What is propranolol?
Propranolol is a beta-blocker. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).
Propranolol is used to treat tremors, angina(chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack, and to reduce the severity and frequency of migraine headaches.
Hemangeol (propranolol oral liquid 4.28 milligrams) is given to infants 5 weeks to 1 year old to treat a genetic condition called infantile hemangiomas. Hemangiomas are caused by blood vessels grouping together in an abnormal way. These blood vessels form benign (non-cancerous) growths that can develop into ulcers or red marks on the skin. Hemangiomas can also cause more serious complications inside the body (in the liver, brain, or digestive system).
Warnings
You should not use propranolol if you have asthma, very slow heart beats, or a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker).
Babies who weigh less than 4.5 pounds should not be given Hemangeol oral liquid.
Before taking this medicine
You should not use propranolol if you are allergic to it, or if you have:
asthma;
history of slow heart beats that have caused you to faint;
severe heart failure (that required you to be in the hospital); or
a serious heart condition such as "sick sinus syndrome" or heart block (2nd or 3rd degree, unless you have a pacemaker).
*You should not use Hemangeol if you have pheochromocytoma (tumor of the adrenal gland). propranolol also should not be used in babies who weigh less than 4.4 pounds.
To make sure propranolol is safe for you, tell your doctor if you have ever had:
slow heartbeats, congestive heart failure;
bronchitis, emphysema, or other breathing disorders;
diabetes (propranolol can make it harder for you to tell when you have low blood sugar);
liver or kidney disease;
a thyroid disorder;
pheochromocytoma (tumor of the adrenal gland);
problems with circulation (such as Raynaud's syndrome); or
if you smoke.
Tell your doctor if you are pregnant or breastfeeding.
What happens if I overdose?
Overdose symptoms may include feeling light-headed or restless, tremors, fast or slow heartbeats, and trouble breathing.
What should I avoid while taking propranolol?
Avoid drinking alcohol. It may increase your blood levels of propranolol.
Propranolol side effects
Get emergency medical help if you have signs of an allergic reaction to propranolol (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).
Call your doctor at once if you have:
slow or uneven heartbeats;
a light-headed feeling, like you might pass out;
wheezing or trouble breathing;
sudden weakness, vision problems, or loss of coordination (especially in a child with hemangioma that affects the face or head);
cold feeling in your hands and feet;
depression, confusion, hallucinations;
heart problems - swelling, rapid weight gain, feeling short of breath;
low blood sugar - headache, hunger, sweating, irritability, dizziness, fast heart rate, and feeling anxious or shaky; or
low blood sugar in a baby - pale skin, blue or purple skin, sweating, fussiness, crying, not wanting to eat, feeling cold, drowsiness, weak or shallow breathing (breathing may stop for short periods), seizure (convulsions), or loss of consciousness.
Common propranolol side effects may include:
dizziness, tiredness;
nausea, vomiting, diarrhea, constipation, stomach cramps;
sleep problems (insomnia); or
runny or stuffy nose, cough, sore throat, hoarse voice.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.
What other drugs will affect propranolol?
Sometimes it is not safe to use certain medicines at the same time. Some drugs can affect your blood levels of other drugs you use, which may increase side effects or make the medicines less effective.
Tell your doctor about all your current medicines. Many drugs can affect propranolol, especially:
cholestyramine or colestipol
warfarin (Coumadin, Jantoven)
an antidepressant
heart or blood pressure medicine;
medicine to treat an infection
medicine to treat a prostate disorder;
steroid medicine; or
NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others.
This list is not complete and many other drugs may interact with propranolol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.
Propranolol Dosage
Applies to the following strengths: 60 mg; 10 mg; 20 mg; 40 mg; 80 mg; 120 mg; 160 mg; 1 mg/mL; 20 mg/5 mL; 80 mg/mL; 40 mg/5 mL; 4.28 mg/mL
Usual Adult Dose for Hypertension
Initial dose:
Immediate-release: 40 mg orally 2 times a day
Sustained-release: 80 mg orally once a day
XL sustained-release: 80 mg orally once a day at bedtime
Maintenance dose:
Immediate-release: 120 to 240 mg orally per day
Sustained-release: 120 to 160 mg orally per day
XL sustained-release: 80 to 120 mg orally once a day at bedtime
Maximum dose:
IR/SR: 640 mg orally per day
XR: 120 mg orally per day
Comments:
- The XL sustained-release formulation should be administered once daily at bedtime (approximately 10 PM) and should be taken consistently either on an empty stomach or with food.
- Dose titration should be done gradually until adequate blood pressure control is achieved.
- The recommended dosing is the same whether used alone or added to a diuretic.
- The time needed for full hypertensive response to a given dosage is variable and may range from a few days to several weeks.
- While twice daily dosing of the immediate release formulation is effective and can maintain a reduction in blood pressure throughout the day, some patients, especially when lower doses are used, may experience a modest rise in blood pressure toward the end of the 12 hour dosing interval. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. If control is not adequate, a larger dose, or 3 times daily therapy may achieve better control.
Usual Adult Dose for Angina Pectoris
Immediate-release: Total daily doses of 80 to 320 mg orally 2 to 4 times a day have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG.
Sustained-release: Initial dose: 80 mg orally once a day. Dosage should be gradually increased at 3 to 7 day intervals. The average optimal dosage appears to be 160 mg once a day.
