Names and pronunciation
(proe-pran′oh-lole) Inderal LA, Inderal XL, Hemangeol
Source page 1100
Loading InternPractice…
Individual generic drug information
Extracted information for propranolol only.
(proe-pran′oh-lole) Inderal LA, Inderal XL, Hemangeol
Source page 1100
Func. class.: Antihypertensive, antian- ginal, antidysrhythmic (class II)
Source page 1100
Chem. class.: β-Adrenergic blocker
Source page 1100
Do not confuse: Inderal/Adderall
Source page 1100
ACTION: Nonselective β-blocker with negative inotropic, chronotropic, dromotropic properties
Source page 1100
USES: Chronic stable angina pectoris, hypertension, supraventricular dysrhyth mias, migraine prophylaxis, pheochro mocytoma, cyanotic spells related to hypertrophic subaortic stenosis, essential tremor, acute MI, vascular headache prophylaxis
Source page 1100
Unlabeled uses: Anxiety, prevention of variceal bleeding caused by portal hyperten- sion, akathisia induced by antipsychotics, portal hypertension, sclerodermal renal cri- sis, unstable angina
Source page 1100
Extracted information for propranolol only.
CONTRAINDICATIONS: Hyper sensitivity to this product; cardiogenic shock, AV heart block; bronchospastic disease; sinus bradycardia; broncho spasm; asthma Precautions: Pregnancy, breastfeeding, children, diabetes mellitus, hyperthyroid- ism, COPD, renal/hepatic disease, myas- thenia gravis, peripheral vascular dis- ease, hypotension, cardiac failure, Raynaud’s disease, sick sinus syndrome, vasospastic angina, smoking, Wolff-Par- kinson-White syndrome, thyrotoxicosis
Source page 1100
Black Box Warning: Abrupt discontinu- ation Black Box Warning: Abrupt withdraw- al: taper over 1-2 wk, do not discontinue abruptly; dysrhythmias, angina, myocar- dial ischemia, or MI may recur • B/P, pulse, respirations during begin- ning therapy; notify prescriber if pulse <50 bpm or systolic B/P <90 mm Hg • ECG continuously if using as antidys- rhythmic IV, PCWP (pulmonary capillary wedge pressure), CVP (central venous pressure) • Hepatic enzymes: AST, ALT, bilirubin; blood glucose (diabetes mellitus) • Angina pain: duration, time started, activity being performed, character • Tolerance with long-term use • Headache, light-headedness, de- creased B/P; may indicate need for de- creased dosage; may aggravate symptoms of arterial insufficiency • Fluid overload: weight daily; report gain of >5 lb • I&O ratio, CCr if kidney damage is di- agnosed; fatigue, weight gain, jugular distention, dyspnea, peripheral edema, crackles • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk, cautious use in breastfeeding
Source pages 1100, 1102
SIDE EFFECTS CNS: Depression, hallucinations, dizzi ness, fatigue, lethargy, paresthesias, bizarre dreams, disorientation CV: Bradycardia, hypotension, HF, pal- pitations, AV block, peripheral vascular insufficiency, vasodilation, cold extremities, pulmonary edema, dysrhythmias EENT: Sore throat, laryngospasm, blurred vision, dry eyes GI: Nausea, vomiting, diarrhea, colitis, constipation, cramps, dry mouth, hepa- tomegaly, gastric pain, acute pancreatitis GU: Impotence, decreased libido, UTIs HEMA: Agranulocytosis, thrombocyto- penia INTEG: Rash, pruritus, fever, Stevens- Johnson syndrome, toxic epidermal necrolysis META: Hyperglycemia, hypoglycemia MISC: Facial swelling, weight change, Raynaud’s phenomenon MS: Joint pain, arthralgia, muscle cramps, pain RESP: Dyspnea, respiratory dysfunction, bronchospasm, cough
Source pages 1101, 1102
INTERACTIONS Increase: toxicity—phenothiazines Increase: propranolol level—propafenone Increase: effect of calcium channel blockers, neuromuscular blocker Increase: negative inotropic effects— disopyramide Increase: β-blocking effect—cimetidine Increase: hypotension—quiNIDine, hal- operidol, prazosin Decrease: β-blocking effects—barbiturates Decrease: propranolol levels— smoking Drug/Herb • Avoid use with feverfew Increase: antihypertensive effect— hawthorn Decrease: antihypertensive effect—ma huang Drug/Lab Test Increase: serum potassium, serum uric acid, ALT, AST, alk phos, LDH Decrease: blood glucose Interference: glaucoma testing
Source page 1102
Extracted information for propranolol only.
