Check with your doctor before you drink alcohol while you are taking Inderal; it may increase the risk of Inderal's side effects. Do NOT take more than the recommended dose without checking with your doctor. Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal. Tell your doctor or dentist that you take Inderal before you receive any medical or dental care, emergency care, or surgery.

If you have a history of any severe allergic reaction, talk with your doctor. You may be at risk of an even more severe allergic reaction if you come into contact with the substance that caused your allergy. Some medicines used to treat severe allergies may also not work as well while you are using Inderal. Inderal may lower your blood sugar levels. This is most likely to happen in infants and children, or in patients who have diabetes or kidney problems.

It may also occur after prolonged physical activity or during fasting. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your heart beat faster; make your vision change; give you a headache, chills, or tremors; or make you more hungry. It is a good idea to carry a reliable source of glucose eg, tablets or gel to treat low blood sugar. If this is not available, you should eat or drink a quick source of sugar like table sugar, honey, candy, orange juice, or non-diet soda.

This will raise your blood sugar level quickly. Tell your doctor right away if this happens. Diabetes patients - Inderal may hide signs of low blood sugar, such as a rapid heartbeat. Be sure to watch for other signs of low blood sugar. Check blood sugar levels closely. If the use of drug is deemed essential, the patient should stop nursing. Pediatric Use Safety and effectiveness in pediatric patients have not been established.

Geriatric Use Clinical studies of Inderide did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

In the event of overdosage or exaggerated response, the following measures should be employed: If ingestion is or may have been recent, evacuate gastric contents, taking care to prevent pulmonary aspiration. Hypotension and bradycardia have been reported following propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a propranolol overdose.

Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine, however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing. The electrocardiogram, pulse, blood pressure, neurobehavioral status and intake and output balance must be monitored.

Isoproterenol and aminophylline may be used for bronchospasm. It specifically competes with beta-adrenergic receptor agonist agents for available receptor sites. When access to beta-receptor sites is blocked by propranolol, the chronotropic, inotropic , and vasodilator responses to beta-adrenergic stimulation are decreased proportionately.

At dosages greater than required for beta blockade, propranolol also exerts a quinidine-like or anesthetic-like membrane action, which affects the cardiac action potential.

The significance of the membrane action in the treatment of arrhythmias is uncertain. Mechanism of Action The mechanism of the antihypertensive effect of propranolol has not been established. Factors that may contribute to the antihypertensive action include: Although total peripheral resistance may increase initially, it readjusts to or below the pretreatment level with chronic use of propranolol. Effects of propranolol on plasma volume appear to be minor and somewhat variable.

In angina pectoris , propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate , systolic blood pressure , and the velocity and extent of myocardial contraction.

Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and systolic ejection period. The net physiologic effect of beta-adrenergic blockade is usually advantageous and is manifested during exercise by delayed onset of pain and increased work capacity. Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action.

In dosages greater than required for beta blockade, propranolol also exerts a quinidine-like or anesthetic-like membrane action, which affects the cardiac action potential. The mechanism of the antimigraine effect of propranolol has not been established. Beta-adrenergic receptors have been demonstrated in the pial vessels of the brain. The specific mechanism of propranolol's antitremor effects has not been established, but beta-2 noncardiac receptors may be involved.

A central effect is also possible. Clinical studies have demonstrated that Inderal propranolol is of benefit in exaggerated physiological and essential familial tremor. Pharmacokinetics And Drug Metabolism Absorption Propranolol is highly lipophilic and almost completely absorbed after oral administration.

Peak plasma concentrations occur about 1 to 4 hours after an oral dose. The binding is enantiomer-selective. Propranolol crosses the blood-brain barrier and the placenta , and is distributed into breast milk. Metabolism and Elimination Propranolol is extensively metabolized with most metabolites appearing in the urine. Propranolol is metabolized through three primary routes: The four major metabolites are propranolol glucuronide, naphthyloxylactic acid and glucuronic acid, and sulfate conjugates of 4-hydroxy propranolol.

