Propranolol

Propranolol Brand Names

HEMANGEOL | Inderal | Inderal LA | Inderal XL | InnoPran XL

What is Propranolol

Propranolol is the prototype of the beta-adrenergic receptor antagonists. It is a competitive, nonselective beta-blocker without intrinsic sympathomimetic activity, similar to nadolol.

Although propranolol has membrane-stabilizing effects on the action potential, these effects are clinically insignificant except in overdose situations. Propranolol is a racemic compound, with only its l-isomer having any adrenergic blocking activity.

The 2007 AHA guidelines for the management of hypertension state beta-blockers should not be used as first-line therapy for the treatment of hypertension, as several comparative clinical trials have shown beta blockers to be inferior to ACE inhibitors, angiotensin-receptor blockers, or calcium channel blockers for preventing both stroke and coronary artery disease complications.

These guidelines do, however, recommend the use of beta-blockers for the treatment of hypertension in patients with angina, prior myocardial infarction, or heart failure.

Propranolol was first approved by the FDA in 1967; an  extended-release formulation designed for bedtime-dosing was approved in March 2003.

Hemangeol, an oral solution specifically approved for treatment of proliferating infantile hemangiomas, was approved by the FDA in March 2014.

Indications

1. acute myocardial infarction
2. agitation
3. angina
4. anxiety
5. atrial fibrillation
6. atrial flutter
7. burns
8. esophageal varices
9. heart failure
10. hemangioma
11. hypertension
12. idiopathic hypertrophic subaortic stenosis (IHSS)
13. junctional ectopic tachycardia
14. migraine prophylaxis
15. paroxysmal supraventricular tachycardia (PSVT)
16. paroxysmal supraventricular tachycardia (PSVT) prophylaxis
17. pheochromocytoma
18. portal hypertension
19. reduction of cardiovascular mortality
20. scleroderma renal crisis
21. supraventricular arrhythmias
22. tetralogy spells
23. thyrotoxicosis
24. tremor
25. unstable angina
26. variceal bleeding prophylaxis
27. Wolff-Parkinson-White (WPW) syndrome

Side Effects

1. abdominal pain
2. agitation
3. agranulocytosis
4. alopecia
5. anaphylactoid reactions
6. anorexia
7. AV block
8. bradycardia
9. bronchospasm
10. colitis
11. coma
12. confusion
13. constipation
14. cough
15. depression
16. diabetes mellitus
17. diaphoresis
18. diarrhea
19. dizziness
20. drowsiness
21. dyspnea
22. elevated hepatic enzymes
23. emotional lability
24. erythema multiforme
25. exfoliative dermatitis
26. fatigue
27. fever
28. hallucinations
29. headache
30. heart failure
31. hyperglycemia
32. hyperkalemia
33. hypertension
34. hypertriglyceridemia
35. hypoglycemia
36. hypotension
37. impotence (erectile dysfunction)
38. infection
39. insomnia
40. irritability
41. laryngospasm
42. lethargy
43. lupus-like symptoms
44. memory impairment
45. myopathy
46. nausea
47. nightmares
48. palpitations
49. paresthesias
50. pharyngitis
51. pruritus
52. psoriaform rash
53. psoriasis
54. seizures
55. sinus tachycardia
56. Stevens-Johnson syndrome
57. thrombosis
58. thrombotic thrombocytopenic purpura (TTP)
59. toxic epidermal necrolysis
60. tremor
61. urticaria
62. visual impairment
63. vomiting
64. weakness
65. withdrawal
66. xerophthalmia
67. xerosis

Monitoring Parameters

• blood pressure
• heart rate

Contraindications

• abrupt discontinuation
• acute bronchospasm
• acute heart failure
• asthma
• AV block
• beta-blocker hypersensitivity
• bradycardia
• breast-feeding
• bronchitis
• cardiogenic shock
• cerebrovascular disease
• children
• chronic obstructive pulmonary disease (COPD)
• depression
• diabetes mellitus
• driving or operating machinery
• emphysema
• geriatric
• hepatic disease
• hyperthyroidism
• hypoglycemia
• hypotension
• infants
• myasthenia gravis
• myopathy
• neonates
• obstetric delivery
• PHACE syndrome
• pheochromocytoma
• pregnancy
• premature neonates
• psoriasis
• pulmonary disease
• pulmonary edema
• Raynaud’s phenomenon
• renal failure
• renal impairment
• sick sinus syndrome
• stroke
• surgery
• thyroid disease
• thyrotoxicosis
• tobacco smoking
• vasospastic angina
• ventricular dysfunction
• Wolff-Parkinson-White syndrome

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