Adult Dosing
Life threatening arrhythmias
- 1-3 mg IV, carefully monitor central venous pressure, perform electrocardiography
- If necessary, a 2nd dose may be given after two minutes, do not administer drug in <4hrs
Note:
- Rate of administration should not be >1mg(1mL)/minute
- Do not administer once desired alteration in rate or rhythm is achieved
- Initiate to oral therapy as soon as possible
- Visually inspect for presence of particulate matter and discoloration prior to administration
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
- Inhibition of circulatory function in patients with congestive heart failure leading to more severe failure have occurred
- Avoid beta-blockers in overt congestive heart failure, in some cases it can be beneficial with close monitoring of patients with a history of failure provided with appropriate therapy including diuretics
- Inotropic action of digitalis on heart muscle is not abolished when used concurrently with the drug
- Avoid beta-blockers in patients with bronchospastic lung disease
- Augments risks of general anesthesia and surgical procedures, severe hypotension have occurred in patients treated with dobutamine or isoproterenol used for reversing effect of propranolol
- Masks signs and symptoms of acute hypoglycemia in labile insulin-dependent diabetics, adjustment of doses of insulin is difficult in such cases
- Masks certain clinical signs of hyperthyroidism, avoid abrupt withdrawal as exacerbation of symptoms of hyperthyroidism, including thyroid storm have occurred
- Induces changes in thyroid-function tests, increases T4 and reverses T3 and decreases T3
- Hypoglycemia have occurred in infants and children especially during fasting, as in preparation for surgery, after prolonged physical exertion and in patients with renal impairment
- Severe bradycardia requiring treatment with a pacemaker in patients with Wolff-Parkinson-White syndrome and tachycardia have occurred
- Reduces intraocular pressure, is reversible on withdrawal, interferes with the glaucoma screening test
- Induces risk of anaphylactic reaction in patients with a history of severe anaphylactic reaction
- Exacerbation of angina, myocardial infarction have occurred on abrupt discontinuance, reinstitute propranolol therapy and take other measures appropriate for the management of angina pectoris, as coronary artery disease may be unrecognized it is advisable to follow this in patients considered at risk of having occult atherosclerotic heart disease receiving propranolol for other indications
- While discontinuing gradually taper over a few weeks, caution patients against interruption or cessation of therapy without a physician's advice
- Elevates levels of serum potassium, serum transaminases and alkaline phosphatase when used in hypertensive patients
- Increases blood urea nitrogen in severe heart failure
Cautions: Use cautiously in:
- Renal impairment
- Hepatic impairment
- Bronchospastic lung disease
- Peripheral vascular disease
- Major surgery
- Diabetes mellitus
- Thyroid disorder
- Wolff-Parkinson-White syndrome
- Pheochromocytoma
- Pregnancy 2nd or 3rd trimester
- Myasthenia gravis
- History of severe anaphylactic reaction
- Concomitant use of drugs acting by CYP2D6, 1A2, or 2C19 metabolic pathways
- Geriatrics
Pregnancy Category:C
Breastfeeding: Probably Safe; as low levels of propranolol are excreted in breastmilk, amounts ingested by the infant are too low to cause any adverse effects in breastfed infants. Studies during breastfeeding have found no adverse reactions in breastfed infants. No special precautions are required. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 November 2010). Manufacturer advises caution on administering to pregnant women.