In vitro studies have indicated that the aromatic hydroxylation of propranolol is catalyzed mainly by polymorphic CYP2D6. Propranolol is also a substrate of CYP2C19 and a substrate for the intestinal efflux transporter, p-glycoprotein p-gp. Studies suggest however that p-gp is not dose-limiting for intestinal absorption of propranolol in the usual therapeutic dose range.

In healthy subjects, no difference was observed between CYP2D6 extensive metabolizers EMs and poor metabolizers PMs with respect to oral clearance or elimination half-life. Partial clearance of 4-hydroxy propranolol was significantly higher and of naphthyloxyactic acid significantly lower in EMs than PMs. The plasma half-life of propranolol is from 3 to 6 hours.

Special Populations Geriatric In a study of 12 elderly years old and 12 young years old healthy subjects, the clearance of S - -enantiomer of propranolol was decreased in the elderly. Clearance of propranolol is reduced with aging due to decline in oxidation capacity ring oxidation and side-chain oxidation.

Conjugation capacity remains unchanged. In a study of 32 patients age 30 to 84 years given a single mg dose of propranolol, an inverse correlation was found between age and the partial metabolic clearances to 4-hydroxypropranolol 40HP-ring oxidation and to naphthoxylactic acid NLA-side chain oxidation.

No correlation was found between age and the partial metabolic clearance to propranolol glucuronide PPLG-conjugation. Gender In a study of 9 healthy women and 12 healthy men, neither the administration of testosterone nor the regular course of the menstrual cycle affected the plasma binding of the propranolol enantiomers.

In contrast , there was a significant, although non-enantioselective diminution of the binding of propranolol after treatment with ethinyl estradiol. These findings are inconsistent with another study, in which administration of testosterone cypionate confirmed the stimulatory role of this hormone on propranolol metabolism and concluded that the clearance of propranolol in men is dependent on circulating concentrations of testosterone.

In women, none of the metabolic clearances for propranolol showed any significant association with either estradiol or testosterone. Propranolol plasma clearance was also reduced in the patients with chronic renal failure. Studies have reported a delayed absorption rate and a reduced half-life of propranolol in patients with renal failure of varying severity.

Despite this shorter plasma half-life, propranolol peak plasma levels were times higher and total plasma levels of metabolites were up to 3 times higher in these patients than in subjects with normal renal function.

Chronic renal failure has been associated with a decrease in drug metabolism via downregulation of hepatic cytochrome P activity resulting in a lower "first-pass" clearance.

Propranolol is not significantly dialyzable. Hepatic Insufficiency Propranolol is extensively metabolized by the liver. In a study conducted in 7 patients with cirrhosis and 9 healthy subjects receiving mg oral propranolol every 8 hours for 7 doses, the steady-state unbound propranolol concentration in patients with cirrhosis was increased 3-fold in comparison to controls. No interactions were observed with either ranitidine or lansoprazole.

No interaction was observed with omeprazole. Inducers of Hepatic Drug Metabolism Blood levels of propranolol may be decreased by co-administration with inducers such as rifampin, ethanol, phenytoin, and phenobarbital. The metabolism of propranolol is reduced by co-administration of quinidine, leading to a two-three fold increased blood concentration and greater degrees of clinical beta-blockade. Propranolol does not affect the pharmacokinetics of verapamil and norverapamil. Verapamil does not affect the pharmacokinetics of propranolol.

Benzodiazepines Propranolol can inhibit the metabolism of diazepam, resulting in increased concentrations of diazepam and its metabolites. Diazepam does not alter the pharmacokinetics of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.

Co-administration with aluminum hydroxide gel mg may result in a decrease in propranolol concentrations. Co-administration of metoclopramide with the long-acting propranolol did not have a significant effect on propranolol's pharmacokinetics.

Propranolol did not have an effect on the pharmacokinetics of fluvastatin. Warfarin Concomitant administration of propranolol and warfarin has been shown to increase warfarin bioavailability and increase prothrombin time.

