Propranolol

Inderal

Pronounced: IN-der-al
Generic name: Propranolol hydrochloride
Other brand name: Inderal LA

Why is this drug prescribed?

Inderal, a type of medication known as a beta blocker, is used in the treatment of high blood pressure, angina pectoris (chest pain, usually caused by lack of oxygen to the heart due to clogged arteries), changes in heart rhythm, prevention of migraine headache, hereditary tremors, hypertrophic subaortic stenosis (a condition related to exertional angina), and tumors of the adrenal gland. It is also used to reduce the risk of death from recurring heart attack.

When used for the treatment of high blood pressure, it is effective alone or combined with other high blood pressure medications, particularly thiazide-type diuretics. Beta blockers decrease the force and rate of heart contractions, reducing the heart's demand for oxygen and lowering blood pressure.

Most important fact about this drug

If you have high blood pressure, you must take Inderal regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of Inderal; and you must continue taking it even if you are feeling well. Inderal does not cure high blood pressure; it merely keeps it under control.

How should you take this medication?

Inderal works best when taken before meals. Take it exactly as prescribed, even if your symptoms have disappeared.

Try not to miss any doses. If this medication is not taken regularly, your condition may worsen.

--If you miss a dose...

Take it as soon as you remember. If it is within 8 hours of your next scheduled dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.

--Storage instructions...

Store at room temperature in a tightly closed, light-resistant container. Protect from freezing or excessive heat.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Inderal.

• Side effects may include:
  Abdominal cramps, colitis, congestive heart failure, constipation, decreased sexual ability, depression, diarrhea, difficulty breathing, disorientation, dry eyes, fever with sore throat, hair loss, hallucinations, headache, light-headedness, low blood pressure, lupus erythematosus (a disease of the connective tissue), nausea, rash, reddish or purplish spots on the skin, short-term memory loss, slow heartbeat, tingling, prickling in hands, tiredness, trouble sleeping, upset stomach, visual changes, vivid dreams, vomiting, weakness, worsening of certain heartbeat irregularities

Why should this drug not be prescribed?

If you have inadequate blood supply to the circulatory system (cardiogenic shock), certain types of irregular heartbeat, a slow heartbeat, bronchial asthma, or severe congestive heart failure, you should not take this medication.

Special warnings about this medication

If you have a history of congestive heart failure, your doctor will prescribe Inderal cautiously.

Inderal should not be stopped suddenly. This can cause increased chest pain and heart attack. Dosage should be gradually reduced.

If you suffer from asthma or other bronchial conditions, coronary artery disease, or kidney or liver disease, this medication should be used with caution.

Ask your doctor if you should check your pulse while taking Inderal. This medication can cause your heartbeat to become too slow.

This medication may mask the symptoms of low blood sugar or alter blood sugar levels. In addition, diabetics who experience a severe drop in blood sugar after taking insulin may suffer a spike in blood pressure if they are also taking Inderal.

Notify your doctor or dentist that you are taking Inderal if you have a medical emergency, and before you have surgery or dental treatment.

Possible food and drug interactions when taking this medication

If Inderal is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Inderal with the following:

Alcohol
Aluminum hydroxide gel (Amphojel)
Antipyrine (Auralgan)
Calcium-blocking blood pressure drugs such as Cardizem, Procardia, and Calan
Certain high blood pressure medications such as Diupres and Ser-Ap-Es
Chlorpromazine (Thorazine)
Cimetidine (Tagamet)
Epinephrine (EpiPen)
Haloperidol (Haldol)
Insulin
Lidocaine (Xylocaine)
Nonsteroidal anti-inflammatory drugs such as Motrin and Naprosyn
Oral diabetes drugs such as Micronase
Phenobarbitone
Phenytoin (Dilantin)
Rifampin (Rifadin)
Theophylline (Theo-Dur and others)
Thyroid medications such as Synthroid

Special information if you are pregnant or breastfeeding

The effects of Inderal during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Inderal appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with this medication is finished.

Recommended dosage

ADULTS

All dosages of Inderal, for any problem, must be tailored to the individual. Your doctor will determine when and how often you should take this drug. If you are over 65, the doctor will probably start with a relatively low dosage. Remember to take it exactly as directed.

Hypertension

The usual starting dose is 40 milligrams 2 times a day. This dose may be in combination with a diuretic. Dosages are gradually increased to between 120 milligrams and 240 milligrams per day for maintenance. In some cases, a dose of 640 milligrams per day may be needed. Depending on the individual, maximum effect of this drug may not be reached for a few days or even several weeks. Some people may do better taking this medication 3 times a day.

Angina Pectoris

The usual daily dosage is 80 milligrams to 320 milligrams, divided into 2, 3, or 4 smaller doses. When your treatment is being discontinued, your doctor will reduce the dosage gradually over a period of several weeks.

Irregular Heartbeat

The usual dose is 10 milligrams to 30 milligrams 3 or 4 times a day, before meals and at bedtime.

Heart Attack

The usual daily dosage is 180 milligrams to 240 milligrams divided into smaller doses. The usual maximum dose is 240 milligrams, although your doctor may increase the dose when treating heart attack with angina or high blood pressure.

Migraine

The usual starting dosage is 80 milligrams per day divided into smaller doses. Dosages can be increased gradually to between 160 milligrams and 240 milligrams per day. If this dose does not relieve your symptoms in 4 to 6 weeks, your doctor will slowly take you off the drug.

Tremors

The usual starting dose is 40 milligrams, 2 times per day. Symptoms will usually be relieved with a dose of 120 milligrams per day; however, on occasion, dosages of 240 milligrams to 320 milligrams per day may be necessary.

Hypertrophic Subaortic Stenosis

The usual dose is 20 milligrams to 40 milligrams, 3 to 4 times a day, before meals and at bedtime.

Before Adrenal Gland Surgery

The usual dose is 60 milligrams a day divided into smaller doses for 3 days before surgery in combination with an alpha-blocker drug.

Inderal may also be taken by people with inoperable tumors in doses of 30 milligrams a day, divided into smaller doses.

CHILDREN

Inderal will be carefully individualized for use in children and is used only for high blood pressure. Doses in children are calculated by body weight, and range from 2 milligrams to 4 milligrams per 2.2 pounds daily, divided into 2 equal doses. The maximum dose is 16 milligrams per 2.2 pounds per day.

If treatment is stopped, this drug must be gradually reduced over a 7- to 14-day period.

Inderal is also available in a sustained-release formulation, called Inderal LA, for once-a-day dosing.

Overdosage

No specific information on Inderal overdosage is available; however, overdose symptoms with other beta blockers include:

Extremely slow heartbeat, irregular heartbeat, low blood pressure, severe congestive heart failure, seizures, wheezing

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

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