INDERAL 10mg, 40mg or 80mg Tablets
( Propranolol Hydrochloride )
PRESENTATION:
Tablets containing 10mg, 40mg or 80mg Propranolol Hydrochloride Ph. Eur.
INDICATIONS:
i) Control of hypertension
ii) Management of angina pectoris
iii) Long term prophylaxis after recovery from acute myocardial infarction
iv) Control of cardiac arrhythmias
v) Prophylaxis of migraine
vi) Management of essential tremor
vii) Control of anxiety and anxiety tachycardia
viii) Adjunctive management of thyrotoxicosis and thyrotoxic crisis
ix) Management of hypertrophic obstructive cardiomyopathy
x) Management of phaeochromocytoma ('Inderal' should only be started in the presence of effective alpha blockade)
DOSAGE AND ADMINISTRATION:
Since the half-time may be increased in patients with significant hepatic or renal impairment, caution must be exercised when starting treatment and selecting the initial dose.
Oral Dosage:
Adults
Hypertension: A starting of 80mg twice a day may be increased at weekly intervals according to response. The usual dose range is 160-320mg per day and maximum daily dose must not exceed 640mg per day (see summary table below). With concurrent diuretic or other antihypertensive drugs a further reduction of blood pressure is obtained.
Angina, anxiety migraine and essential tremor: A starting dose 40mg two or three times daily may be increased by the same amount at weekly intervals according to patient response. An adequate response in anxiety, migraine and essential tremor is usually seen in the range 80-160mg/day, and in migraine and 480mg for angina must not be exceeded. (see summary table).
Arrhythmias, anxiety, tachycardia, hypertrophic obstructive cardiomyopathy and thyrotoxicosis: A dosage range of 10-40mg three or four times a day usually achieves the required response. A maximum daily dose of 240mg for arrhythmias must not be exceeded. (see summary table).
Post-myocardial infarction: Treatment should start between days 5 and 21 after myocardial infarction, with an initial dose of 40 mg four times a day for 2 or 3 days. In order to prove compliance the total daily dosage may thereafter be given as 80 mg twice a day (see summary table).
Phaeochromocytoma: ('Inderal' is to be used only in the presence of effective alpha-blockade). Preoperative: 60 mg daily for three days is recommended. Non-operable malignant cases:30 mg daily (see summary table).
Summary Table of Inderal Oral Dosage - Adults
( Propranolol Hydrochloride )
PRESENTATION:
Tablets containing 10mg, 40mg or 80mg Propranolol Hydrochloride Ph. Eur.
INDICATIONS:
i) Control of hypertension
ii) Management of angina pectoris
iii) Long term prophylaxis after recovery from acute myocardial infarction
iv) Control of cardiac arrhythmias
v) Prophylaxis of migraine
vi) Management of essential tremor
vii) Control of anxiety and anxiety tachycardia
viii) Adjunctive management of thyrotoxicosis and thyrotoxic crisis
ix) Management of hypertrophic obstructive cardiomyopathy
x) Management of phaeochromocytoma ('Inderal' should only be started in the presence of effective alpha blockade)
DOSAGE AND ADMINISTRATION:
Since the half-time may be increased in patients with significant hepatic or renal impairment, caution must be exercised when starting treatment and selecting the initial dose.
Oral Dosage:
Adults
Hypertension: A starting of 80mg twice a day may be increased at weekly intervals according to response. The usual dose range is 160-320mg per day and maximum daily dose must not exceed 640mg per day (see summary table below). With concurrent diuretic or other antihypertensive drugs a further reduction of blood pressure is obtained.
Angina, anxiety migraine and essential tremor: A starting dose 40mg two or three times daily may be increased by the same amount at weekly intervals according to patient response. An adequate response in anxiety, migraine and essential tremor is usually seen in the range 80-160mg/day, and in migraine and 480mg for angina must not be exceeded. (see summary table).
Arrhythmias, anxiety, tachycardia, hypertrophic obstructive cardiomyopathy and thyrotoxicosis: A dosage range of 10-40mg three or four times a day usually achieves the required response. A maximum daily dose of 240mg for arrhythmias must not be exceeded. (see summary table).
Post-myocardial infarction: Treatment should start between days 5 and 21 after myocardial infarction, with an initial dose of 40 mg four times a day for 2 or 3 days. In order to prove compliance the total daily dosage may thereafter be given as 80 mg twice a day (see summary table).
Phaeochromocytoma: ('Inderal' is to be used only in the presence of effective alpha-blockade). Preoperative: 60 mg daily for three days is recommended. Non-operable malignant cases:30 mg daily (see summary table).
Summary Table of Inderal Oral Dosage - Adults
(in divided daily doses)
| Inderal Oral Dosage Table | Max/day | Min/day |
| Hypertension | 640mg | 160mg |
| Angina pectoris | 480mg | 80mg |
| Arrhythmias | 240mg | 30mg |
| Migraine | 240mg | 80mg |
| Tremor | 160mg | 40mg |
| Anxiety | 160mg | 80mg |
| Anxiety Tachycardia | 160mg | 30mg |
| Thyrotoxicosis | 160mg | 30mg |
| Cardiomyopathy | 160mg | 30mg |
| Phaeochromocytoma | 60mg (pre op) | 60mg |
| Or | 30mg (maintenance) | 30mg |
| Post-infarction | 160mg | 160mg |
Elderly:
Evidence concerning the relation between blood level and age is conflicting. With regard to the elderly, the optimum dose should be individually determined according to clinical response.
Children:
Dosage should be individually determined and the following is only a guide:
Arrhythmias, phaeochromocytoma, thyrotoxicosis: Oral: 0.25 - 0.5mg/kg three or four times daily as required.
Migraine: Oral: Under the age of 12: 20mg two or three times daily. Over the age of 12: the adults dose.
CONTRA-INDICATIONS:
INDERAL mustnot be used if there is a history of bronchial asthma or bronchospasm.
bronchospasm can usually be reversed by beta 2- agonist bronchodilators such as salbutamol. Large doses of the beta2-agonist bronchodiltor may be required to over come the beta-blockade produced by propranolol and the doses shoud be titrated according to the clinical response; both intravenous and inhalatinnal administration should be considered . The use of intravenous aminophyline and\or the use of ipratropium, (1 to 2 mg given intravenously) has also been reported to produce a bronchodiltor effect in asthmatic patients. Oxygen or artificial ventilation may be required in sever cases.
'Inderal' as with other beta-blockers must not be used in patients with any of the following: knows hypersensitivity to the substance; bradycardia; cardiagenic shock; hypertension; matabolic acidosis; after prolonged fasting; serve peripheral arterial circulatory disturbance; second or third degree heart block; sick sinus syndrome; untreated (with an alpha adrenoceptor antagonist) phaeochromocytoma; uncontrolled heart failure; Prinzmetal's angina.
'Inderal' must not be used in patients prone to hypoglycaemia, i,e, patients after prolonged fasting or patients with restricted counter-regulatory reserves. Patients with restricted-counter regulatory reserves may have reduced autonomic and hormonal responses to hypoglycaemia which includes glycogenolysis, gluconeogensis and/or impaired modulation of insulin secretion. patients at risk for an inadequate response to hypoglycaemia includes individuals with malnutrition, prolonged fasting, starvation, chronic liver disease, diabetes and concomitant use of drugs which block the full response to catecholamines.