Alcohol Concomitant use of alcohol may increase plasma levels of propranolol. Pharmacodynamics And Clinical Effects Hypertension In a retrospective, uncontrolled study, patients with diastolic blood pressure to mmHg received propranolol mg t. Propranolol contributed to control of diastolic blood pressure, but the magnitude of the effect of propranolol on blood pressure cannot be ascertained.

Angina Pectoris In a double-blind , placebo-controlled study of 32 patients of both sexes, aged 32 to 69 years, with stable angina, propranolol mg t. Propranolol was administered at either 60 or 80 mg t. Therapy with Inderal propranolol , begun 5 to 21 days following infarction, was shown to reduce overall mortality up to 39 months, the longest period of follow-up. This was primarily attributable to a reduction in cardiovascular mortality.

The protective effect of Inderal propranolol was consistent regardless of age, sex, or site of infarction. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction.

Clinical Laboratory Tests In patients with hypertension , use of propranolol has been associated with elevated levels of serum potassium , serum transaminases, and alkaline phosphatase. In severe heart failure, the use of propranolol has been associated with increases in Blood Urea Nitrogen. Cardiovascular Drugs Antiarrhythmics Propafenone has negative inotropic and beta-blocking properties that can be additive to those of propranolol.

Quinidine increases the concentration of propranolol and produces greater degrees of clinical betablockade and may cause postural hypotension. The clearance of lidocaine is reduced with administration of propranolol. Lidocaine toxicity has been reported following co-administration with propranolol.

Caution should be exercised when administering Inderal LA with drugs that slow A-V nodal conduction, e. Digitalis Glycosides Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate.

Concomitant use can increase the risk of bradycardia. Both agents may depress myocardial contractility or atrioventricular conduction. There have been reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers.

Co-administration of propranolol and diltiazem in patients with cardiac disease has been associated with bradycardia, hypotension , high degree heart block , and heart failure. ACE Inhibitors When combined with beta-blockers, ACE inhibitors can cause hypotension, particularly in the setting of acute myocardial infarction.

The antihypertensive effects of clonidine may be antagonized by beta-blockers. Inderal LA should be administered cautiously to patients withdrawing from clonidine.

Alpha Blockers Prazosin has been associated with prolongation of first dose hypotension in the presence of betablockers. Postural hypotension has been reported in patients taking both beta-blockers and terazosin or doxazosin. Reserpine Patients receiving catecholamine-depleting drugs, such as reserpine should be closely observed for excessive reduction of resting sympathetic nervous activity, which may result in hypotension, marked bradycardia, vertigo , syncopal attacks, or orthostatic hypotension.

Inotropic Agents Patients on long-term therapy with propranolol may experience uncontrolled hypertension if administered epinephrine as a consequence of unopposed alpha-receptor stimulation. Isoproterenol And Dobutamine Propranolol is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, e. Also, propranolol may reduce sensitivity to dobutamine stress echocardiography in patients undergoing evaluation for myocardial ischemia.

Administration of indomethacin with propranolol may reduce the efficacy of propranolol in reducing blood pressure and heart rate. Antidepressants The hypotensive effects of MAO inhibitors or tricyclic antidepressants may be exacerbated when administered with beta-blockers by interfering with the beta-blocking activity of propranolol.

Anesthetic Agents Methoxyflurane and trichloroethylene may depress myocardial contractility when administered with propranolol. Warfarin Propranolol when administered with warfarin increases the concentration of warfarin. Prothrombin time , therefore, should be monitored. Neuroleptic Drugs Hypotension and cardiac arrest have been reported with the concomitant use of propranolol and haloperidol. Thyroxine Thyroxine may result in a lower than expected T concentration when used concomitantly with propranolol.

On a body surface area basis, this dose in the mouse and rat is, respectively, about equal to and about twice the maximum recommended human oral daily dose MRHD of mg propranolol hydrochloride. In a study in which both male and female rats were exposed to propranolol hydrochloride in their diets at concentrations of up to 0.

Based on differing results from Ames Tests performed by different laboratories, there is equivocal evidence for a genotoxic effect of propranolol in bacteria S.