DOSAGE AND ROUTES Dysrhythmias • Adult: PO 10-30 mg tid-qid; IV BOL 1-3 mg give 1 mg/min; may repeat after 2 min, may repeat q4hr thereafter • Child: PO 1 mg/kg/day in 2 divided doses; IV 0.01-0.1 mg/kg over 5 min Hypertension • Adult: PO 40 mg bid or 80 mg/day (ext rel) initially; usual dose 120-240 mg/day bid-tid or 120-160 mg/day (ext rel) • Child: PO 0.5-1 mg/kg/day divided q6- 12hr Angina • Adult: PO 10-20 mg bid-qid, increase at 3-7 day intervals up to 160-320 mg/ day or EXT REL 80 mg daily MI prophylaxis • Adult: PO 180-240 mg/day tid-qid starting 5 days to 2 wk after MI Pheochromocytoma • Adult: PO 60 mg/day × 3 days preop- eratively in divided doses or 30 mg/day in divided doses (inoperable tumor) Migraine • Adult: PO 80 mg/day (ext rel) or in divided doses; may increase to 160-240 mg/day in divided doses • Child >35 kg (unlabeled): PO 20-40 mg tid • Child ≤35 kg (unlabeled): PO 10-20 mg tid Essential tremor • Adult: PO 40 mg bid; usual dose 120 mg/day Acute MI • Adult: PO 180-320 mg/day in 3-4 di- vided doses; IV 0.1 mg/kg in 3 divided doses at 2-3 min intervals Anxiety (unlabeled) • Adult: PO 10-80 mg given 1 hr before anxiety-producing event Scleroderma renal crisis (unlabeled) • Adult: PO 40 mg bid, may increase q3-7days, max 160-480 mg/day Esophageal varices (portal hypertension) (unlabeled) • Adult: PO 40 mg bid, titrate to heart rate reduction of 25%
Source page 1100
Available forms: Ext rel caps 60, 80, 120, 160 mg; tabs 10, 20, 40, 60, 80, 90 mg; inj 1 mg/mL; oral sol 20 mg, 40 mg/mL; oral sol (Hemangeol) 4.28 mg/mL
Source page 1100
Administer: PO route • Do not break, crush, chew, or open ext rel cap • Do not use ext rel cap for essential tremor, MI, cardiac dysrhythmias; do not use InnoPran XL in hypertropic subaortic stenosis, migraine, angina pectoris • Ext rel caps should be taken daily; In- noPran XL should be taken at bedtime • May mix oral sol with liquid or semisolid food; rinse container to get entire dose • With 8 oz water with food; food en- hances bioavailability • Do not give with aluminum-containing antacid; may decrease GI absorption Direct IV route IV undiluted or diluted 10 mL D5W for inj; give 0.5 mg/min (adult), over 10 min (child) Intermittent IV INFUSION route • May be diluted in 50 mL NaCl and run over 10-15 min Y-site compatibilities: Acyclovir, alfent- anil, alteplase, amikacin, aminocaproic acid, aminophylline, anidulafungin, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, car- mustine, caspofungin, cefamandole, ceFAZolin, cefmetazole, cefonicid, cefo- perazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, cephalothin, cephapirin, chloramphenicol, chlor- proMAZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclo- phosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, dexamethasone, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, eto- poside phosphate, famotidine, fenoldo- pam, fentaNYL, fluconazole, fludara- bine, fluorouracil, folic acid, furosemide, ganciclovir, gatifloxacin, gemcitabine, gemtuzumab, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, inamrinone, irino- tecan, isoproterenol, ketorolac, labet- alol, levoFLOXacin, lidocaine, linezolid, LORazepam, magnesium, mannitol, mechlorethamine, meperidine, meta- raminol, methicillin, methotrexate, methoxamine, methyldopate, methyl- PREDNISolone, metoclopramide, meto- prolol, metroNIDAZOLE, mezlocillin, miconazole, midazolam, milrinone, minocycline, mitoXANTRONE, mor- phine, moxalactam, multiple vitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, nitro- glycerin, nitroprusside, norepineph- rine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, palonosetron, pamidronate, pancuronium, papaver- ine, PEMEtrexed, penicillin G potas- sium/sodium, pentamidine, pentazo- cine, PENTobarbital, PHENobarbital, phenylephrine, phytonadione, piper- acillin, polymyxin B, potassium chlo- ride, procainamide, prochlorperazine, promethazine, propofol, protamine, P pyridoxine, quiNIDine, quinupristin- raNITIdine, ritodrine, dalfopristin, rocuronium, sodium acetate/bicarbon- ate, succinylcholine, SUFentanil, tacroli- mus, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavula- nate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, van- comycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voriconazole, zoledronic acid
Source pages 1100, 1101
Extracted information for propranolol only.
Assess:
Source page 1102
Evaluate: • Therapeutic response: decreased B/P, dysrhythmias
Source page 1102
CLINICAL CONSIDERATIONS
Source page 1102
Patient and caregiver information: • Not to discontinue abruptly; may pre- cipitate life-threatening dysrhythmias, exacerbation of angina, MI; to take prod- uct at same time each day, either with or without food consistently; to decrease dosage over 2 wk • To avoid OTC products unless ap- proved by prescriber; to avoid alcohol • To avoid hazardous activities if dizzy • About the importance of compliance with complete medical regimen; to moni- tor blood glucose, may mask symptoms of hypoglycemia • To make position changes slowly to prevent fainting • That sensitivity to cold may occur • How to take pulse, B/P; to withhold prod- uct if <50 bpm or systolic B/P <90 mm Hg
Source pages 1102, 1103
Extracted information for propranolol only.
PHARMACOKINETICS Metabolized by liver; crosses placenta, blood-brain barrier; excreted in breast milk; protein binding 90%; CYP2D6 enzyme system causes 7% of population to be poor metabolizers PO: Onset 30 min, peak 1-11/2 hr, dura- tion 12 hr, half-life 3-8 hr PO-ER: Peak 6 hr, duration 24 hr, half- life 8-11 hr IV: Onset 2 min, peak 1 min, duration 2-4 hr
Source page 1102
Filter the extracted dose blocks for this individual drug.
Dysrhythmias
• Child: PO 1 mg/kg/day in 2 divided doses; IV 0.01-0.1 mg/kg over 5 min Hypertension
Candidate age grouping · source page 1100
Dysrhythmias
• Child: PO 0.5-1 mg/kg/day divided q6- 12hr Angina
Candidate age grouping · source page 1100
Dysrhythmias
• Child >35 kg (unlabeled): PO 20-40 mg tid
Candidate age grouping · source page 1100
Dysrhythmias
• Child ≤35 kg (unlabeled): PO 10-20 mg tid Essential tremor
Candidate age grouping · source page 1100