Inderal

What is it?

A preparation which is a non-cardioselective β-blocker produced as pink, film-coated tablets containing 10mg, 40mg and 80mg of propranolol hydrochloride all marked with name and strength. Also, INDERAL INJECTION containing 1mg of propranolol hydrochloride per ml in ampoules for injection.

Medical Uses

Heart arrhythmias, prevention of second heart attack, enlarged and weakened heart muscle, angina, Fallot's tetralogy (a congenital defect of the heart), high blood pressure, additional therapy in thyrotoxicosis (toxicity of thyroid gland), phaeochromocytoma (adrenal gland tumour), situational and generalized anxiety.

Dosage

Tablets, adults, prevention of second heart attack, 40mg 4 times each day for 2 or 3 days starting from 5 to 21 days after first attack. Then a maintenance dose of 80mg twice each day. Arrhythmias and enlarged heart, 10 to 40mg 3 or 4 times each day. Angina, 40mg 2 or 3 times each day at first increasing at weekly intervals if required to a usual dose in the order of 120-240mg daily. Hypertension, 80mg twice each day at first increasing at weekly intervals if required to usual dose in the order of 160 to 320mg daily. Phaeochromocytoma, 60mg each day taken along with an alpha-blocker for 3 days before operation for removal. If tumour is inoperable, a 30mg daily dose should be taken. Situational anxiety, 40mg each day; generalized anxiety, the same dose twice daily increasing to 3 times each day if needed. Tablets, children, arrhythmias, 0.25 to 0.5mg per kg of body weight 3 to 4 times each day. Fallot's tetralogy, up to 1mg per kg of body weight 3 or 4 times each day. Phaeochromocytoma, 0.25 to 0.5mg per kg of body weight 3 or 4 times each day, dose varying according to needs of patient. Injection, adults and children, according to manufacturer's instructions.

Special Care

Pregnancy, breast-feeding, patients with weak hearts should receive diuretics and digitalis, liver or kidney disease, diabetes, metabolic acidosis, weakness, insufficient cerebral circulation, thyrotoxic crisis, tendency to exhibit allergic symptoms. Persons undergoing general anaesthesia may need to be withdrawn before planned surgery. Withdraw drug gradually.

Avoid Use

Children, patients with obstructive airways disease or history of bronchospasm (asthma), various heart disorders including heart block, heart shock, heart failure, sick sinus syndrome, serious peripheral arterial disease, sinus bradycardia, disease of heart muscle, Prinzmetal's angina, hypotension, right ventricular failure resulting from pulmonary hypertension, untreated phaeochromocytoma (tumour of the adrenal glands).

Possible Drug and Food Interactions

Cardiac depressant anaesthetics, theophylline, anti- hypertensives, ergot alkaloids, diltiazem, sympathomimetics, verapamil, clonidine withdrawal, CNS depressants, class I antiarrhythmic drugs, rifampicin, cimetidine, class II calcium antagonists, warfarin, reserpine, ibuprofen, indomethacin, hypoglycaemics.

Known Side Effects

Bradycardia, fatigue on exercise, cold hands and feet, central nervous system effects, disturbance of sleep, gastro-intestinal upset, bronchospasm, heart failure, low blood pressure, baldness, thrombocytopenia (reduction in blood platelets). Withdraw drug gradually if dry eyes or skin rash occur.