Adult Dosing
Hypertension
- TABS
- Initial dose: 40 mg PO bid, may increase gradually until adequate blood pressure control is achieved
- Maintenance dose: 120-240 mg/day PO divided bid
- Max: 640 mg/day
- ECAPS
- Initial dose: 80 mg PO daily
- Maintenance dose: 120-160 mg PO daily
- Max: 640 mg/day
Angina pectoris
- TABS
- 80-320 mg PO divided bid-qid (before meal and at bedtime)
- ECAPS
- Initial dose: 80 mg PO daily, may increase q3-7 days until optimal response is obtained
- Optimal dose: 160 mg PO daily
- Max: 320 mg/day
Atrial Fibrillation
Myocardial infarction
- 40 mg PO tid-qid x 1 month
- Titrate to 60-80 mg tid-qid
- Max: 240 mg/day
Migraine
- TABS
- Initial dose: 80 mg PO divided bid-qid, may increase gradually to achieve optimum migraine
- Maintenance dose: 160-240 mg/day
- Discontinue if no response within 4-6 wks
- ECAPS
- Initial dose: 80 mg PO daily
- Maintenance dose: 160-240 mg PO daily
- Discontinue if no response within 4-6 wks
Essential tremor
- Initial dose: 40 mg PO bid
- Usual dose: 120-240 mg/day
- Max: 320 mg/day
Hypertrophic subaortic stenosis
- TABS
- 20-40 mg PO tid-qid (before meal and at bedtime)
Pheochromocytoma
- 60 mg PO divided bid-qid x 3 days prior to surgery, as adjunctive therapy to alpha-adrenergic blockade,
- Inoperable tumors: 30 mg divided bid-qid, as adjunctive therapy to alpha-adrenergic blockade
Note:- Discontinue the drug gradually by reducing the dose over a period of several wks
- Care should be taken to assure the desired therapeutic effect when switching from propranolol hydrochloride tablets to propranolol hydrochloride ECAPS
Thyrotoxicosis [Non-FDA Approved]
- Start at 40 mg PO bid, may increase as needed [Max 640 mg/day]
Pediatric Dosing
Proliferating infantile hemangioma (Hemangeol)
- Initiate treatment at age 5 weeks to 5 months
- 0.15 mL/kg PO bid taken 9 hours apart; may increase dose to 0.3 mL/kg PO bid, after 2weeks of treatment increase the dose to 0.4 mL/kg PO bid and maintain this for 6 months
- Readjust the dose periodically as the child’s weight increases
Notes- Administer orally during or right after a feeding to reduce the risk of hypoglycemia. Skip the dose if the child is not eating or is vomiting
- Monitor heart rate and blood pressure for 2 hours after therapy initiation or dose increases
- Refer package insert for dose titration according to weight
Thyrotoxicosis [Non-FDA Approved]
- Neonates: 2 mg/kg/day PO divided bid–qid
- Adolescents: 10-40 mg/dose PO qid
[Outline]
- Exacerbation of angina and myocardial infarction have been reported following abrupt discontinuance of propranolol therapy [US Black Box Warning]
- Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions have been reported with use of propranolol
- Use of beta blockers in patients with congestive heart failure, precipitates more severe failure. Hence avoid in overt congestive heart failure, but can be used with close follow-up in patients with a history of failure receiving additional therapies
- Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle
- Use cautiously in patients with bronchospastic lung disease, as it can provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors
- Prolong beta-blocking therapy should not be withdrawn prior to major surgery, however it may augment the risks of general anesthesia and surgical procedures due to the impaired ability of the heart to respond to reflex adrenergic stimuli
- Propranolol can cause hypoglycemia after prolonged physical exertion and in patients with renal insufficiency and can prevent the appearance of certain premonitory signs and symptoms of acute hypoglycemia, especially in labile insulin-dependent diabetics, making it difficult to adjust the dosage of insulin
- 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
- Concomitant use of both beta and alpha blockade in the event of hemorrhage or shock, prevents the increase in heart rate and peripheral vasoconstriction needed to maintain blood pressure
- Severe bradycardia requiring treatment with a pacemaker has been reported in patients with Wolff-Parkinson-White syndrome and tachycardia receiving beta-adrenergic blockade
- Reduction of intraocular pressure has been reported with beta-adrenergic receptor blockade, which is reversible on withdrawal and interferes with the glaucoma screening test
- Elevates levels of serum potassium, serum transaminases and alkaline phosphatase when used in hypertensive patients
- Increases blood urea nitrogen in severe heart failure
- Exacerbation of myopathy and myotonia has been reported
Caution: Use cautiously in
- Renal impairment
- Hepatic impairment
- Bronchospastic lung disease
- Diabetes mellitus
- Major surgery
- Thyroid disorder
- Wolff-Parkinson-White syndrome
- Pheochromocytoma
- History of severe anaphylactic reaction
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 27 April 2011). Manufacturer advises caution.
Pricing data from www.DrugStore.com in U.S.A.
- Propranolol HCl 60 MG TABS [Bottle] (HERITAGE PHARMACEUTICALS)
60 mg = $58.99
180 mg = $156.97 - Inderal LA 120 MG CP24 [Bottle] (AKRIMAX PHARMACEUTICALS)
30 mg = $185.99
90 mg = $536.96 - Propranolol HCl 20 MG/5ML SOLN [Bottle] (ROXANE)
240 5ml = $25.99
480 5ml = $45.97 - Inderal LA 160 MG CP24 [Bottle] (AKRIMAX PHARMACEUTICALS)
30 mg = $264.99
90 mg = $755.97 - InnoPran XL 80 MG CP24 [Bottle] (GLAXO SMITH KLINE)
30 mg = $71.74
90 mg = $202.51 - InnoPran XL 120 MG CP24 [Bottle] (GLAXO SMITH KLINE)
30 mg = $71.99
90 mg = $200.97 - Inderal LA 60 MG CP24 [Bottle] (AKRIMAX PHARMACEUTICALS)
30 mg = $155.99
90 mg = $449.97
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
