propranolol hydrochloride

Drug Name

Generic Name : propranolol hydrochloride

Brand Name: Apo-Propranolol (CAN), Inderal, Inderal LA, InnoPran XL, Nu-Propranolol (CAN), Propranolol Intensolol

Classification: Beta-adrenergic blocker (nonselective), Antianginal, Antiarrhythmic, Antihypertensive

Pregnancy Category C 

Dosage & Route

Available forms : ER capsules—60, 80, 120, 160 mg; tablets—10, 20, 40, 60, 80, 90 mg; SR capsules—60, 80, 120, 160 mg; injection—1 mg/mL; oral solution—4, 8 mg/mL; concentrated oral solution—80 mg/mL

ADULTS

Oral

  • Hypertension: 40 mg regular propranolol bid or 80 mg SR daily initially; usual maintenance dose, 120–240 mg/day given bid or tid or 120–160 mg SR daily (maximum dose, 640 mg/day).
  • Angina: 80–320 mg/day divided bid, tid, or qid or 80 mg SR daily initially; gradually increase dosage at 3- to 7-day intervals; usual maintenance dose, 160 mg/day (maximum dose, 320 mg/day).
  • IHSS: 20–40 mg tid or qid or 80–160 mg SR daily.
  • Arrhythmias: 10–30 mg tid or qid.
  • MI: 180–240 mg/day given tid or qid (maximum dose, 240 mg/day).
  • Pheochromocytoma: Preoperatively, 60 mg/day for 3 days in divided doses; inoperable tumor, 30 mg/day in divided doses.
  • Migraine: 80 mg/day daily (SR) or in divided doses; usual maintenance dose, 160–240 mg/day.
  • Essential tremor: 40 mg bid; usual maintenance dose, 120 mg/day (maximum dose, 320 mg/day)

Parenteral

  • WARNING: IV dose is markedly less than oral because of first-pass effect with oral propranolol.
  • Life-threatening arrhythmias: 1–3 mg IV with careful monitoring, not to exceed 1 mg/min; may give second dose in 2 min, but then do not repeat for 4 hr.
PEDIATRIC PATIENTS
  • Safety and efficacy not established.
Therapeutic actions
  • Propranolol competitively blocks β1- and β2-receptors resulting to decreased heart rate myocardial contractility, BP and myocardial oxygen demand. It only possesses membrane-stabilising properties.
Indications
  • Hypertension alone or with other drugs, especially diuretics
  • Angina pectoris caused by coronary atherosclerosis
  • Idiopathic hypertrophic subaortic stenosis to manage associated stress-induced angina, palpitations, and syncope
  • Cardiac arrhythmias, especially supraventricular tachycardia, and ventricular tachycardias induced by digitalis or catecholamines
  • Prevention of reinfarction in clinically stable patients 5–21 days after MI
  • Pheochromocytoma, an adjunctive therapy after treatment with an alpha-adrenergic blocker to manage tachycardia before or during surgery or if the pheochromocytoma is inoperable
  • Prophylaxis for migraine headache
  • Treatment of essential tremor, familial or hereditary
  • Unlabeled uses: Recurrent GI bleeding in cirrhotic patients, schizophrenia, tardive dyskinesia, acute panic symptoms, anxiety, CHF
Adverse effects
  • Cold extremities, insomnia, fatigue, dizziness, vivid dreams, lassitude, nausea, constipation or diarrhoea, vomiting, anorexia, stomach discomfort, impotence. Weakness, paraesthesia, wheezing, pharyngitis, bronchospasm. CNS disturbances at higher doses and mood alterations. Thrombocytopenic purpura, agranulocytosis, nonthrombocytopenic purpura, thrombocytopenia. Depression, confusion, cognitive dysfunction, emotional lability, fatigue, hallucinations.
  • Potentially Fatal: Heart failure, heart block and bronchospasm.
Contraindications
  • Sinus bradycardia, cardiogenic shock, pulmonary oedema, severe hyperactive airway disease, compensated cardiac failure, Raynaud’s disease, hypoglycaemia, severe haemorrhage, metabolic acidosis, severe peripheral arterial disease, 2nd or 3rd degree heart block. Pregnancy (2nd and 3rd trimesters).
Nursing considerations
Assessment
  • History: Allergy to beta-blocking agents, sinus bradycardia, second- or third-degree heart block, cardiogenic shock, CHF, bronchial asthma, bronchospasm, COPD, hypoglycemia and diabetes, thyrotoxicosis, hepatic impairment, pregnancy, lactation
  • Physical: Weight, skin color, lesions, edema, T; reflexes, affect, vision, hearing, orientation; BP, P, ECG, peripheral perfusion; R, auscultation; bowel sounds, normal output, liver evaluation; bladder palpation; LFTs, thyroid function tests; blood and urine glucose
Interventions
  • WARNING: Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring.
  • WARNING: Ensure that alpha-adrenergic blocker has been given before giving propranolol when treating patients with pheochromocytoma; endogenous catecholamines secreted by the tumor can cause severe hypertension if vascular beta receptors are blocked without concomitant alpha blockade.
  • Consult with physician about withdrawing drug if patient is to undergo surgery (withdrawal is controversial).
  • Provide continuous cardiac and regular BP monitoring with IV form. Change to oral form as soon as possible.
  • Give oral drug with food to facilitate absorption.
Teaching points
  • Take this drug with meals. Do not discontinue the medication abruptly; abrupt discontinuation can cause a worsening of your disorder.
  • If you have diabetes, the normal signs of hypoglycemia (tachycardia) may be blocked by this drug; monitor your blood or urine glucose carefully; eat regular meals, and take your diabetic medication regularly.
  • You may experience these side effects: Dizziness, drowsiness, light-headedness, blurred vision (avoid driving or performing hazardous tasks); nausea, loss of appetite (eat frequent small meals); nightmares, depression (request change of your medication); sexual impotence.
  • Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.