Indirin

Control of HTN; cardiac arrhythmias; anxiety & anxiety tachycardia. Management of pheochromocytoma; angina pectoris; essential tremor; hypertrophic obstructive cardiomyopathy. Adjunctive management of thyrotoxicosis & thyrotoxic crisis. Long-term prophylaxis after recovery from acute MI; migraine; upper GI bleeding in patients w/ portal HTN & esophageal varices.

Adult HTN Initially 40 mg bid-tid, may be increased by 80 mg/day at wkly intervals. Max: 160-320 mg/day. Angina, migraine & essential tremor Starting dose of 40 mg bid-tid, may be increased by the same amount wkly. Max: 80-160 mg/day for migraine, 120-240 mg/day for angina & essential tremor. Arrhythmias, hypertrophic obstructive cardiomyopathy & thyrotoxicosis 10-40 mg tid-qid. Post MI Initially, 40 mg qid for 2-3 days, start between days 5 & 21. May be given as 80 mg bid to improve compliance. Portal HTN Initially 40 mg bid, increase to 80 mg bid depending on heart rate response. Max: 160 mg bid. Pheochromocytoma Preop: 60 mg daily for 3 days. Non-operable malignant cases: 30 mg daily, to be used only in the presence of effective α-blocker. Hepatic impairment Initially not exceeding 20 mg tid in patients w/ severe liver disease (eg, cirrhosis). Childn & adolescent Arrhythmias 0.25-0.5 mg/kg tid-qid. Migraine >12 yr 40 mg bid-tid; <12 yr 20 mg bid-tid.

May be taken with or without food.

Hypersensitivity to propranolol. History of bronchospasm, bronchial asthma or COPD. Cardiac decompensation, sick sinus syndrome/SA block, metabolic acidosis, 2nd & 3rd degree heart block, cardiogenic shock, untreated pheochromocytoma, severe bradycardia, hypotension, peripheral arterial disturbances, Prinzmetal's angina. Patients prone to hypoglycemia.

Patients whose cardiac reserve is poor. In combination w/ Ca-channel blockers w/ -ve inotropic effects (eg, verapamil, diltiazem) particularly in patients w/ impaired ventricular function &/or SA or AV conduction abnormalities. Severe peripheral arterial circulatory disturbances; 1st degree heart block. May block/modify the signs & symptoms of hypoglycemia (especially tachycardia). Concurrent use w/ hypoglycemic therapy in diabetic patients. May mask signs of thyrotoxicosis. May develop symptoms attributable to slow heart rate. Do not discontinue abruptly in patients suffering from ischemic heart disease. Avoid abrupt w/drawal of β-blockers. Discontinue β-blocker therapy at least 48 hr prior to procedure in patient scheduled for surgery. History of anaphylactic reaction; decompensated cirrhosis; hepatic or renal impairment. May exacerbate myasthenia gravis like syndrome. Should not be taken by patients w/ galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. May deteriorate liver function & develop hepatic encephalopathy in patients w/ portal HTN. May affect ability to drive or operate machinery. Should not be given during pregnancy. Not recommended during lactation.

Thrombocytopenia, agranulocytosis; angioedema; hypoglycemia, changes in lipid metabolism; sleep disturbances, nightmares, hallucinations, psychosis, mood changes, depression; CNS disorders; dry eyes, visual disturbance, conjunctivitis; cardiac disorders; Raynaud's phenomenon, exacerbation of intermittent claudication; breathlessness, bronchospasm, dyspnea; GI disturbances eg, nausea, vomiting, diarrhea, constipation, dry mouth; purpura, alopecia, psoriasiform skin reactions, exacerbation of psoriasis, skin rashes, hyperhidrosis; arthralgia; reduced renal blood flow & GFR; impotence; fatigue &/or lassitude, dizziness.

May exaggerate -ve AV conduction & sinus node function w/ Ca channel blockers w/ -ve inotropic effects. May counteract effects w/ sympathomimetic agent eg, adrenaline. Oppose the bronchodilator effects of β-agonist bronchodilators. Potentiation of bradycardia (w/ possible fatal outcomes) w/ fingolimod. Reduced plasma levels & effect w/ barbiturates. Increase plasma conc w/ propafenone, warfarin, cimetidine. May diminish the antihypertensive effects w/ MAOIs (except MAO-B). May increase atrioventricular conduction time w/ digitalis glycosides. Severe sinus tachycardia w/ amiodarone. Additive inotropic effects w/ class I antiarrhythmics eg, disopyramide, quinidine. May counteract the antihypertensive effects w/ NSAIDs (mainly indomethacin). Attenuation of reflex tachycardia & increased risk of hypotension w/ anesth. Severe HTN & bradycardia w/ epinephrine. May inhibit oxidative metabolism & increased plasma level including severe bradycardia w/ fluvoxamine. May exacerbate rebound HTN w/ clonidine, moxonidine, methyldopa. Increased metabolism w/ rifampicin. Increases the risk of orthostatic hypotension, tachycardia & palpitations w/ α-blockers. May increase risk of hypotension & cardiac failure w/ dihydropyridine Ca channel blockers eg, nifedipine. May increase plasma conc of lidocaine. Inhibits the 1st-pass metabolism of rizatriptan (increased AUC). Vasospastic w/ ergotamine. Reduces the metabolic clearance of theophylline. May prolong hypoglycemic response to insulin. Reduced beneficial effects on heart rate & BP w/ tobacco smoking. Interfere w/ the estimation of serum bilirubin by diazo method & determination of catecholamines by fluorescence method.

Beta-Blockers

C07AA05 - propranolol ; Belongs to the class of non-selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

Rx