Introduction
G Propranolol belongs to a group of medicines called beta-blockers. It helps to decrease anxiety and relieve tremors. It is also used to help prevent migraine, heart-related chest pain (angina), and bleeding in the stomach caused by high blood pressure in the liver (portal hypertension).
G Propranolol may also be used to treat high blood pressure and some types of abnormal heartbeat (arrhythmia). The dose will depend on what you are being treated for and how you respond to the medicine. You should always take it as prescribed by the doctor. It should be taken on an empty stomach and try to take it at the same time each day. You should keep taking it even if you feel well, as you are still getting the benefits. If you stop taking it suddenly, your condition may worsen.
The most common side effects are tiredness, weakness cold fingers and toes (Raynaud phenomenon), irregular or slow heartbeat, numbness in your fingers, and breathlessness. You may also experience nausea, vomiting and diarrhea. Talk to your doctor if the side effects bother you or do not go away. Most side effects are short-lived and improve as your body gets used to the medicine.
You should not use this medicine if you have asthma, very slow or uneven heartbeats or a serious heart condition, including heart failure. Talk to your doctor before taking it if you have kidney or liver problems or chronic obstructive pulmonary disease (COPD). In terms of lifestyle, alcohol may affect the way this medicine works and should be avoided. You should not drive if this medicine makes you feel dizzy. Ask your doctor whether it is safe to take this medicine if you are pregnant or breastfeeding.
Uses of G Propranolol
- Hypertension (high blood pressure)
- Angina (heart-related chest pain)
- Prevention of migraine
- Anxiety
- Tremors
- Arrhythmia
Side effects of G Propranolol
Common
- Arrhythmia (irregular heartbeats)
- Raynaud phenomenon
- Weakness
How to use G Propranolol
Use it as advised by your doctor or check the label for directions before use. G Propranolol is to be taken empty stomach.
Avoid G Propranolol with high-fat meals such as olive oil, nuts & seeds (Brazil nuts), dark chocolate, butter and meat.
How G Propranolol works
G Propranolol is a beta blocker. It works by affecting the body’s response to nerve impulses, especially in the heart. It slows down your heart rate and makes it easier for the heart to pump blood around the body. It also widens the blood vessels in the body for better blood flow.
What if you forget to take G Propranolol?
If you miss a dose of G Propranolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
Indication
HTN, Cardiac arrhythmias, Myocardial infarction, Angina pectoris, Portal hypertension, Migraine prophylaxis, Phaeochromocytoma, Hyperthyroidism, Essential tremor
Administration
Tab: Should be taken on an empty stomach. Take before meals.
Cap: May be taken with or without food. Take consistently either always w/ or always w/o meals.
Adult Dose
Oral
Hypertension
As conventional tab or oral soln: Initially, 40-80 mg bid. Usual range: 160-320 mg/day. Max: 640 mg/day.
As extended release cap: Initially, 80 mg once daily. Usual range: 120-160 mg once daily. Max: 640 mg/day.
Phaeochromocytoma
As conventional tab or oral soln: 60 mg/day in divided doses given 3 days pre-op w/ alpha-blocker. If tumour is inoperable, 30 mg/day in divided doses may be given.
Myocardial infarction
As conventional tab or oral soln: 40 mg 4 times daily for 2-3 days followed by 80 mg bid. Alternatively, 180-240 mg/day in divided doses. Doses are given w/in 5-21 days of MI.
Cardiac arrhythmias
Adult: As conventional tab or oral soln: 30-160 mg/day in divided doses.
Prophylaxis of migraine
As conventional tab or oral soln: Initially, 40 mg bid or tid. Usual range: 120-240 mg/day.
As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day.
Portal hypertension
As conventional tab or oral soln: Initially, 40 mg bid increased at wkly intervals up to 160 mg bid. As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 320 mg once daily.
Angina pectoris
As conventional tab or oral soln: Initially, 40 mg bid or tid. Usual range: 120-240 mg/day. Max: 320 mg/day.
As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day.
