutaline. 7. Beta blockers can also interact with insulin or oral antidiabetic agents, raising or lowering blood sugar levels or masking the symptoms of low blood sugar. 8. The action of beta blockers may be excessively increased if they are used with chlorpromazine, furosemide, or hydralazine. BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially any of those listed above. WARNINGS * Before starting to take this medication, it is important to tell your doctor if you have ever had unusual or allergic reactions to any beta blocker (acebutolol, atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, propranolol, or timolol). * Tell your doctor if you now have or if you have ever had allergies, asthma, hay fever, eczema, slow heartbeat, bronchitis, diabetes mellitus, emphysema, heart or blood vessel disease, kidney disease, liver disease, thyroid disease, or poor circulation in the fingers or toes. * You may want to check your pulse while taking this medication. If your pulse is much slower than your usual rate (or if it is less than 50 beats per minute), check with your doctor. A pulse rate that is too slow may cause circulation problems. * This medicine may affect your body's response to exercise. Make sure you ask your doctor what an appropriate amount of exercise would be for you, taking into account your medical condition. * It is important that you do not stop taking this medicine without first checking with your doctor. Some conditions may become worse when the medicine is stopped suddenly, and the danger of a heart attack is increased in some patients. Your doctor may want you to gradually reduce the amount of medicine you take before stopping completely. Make sure that you have enough medicine on hand to last through vacations, holidays, and weekends. * Before having surgery or any other medical or dental treatment, tell your physician or dentist that you are taking this medicine. Often, this medication will be discontinued 48 hours prior to any major surgery. * Propranolol can cause dizziness, drowsiness, light-headedness, and decreased alertness. Use caution while driving a car or operating dangerous machinery. Be especially careful when going up or down stairs. * While taking this medicine, do not use any over-the-counter (nonprescription) allergy, asthma, cough, cold, sinus, or diet preparations without first checking with your pharmacist or doctor. The combination of these medicines with a beta blocker can result in high blood pressure. * Be sure to tell your doctor if you are pregnant. Animal studies have shown that some beta blockers can cause problems in pregnancy when used at very high doses. Adequate studies have not been done in humans, but there has been some association between use of beta blockers during pregnancy and low birth weight, as well as breathing problems and slow heart rate in newborn infants. However, other reports have shown no effects in newborn infants. Also, tell your doctor if you are breast-feeding an infant. Although this medicine has not been shown to cause problems in breast-fed infants, some of the medicine may pass into breast milk, so caution is warranted. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.