Indirin Dosage/Direction for Use

Mode of Administration: Since the half-life may be increased in patients with significant hepatic or renal impairment, caution must be exercised when starting treatment and selecting the initial dose.
For Oral Administration: Adults: Hypertension: Initially 40 mg two to three times daily, which may be increased by 80 mg per day at weekly intervals according to response. The usual dose range is 160 to 320 mg per day. With concurrent diuretic or other antihypertensive drugs, a further reduction of blood pressure is obtained.
Angina, migraine and essential tremor: A starting dose of 40 mg two or three times daily may be increased by the same amount at weekly intervals according to patient response. An adequate response in migraine is usually seen in the range 80 to 160 mg/day and in angina and essential tremor in the range 120 to 240 mg/day.
Arrhythmias, hypertrophic obstructive cardiomyopathy and thyrotoxicosis: A dosage range of 10 to 40 mg three or four times a day usually achieves the required response.
Post-myocardial infarction: Treatment should start between days 5 and 21 after myocardial infarction, with an initial dose of 40 mg four times a day for 2 or 3 days. In order to improve compliance, the total daily dosage may thereafter be given as 80 mg twice a day.
Hyperthyroidism: The dose is adjusted according to clinical response.
Portal Hypertension: Dosage should be titrated to achieve approximately 25% reduction in heart rate at rest. Dosing should begin with 40 mg twice daily, increasing to 80 mg twice daily depending on heart rate response. If necessary, the dose may be increased incrementally to a maximum of 160 mg twice daily.
Phaeochromocytoma: Propranolol Hydrochloride (Indirin) is used only in the presence of effective alpha-blocker. Pre-operative: 60 mg daily for 3 days is recommended. Non-operable malignant cases: 30 mg daily.
Hepatic Impairment: The bioavailability of propranolol may be increased in patients with hepatic impairment and dose adjustments may be required. In patients with severe liver disease (e.g. cirrhosis), a low initial dose is recommended (not exceeding 20 mg three times a day) with close monitoring of the response to treatment (such as the effect on heart rate).
Renal Impairment: Concentrations of propranolol may increase in patients with significant renal impairment and hemodialysis. Caution should be exercised when starting treatment and selecting the initial dose. As with the other beta-adrenoreceptor blocking agents, treatment should not be discontinued abruptly. The dosage should be withdrawn gradually over a period of 7 to 14 days. Either the equivalent dosage of another beta-adrenoreceptor blocker may be substituted or the withdrawal of propranolol should be gradual. Patients should be followed during withdrawal especially those with ischaemic heart disease. The risk/benefit of stopping beta blockade should be made for each patient.
Elderly: Evidence concerning the relationship between blood level and age is conflicting. Propranolol should be used to treat older people with caution. It is suggested that treatment should start with the lowest dose. The optimum dose should be individually determined according to clinical response.
Pediatrics: Arrhythmias: Dosage should be determined according to the cardiac status of the patient and the circumstances necessitating treatment. The dose should be adjusted individually and the following is a guide: Children and adolescents: 0.25-0.5 mg/kg three or four times daily, adjusted according to clinical response.
Migraine: Under the age of 12: 20 mg two or three times daily.
Over the age of 12: the adult dose.