Maximum dose: 320 mg per day
Comments:
- If treatment is to be discontinued, dosage should be reduced gradually over a period of a few weeks.
Usual Adult Dose for Arrhythmias
Immediate-release: 10 to 30 mg orally 3 to 4 times a day, before meals and at bedtime
IV: 1 to 3 mg at a rate not exceeding 1 mg/min. Sufficient time should be allowed for the drug to reach the site of action even when a slow circulation is present. A second dose may be given after 2 minutes. Thereafter, additional drug should not be given in less than 4 hours.
Comments:
- IV administration is usually reserved for life-threatening arrhythmias or those occurring under anesthesia.
- IV doses should be administered under careful monitoring, such as electrocardiography, and central venous pressure.
- The rate of IV administration should not exceed 1 mg (1 mL) per minute to decrease the possibility of lowering blood pressure and causing cardiac standstill.
- Transfer from IV to oral therapy should be considered as soon as possible.
Usual Adult Dose for Myocardial Infarction
Immediate-release:
Initial dose: 40 mg orally 3 times a day for 1 month, then increase to 60 to 80 mg orally 3 times a day as tolerated.
Maintenance dose: 180 mg to 240 mg orally per day in divided doses (2 to 4 times daily)
Maximum dose: 240 mg orally per day
Usual Adult Dose for Migraine Prophylaxis
Immediate-release:
Initial dose: 80 mg orally per day in divided doses
Maintenance dose: 160 to 240 mg orally per day in divided doses
Sustained-release:
Initial dose: 80 mg orally once a day
Maintenance dose: 160 to 240 mg once a day
Comments:
- The dosage should be increased gradually to achieve optimum migraine prophylaxis. If a satisfactory response is not obtained within 4 to 6 weeks after reaching the maximum dose, therapy should be discontinued.
- Withdrawal of therapy should be accomplished over a period of several weeks.
Usual Adult Dose for Benign Essential Tremor
Immediate-release:
Initial dose: 40 mg orally 2 times a day
Maintenance dose: 120 to 320 mg orally per day
Comments:
- Optimum reduction of essential tremor is usually achieved with a dose of 120 mg orally per day.
- Occasionally, it may be necessary to administer 240 to 320 mg orally per day.
Usual Adult Dose for Aortic Stenosis
Immediate-release: 20 to 40 mg orally 3 to 4 times a day, before meals and at bedtime
Sustained-release: 80 to 160 mg orally once a day
Use: Hypertrophic Subaortic Stenosis
Usual Adult Dose for Pheochromocytoma
Immediate-release:
Preoperatively: 60 mg orally daily in divided doses for 3 days prior to surgery as adjunctive therapy to alpha-adrenergic blockade
Management of Inoperable Tumor: 30 mg orally daily in divided doses as adjunctive therapy to alpha-adrenergic blockade
Usual Adult Dose for Atrial Fibrillation
Immediate-release: 10 mg to 30 mg orally 3 or 4 times a day before meals and at bedtime
Usual Pediatric Dose for Arrhythmias
Oral: Children: Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 8 hours; titrate dosage upward every 3 to 5 days; usual dose: 2 to 4 mg/kg/day; higher doses may be needed; do not exceed 16 mg/kg/day
IV: Children: 0.01 to 0.1 mg/kg slow IV over 10 minutes; maximum dose: 1 mg (infants); 3 mg (children)
Usual Pediatric Dose for Hypertension
Children:
Immediate release formulations:
Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 12 hours; increase gradually every 5 to 7 days
Usual dose: 1 to 5 mg/kg/day
Maximum dose: 8 mg/kg/day
Children and Adolescents 1 to 17 years:
Immediate release formulations:
Initial: 1 to 2 mg/kg/day divided in 2 to 3 doses/day; titrate dose to effect
Maximum dose: 4 mg/kg/day up to 640 mg/day; sustained release formulation may be dosed once daily (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents).
Usual Pediatric Dose for Thyrotoxicosis
Neonates: Oral: 2 mg/kg/day in divided doses every 6 to 12 hours; occasionally higher doses may be required
Adolescents: Oral: 10 to 40 mg/dose every 6 hours
Usual Pediatric Dose for Hemangioma
Propranolol oral solution 4.28 mg/mL:
Initiate treatment at ages 5 weeks to 5 months:
Initial dose: 0.15 mL/kg (0.6 mg/kg) orally 2 times a day (at least 9 hours apart)
- After 1 week: Increase the daily dose to 0.3 mL/kg (1.1 mg/kg) orally 2 times a day (at least 9 hours apart)
- After 2 weeks: Increase the dose to 0.4 mL/kg (1.7 mg/kg) orally 2 times a day (at least 9 hours apart) maintain for 6 months
Comments:
- Dose should be periodically adjusted as the weight of the child increases.
- Administration directly into the mouth of the child is recommended; however, the product may be diluted in a small quantity of milk or fruit juice, given in a bottle.
- This drug should be administered during or right after a feeding to reduce the risk of hypoglycemia.
- The dose should be skipped if the child is not eating or is vomiting.
- Heart rate and blood pressure should be monitored for 2 hours after drug initiation or dose increases.
- If hemangiomas recur, treatment may be reinitiated.
Uses: For the treatment of proliferating infantile hemangioma requiring systemic therapy.
#OnedayOnemedicinechallenge
No comments:
Post a Comment