Classes
DEA Class; Rx
Common Brand Names; Inderal, Inderal LA, InnoPran XL, Hemangeol
- Antidysrhythmics, II;
- Beta-Blockers, Nonselective;
- Antianginal Agents;
- Antimigraine Agents
Description
Competitive, nonselective beta-blocker without intrinsic sympathomimetic activity
Used for many cardiac indications such as: angina, ventricular rate control, hypertension, PSVT, etc.
Also used for non-cardiac indications: migraine prophylaxis, tremor, infantile hemangioma
Indications
Indicated for management of hypertension
Indicated for prophylaxis of common migraine headache
Indicated to decrease angina frequency and increase exercise tolerance in patients with chronic stable angina
Indiated as adjunct to alpha-adrenergic blockers to control blood pressure and symptoms of catecholamine-secreting tumors
Indicated for symptomatic treatment of hypertrophic cardiomyopathy with left ventricular outflow tract obstruction
Indicated to reduce cardiovascular mortality in patients who have survived the acute phase of myocardial infarction (MI) and are clinically stable
Indicated for control of supraventricular arrhythmias (eg, atrial fibrillation and flutter, atrioventricular nodal reentrant tachycardia) and ventricular tachycardias (eg, catecholamine-induced arrhythmias, digoxin toxicity)
Indicated for management of familial or hereditary essential tremor
Prevention of variceal bleeding
Contraindications
Asthma, COPD
Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker)
Cardiogenic shock
Uncompensated congestive heart failure
Hypersensitivity
Overt heart failure
Sick sinus syndrome without permanent pacemaker
Adverse Effects
- Aggravated congestive heart failure
- Bradycardia
- Hypotension
- Arthropathy
- Raynaud phenomenon
- Hyper/hypoglycemia
- Depression
- Fatigue
- Insomnia
- Paresthesia
- Psychotic disorder
- Pruritus
- Nausea
- Vomiting
- Hyperlipidemia
- Hyperkalemia
- Cramping
- Bronchospasm
- Dyspnea
- Pulmonary edema
- Respiratory distress
- Wheezing
Warnings
Do not use InnoPran XL in pediatric patients
Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures
Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions
Sudden discontinuance can exacerbate angina and lead to myocardial infarction
Use in pheochromocytoma
Increased risk of stroke after surgery
Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported
Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported
Exacerbation of myopathy and myotonia has been reported
Less effective than thiazide diuretics in black and geriatric patients
May worsen bradycardia or hypotension; monitor HR and BP
Pregnancy and Lactation
Prolonged experience with propranolol in pregnant women over several decades, based on published interventional and observational studies, has not identified a drug-associated risk of major birth defects, miscarriage, or other adverse maternal outcomes
The drug is present in human milk at low levels, but related risk to a breastfed infant is unknown; there are no data on effects on milk production
Maximum Dosage
Hypertension
Immediate release: 40 mg PO q12hr initially, increasing every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day
Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day
InnoPran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO
Migraine
80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr
Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day
Withdraw therapy if satisfactory response not seen after 6 weeks
Angina
80-320 mg/day PO divided q6-12hr
Inderal LA: 80 mg/day PO; not to exceed 320 mg/day
Pheochromocytoma
30-60 mg/day PO in divided doses
Hypertrophic Subaortic Stenosis
20-40 mg PO q6-8hr
Myocardial Infarction
Initiate within 24 hr of MI and reevaluate for secondary prevention at later date
Immediate-release: 60-120 mg/day divided BID/TID; titrate dose based on heart rate and blood pressure as tolerated up to 240 mg/day
Supraventricular Arrhythmia
PO: 10-30 mg q6-8hr
IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg
Once response or maximum dose achieved, do not give additional dose for at least 4 hr
Essential Tremor
40 mg PO q12hr initially; maintenance: 120-320 mg/day PO divided q8-12hr
Portal Hypertension (Off-label)
Prevention of variceal bleeding
10-60 mg PO q6-8hr; 10 mg PO q8hr initially; titrate dose to reduce resting heart rate by 25%
Antipsychotic-Induced Akathisia (Off-label)
30-120 mg PO q8-12hr
Esophageal Bleeding (Off-label)
20-180 mg PO q12hr; adjust to maximum tolerated dose
Panic Disorder (Off-label)
40-320 mg/day PO
Aggressive Behavior (Off-label)
80-300 mg/day PO
Pediatric
Initiate treatment at aged 5 weeks to 5 months
Starting dose: 0.6 mg/kg (0.15 mL/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 mL/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 mL/kg) BID
How supplied
Propranolol hydrochloride
oral solution
- 20mg/5mL
- 40mg/5mL
injectable solution
- 1mg/mL
tablet
- 10mg
- 20mg
- 40mg
- 60mg
- 80mg
capsule, extended-release
- 60mg
- 80mg
- 120mg
- 160mg
