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

 
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