Propranolol 80mg

Antianginal Agent; Class II Antiarrhythmic; Nonselective Beta-Blocker

“ALERT: US Boxed Warning

Cardiac ischemia after abrupt discontinuation (Inderal LA, Inderal XL, Innopran XL):

Following abrupt discontinuation of therapy with beta-blockers, exacerbations of angina pectoris and myocardial infarction (MI) have occurred.

When discontinuing long-term administration of propranolol, particularly in patients with ischemic heart disease, gradually reduce the dose over a period of 1 to 2 weeks and monitor the patient. If angina markedly worsens or acute coronary insufficiency develops, promptly resume therapy, at least temporarily, and take other measures appropriate for the management of unstable angina. Warn patients against interruption or discontinuation of therapy without health care provider’s advice.

Because coronary artery disease is common and may be unrecognized, avoid abrupt discontinuation of propranolol therapy, even in patients treated only for hypertension.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Propranolol/Inderal competitively blocks beta1 and beta2 adrenergic receptors resulting in decreased heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand.  Reduces portal vein (major blood vessel that feeds into liver) pressure via beta2 effects on splanchnic vasoconstriction which in turn lowers portal blood flow.

Propranolol/Inderal is officially indicated for chronic stable angina, cardiac arrythmias, essential tremor, hypertension, migraine prophylaxis, myocardial infarction early treatment and secondary prevention, obstructive hypertrophic cardiomyopathy, pheochromocytoma, or proliferating infantile hemangioma.  It is also prescribed off-label for use in antipsychotic induced akathisia, performance anxiety disorder, thyroid storm, thyrotoxicosis, lithium induced tremor, and variceal hemorrhage prophylaxis.  

Before starting Propranolol/Inderal make sure your physician is aware of any allergies, medications you currently take, if you have a low resting heart rate, asthma or other bronchospastic disease, cardiac conduction abnormalities, diabetes, liver disease, myasthenia gravis, peripheral vascular disease, hyperthyroidism, kidney disease, psoriasis, or if pregnant/breastfeeding

Instant release: 10-160 mg divided in up to four daily dosages 

Extended release: 60-320 mg once daily

How to Take: Follow instructions provided by physician/pharmacy label, swallow whole (extended release), take consistently at same times each day unless otherwise directed, take instant release tablets on an empty stomach, extended can be with or without but be consistent, store at room temperature

You Need to Avoid: Careful standing up too quickly as you may get dizzy.  Do not stop this medication abruptly to avoid rebound tachycardia, hypertension and in severe cases angina, heart attack, or arrythmia.  Consume alcohol with caution as it may affect blood levels of propranolol.  If consumed, then monitor blood pressure and heart rate.

Hypotension, dizziness, fatigue, bradycardia (low heart rate), depression, insomnia, weakness, disorientation, nausea, purpura (red/purple spots on skin), alopecia, impotence 

Note this is not a complete list of side effects, only common ones

1. Why am I so tired since starting propranolol?
    It is a common side effect that is not harmful and after 2 weeks or so it should subside as you adjust to the medication.  It is important to try and give the medication at least 2 weeks if fatigue is an issue as it usually will resolve.  If side effects are intolerable speak to your physician, do not discontinue medication without their consent as this can be a vital medication to take for many conditions.
2. Why does exercise exhaust me so much more since starting this medication?
   Blocking cardiac output can lower your exercise tolerance as the heart cannot pump as hard or fast as it used to in response to exercise.  This is normal and helps protect the heart from overworking itself in many cardiac conditions.  If using for a non cardiac condition it is then a side effect that if intolerable should be discussed with your physician.