Hypertrophic cardiomyopathy
Adult: As conventional tab or oral soln: 10-40 mg, 3-4 times daily.
Hyperthyroidism
As conventional tab or oral soln: 10-40 mg, 3-4 times daily.
As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day.
Anxiety
As conventional tab or oral soln: 10-40 mg bid or tid.
As extended release cap: 80 mg once daily. Max: 160 mg once daily.
Essential tremor
As conventional tab or oral soln: Initially, 40 mg bid or tid. Usual range: 120-240 mg/day.
As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day.
Hepatic impairment: Severe: 20 mg tid. As extended release cap: 80 mg once daily or 160 mg every other day.
Child Dose
Oral
Hypertension
Child: As conventional tab: Initially, 1 mg/kg/day in 2 divided doses. Usual range: 2-4 mg/kg/day in 2 divided doses. Max: 4 mg/kg/day in 2 or 3 divided doses.
Phaeochromocytoma
Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily.
Cardiac arrhythmias
Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily.
Prophylaxis of migraine
Child: As conventional tab or oral soln: ?12 yr 10-20 mg bid or tid. >12 yr Initially, 40 mg bid or tid increased to wkly intervals up to 160 mg/day. Max: 240 mg/day.
Hyperthyroidism
Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily.
Contraindication
Sinus bradycardia, cardiogenic shock, sick sinus syndrome, Raynaud's syndrome, 2nd and 3rd degree heart block, overt CHF, bronchial asthma, COPD, untreated phaeochromocytoma, Prinzmetal's angina; severe peripheral arterial disease, metabolic acidosis. Concomitant use w/ thioridazine.
Mode of Action
Propranolol is a non-cardioselective beta-blocker that competitively blocks beta1- and beta2-receptors resulting in decreased heart rate, myocardial contractility, BP and myocardial oxygen demand. It has membrane-stabilising properties.
Precaution
Sinus node dysfunction, DM, history of nonallergic bronchospasm (e.g. chronic bronchitis, emphysema), myasthenia gravis, 1st degree heart block. May mask signs of hyperthyroidism and hypoglycaemia. Renal or hepatic impairment. Abrupt withdrawal may exacerbate angina symptoms or precipitate MI in patients w/ coronary artery disease. Elderly. Pregnancy and lactation. Patient Counselling Avoid cigarette smoking. Monitoring Parameters Monitor ECG, heart rate and BP.
Side Effect
Most adverse effects have been mild and transient and have rarely required the withdrawal of therapy.
Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type.
Central Nervous System: Lightheadedness; mental depression manifested by insomnia, lassitude, weakness, fatigue; reversible mental depression progressing to catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics. For immediate formulations, fatigue, lethargy, and vivid dreams appear dose related.
Gastrointestinal: Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, and ischemic colitis.
Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, pharyngitis and agranulocytosis, erythematous rash, fever combined with aching and sore throat, laryngospasm, and respiratory distress.
Respiratory: Bronchospasm.
Hematologic: Agranulocytosis, nonthrombocytopenic purpura, and thrombocytopenic purpura.
Skin: Stevens-Johnson Syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria.
Pregnancy Category Note
Pregnancy category: C, D in 2nd & 3rd trimesters.
Interaction
May cause additive negative chronotropic and/or inotropic effect w/ amiodarone, disopyramide, quinidine, flecainide and Ca channel blockers. May cause additive hypotensive effect w/ phenothiazines. β-adrenergic stimulating effects of sympathomimetic agents are antagonised. Concomitant admin w/ catecholamine-depleting drugs (e.g. reserpine) may cause additive effects and potentiate depression. Reduced antihypertensive effect w/ aluminium and NSAIDs. Coadministration w/ warfarin increases its bioavailability and prothrombin time. Altered antidiabetic response when used w/ antidiabetic agents and insulin. Increased risk of hypotension and attenuation of the reflex tachycardia w/ anaesth drugs.
Potentially Fatal: Increased risk of QT interval prolongation and torsades de pointes w/ thioridazine.