Product Name: Inderal
Generic Name: Propranolol
Common Brands: Inderal-LA, InnoPran-XL
Pharmaceutical Categories: Cardio, Blood Pressure, Cholesterol
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Here is an additional general information about this medication active ingredient propranolol:
Inderal is a non-selective beta-blocker. This medication has antihypertensive, antianginal and antiarrhythmic action.
The hypotensive effect is associated with a decrease in minute volume of blood, sympathetic stimulation of peripheral vascular disease, decreased activity of the renin-angiotensin system (has a value in patients with initial hypersecretion of renin), sensitivity of baroreceptors of the aortic arch (not going to enhance their activity in response to decreased blood pressure) and the effect on the CNS. The hypotensive effect is stabilized by the end of the second week of the prescription course.
The antianginal effect of Inderal is due to reduced myocardial oxygen demand (due to the negative chronotropic and inotropic effect).
The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increase of cAMP, hypertension), decrease in the rate of spontaneous excitation of the sinus and ectopic pacemakers and slowing of AV-holding.
The ability of this drug to prevent the development of headache of vascular origin is due to a decrease in expression of the expansion of cerebral arteries due to beta-adrenoblockade vascular receptors, inhibition induced by catecholamines platelet aggregation and lipolysis, reduction of platelet adhesiveness, prevention of activation of coagulation factors during the release of adrenaline, the stimulation of oxygen supply to tissues and decreased secretion of renin.
Reduction of tremor during treatment with propranolol caused mainly by the blockade of peripheral beta2-adrenergic receptors.
This medicine increases the atherogenic properties of blood; strengthens uterine contractions (spontaneous or induced by means of stimulating the myometrium); increases the tone of the bronchi; in high doses cause sedation.
After oral administration Inderal absorbed about 90% of the dose but bioavailability is low due to metabolism at the "first pass" through the liver. Cmax in plasma levels reached after 1-1.5 h. The protein binding is 93%. T1/2 is 3-5 h. This medication is excreted by the kidneys mainly as metabolites, unchanged - less than 1%.
Why is Inderal prescribed?
Hypertension; stenocardia, unstable stenocardia, sinus tachycardia (including in hyperthyroidism), supraventricular tachycardia, tachysystolic form of atrial fibrillation, supraventricular and ventricular extrasystoles, essential tremor, prevention of migraine, alcohol withdrawal syndrome (agitation, and tremor), anxiety, pheochromocytoma (adjuvant treatment), diffuse toxic goiter and thyrotoxic crisis (as subsidiary means, including intolerance to thyreostatics), sympathadrenalic crises against the backdrop of diencephalic syndrome.
Dosage and administration
The dosing regimen of Inderal is individual. For oral administration the starting dose is 20 mg, the single dose is 40-80 mg, the frequency of reception is 2-3 times / day.
For IV jet slowly injection the initial dose is 1 mg; after 2 minutes is administered the same dose again. In the absence of the effect of it is possible repeated injections.
Maximum doses: for oral administration - 320 mg / day; the repeated IV total dose is 10 mg (under the control of blood pressure and ECG).
Inderal side effects, adverse reactions
CNS and peripheral nervous system: fatigue, weakness, dizziness, headache, drowsiness or insomnia, vivid dreams, depression, anxiety, confusion, hallucinations, tremors, nervousness, anxiety.
Sensory organs: a decrease in the secretion of tear fluid (dryness and soreness of the eyes).
Cardiovascular system: sinus bradycardia, AV block (up to the full development of cross-blockade and cardiac arrest), arrhythmia, development (worsening) of chronic heart failure, decreased blood pressure, orthostatic hypotension, manifestation of angiospasm (increased peripheral circulatory disorders, cold lower extremities, Raynaud's syndrome), pain in the chest.
Digestive system: nausea, vomiting, epigastric discomfort, constipation or diarrhea, liver problems (dark urine, yellow skin or sclera, cholestasis), changes in taste, elevated liver enzymes, lactate dehydrogenase.
Respiratory system: nasal congestion, bronchospasm.
Endocrine: changes in blood glucose (hypo- or hyperglycemia).
hematopoietic system: thrombocytopenia (unusual bleeding and hemorrhage), leukopenia.
Dermatological reactions: increased sweating, psoriasis such as skin reactions, exacerbation of psoriasis symptoms.
Allergic reactions: itching, skin rash, urticaria.
Other: back pain, arthralgia, reduced potency, withdrawal symptoms (increasing stenocardia attacks, myocardial infarction, increased blood pressure).
AV-block II and III degree, sinoatrial block, bradycardia (heart rate is less than 55 beats / min), SSS, hypotension (systolic blood pressure is less than 90 mm Hg, especially in myocardial infarction), chronic heart failure IIB-III stages, acute heart failure, cardiogenic shock, hypersensitivity to propranolol.
Using during pregnancy and breastfeeding
The use of Inderal during pregnancy is only possible if the intended benefits to the mother outweighs the potential risk to the fetus. If necessary to use this medication in this period it should be careful monitoring of the fetus, for 48-72 hours before delivery propranolol should be discontinued.
It should be borne in mind that the possible negative effects on the fetus: fetal growth retardation, hypoglycemia, bradycardia.
Propranolol is excreted in breast milk. If necessary to use Inderal during lactation it should be set-up of the child or to stop breastfeeding.
Use Inderal with caution in patients with bronchial asthma, COPD, bronchitis, decompensated heart failure, diabetes, renal and / or liver failure, hyperthyroidism, depression, myasthenia gravis, psoriasis, occlusive peripheral vascular disease, pregnancy, lactation, elderly patients, children (efficacy and safety are not defined).
During the period of treatment it may been exacerbation of psoriasis.
When pheochromocytoma propranolol can be applied only after taking alpha-blockers.
After a lengthy course of treatment Inderal should be lifted gradually, under medical supervision.
During treatment with this drug it should be avoided in the intravenous administration of verapamil, diltiazem.
A few days before the anesthesia it is necessary to stop taking propranolol or find a means of anesthesia with minimal negative inotropic effects.
Patients whose work requires more attention, the application of this medication outpatients should be addressed only after the evaluation of individual patient response.
Inderal drug interactions
This medicine strengthens (relatively) the negative effect of verapamil and diltiazem on myocardium, prolongs the action non depolarizing muscle relaxant, inhibits the excretion of lidocaine. NSAIDs, corticosteroids, estrogens, cocaine weaken the anti-hypertensive effect of Inderal; nitrates and other antihypertensive drugs increase it. Heparin, antacids decrease the level of this drug in plasma; cimetidine and phenothiazines increase it. It is not recommended for concomitant use with MAO inhibitors. Slows down the metabolism of theophylline and increase its concentration in blood plasma.
Inderal in case of emergency / overdose
Symptoms: dizziness, bradycardia, arrhythmia, heart failure, hypotension, collapse, difficulty breathing, acrocyanosis, convulsions.
Treatment: gastric lavage and the appointment of absorbent material, symptomatic therapy: atropine, beta-adrenoceptor agonists (isoprenaline, izadrin), sedatives (diazepam, lorazepam), cardiac (dobutamine, dopamine, epinephrine) medications, pressor drugs, glucagon, etc.; it is possible to conduct transvenous stimulation. Hemodialysis is ineffective.
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