Pregnancy Pregnancy Category C In a series of reproductive and developmental toxicology studies, propranolol was given to rats by gavage or in the diet throughout pregnancy and lactation.

No evidence of embryo or neonatal toxicity was noted. There are no adequate and well-controlled studies in pregnant women.

Intrauterine growth retardation , small placentas, and congenital abnormalities have been reported in neonates whose mothers received propranolol during pregnancy. Adequate facilities for monitoring such infants at birth should be available. Inderal LA should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers Propranolol is excreted in human milk. Caution should be exercised when Inderal LA is administered to a nursing woman. Pediatric Use Safety and effectiveness of propranolol in pediatric patients have not been established. Bronchospasm and congestive heart failure have been reported coincident with the administration of propranolol therapy in pediatric patients.

Geriatric Use Clinical studies of Inderal LA did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of the decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy. In the event of overdosage or exaggerated response, the following measures should be employed: General If ingestion is or may have been recent, evacuate gastric contents, taking care to prevent pulmonary aspiration.

Supportive Therapy Hypotension and bradycardia have been reported following propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a propranolol overdose.

Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine , however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing. The electrocardiogram , pulse , blood pressure, neurobehavioral status and intake and output balance must be monitored.

Isoproterenol and aminophylline may be used for bronchospasm. It specifically competes with beta-adrenergic receptor-stimulating agents for available receptor sites. When access to beta-receptor sites is blocked by propranolol, the chronotropic, inotropic , and vasodilator responses to beta-adrenergic stimulation are decreased proportionately.

Propranolol HCL

Atrial Fibrillation Inderal is indicated to inderal ventricular rate in patients with atrial fibrillation and a rapid ventricular response. Antipyrine and lidocaine have reduced clearance when used concomitantly with propranolol. Orthostatic hypotension may be aggravated by alcohol, barbiturates or narcotics. The usual effective dose range is mg to mg per day. Propranolol may change thyroid-function tests, increasing T4 and reverse T3 and decreasing T3. Symptoms include acute onset of decreased visual acuity or ocular pain and typically inderal within hours to weeks of drug initiation. Inderal crosses 80mg blood-brain barrier and the placenta, and is distributed into breast milk. Dispense in a well-closed container as defined in the USP. Supportive Therapy Hypotension and 80mg have been reported following propranolol overdose and should be treated appropriately. Inderal chloride deficit is generally mild, and usually does not require tab trental 400mg treatment except under extraordinary circumstances as in liver or renal disease. Propranolol crosses the blood-brain barrier and the placentainderal 80mg, and is distributed into breast inderal. In dosages greater than required for beta blockade, inderal 80mg, propranolol also exerts a quinidine-like or anesthetic-like membrane action which affects the cardiac action potential. Propranolol is 80mg through three primary routes: Hypotension and cardiac 80mg have been reported with the concomitant use of propranolol and haloperidol, inderal 80mg. Pheochromocytoma The 80mg dosage is 60 mg Inderal daily in divided doses for three days prior to surgery as adjunctive therapy to alpha-adrenergic blockade. Diazepam does not alter inderal pharmacokinetics of propranolol. The net physiologic effect of beta-adrenergic blockade is 80mg advantageous and is manifested during exercise by delayed onset of pain and increased work capacity, inderal 80mg.

INDERAL LA 80 (Inderal LA 80 mg)

Caution should be exercised when administering Inderal LA with drugs that slow A-V nodal conduction, inderal 80mg, e. In severe heart failure, inderal 80mg, 80mg use of propranolol has 80mg associated with increases in Blood Urea Nitrogen. Genitourinary Male impotence ; Peyronie's disease. The antihypertensive effects of clonidine may be antagonized by beta-blockers. Medication such as digitalis may also influence serum inderal. Do not drive or perform other possible unsafe tasks until you know how you react to it. Hydrochlorothiazide Thiazides should be used with caution in severe renal disease, inderal 80mg. Although the clinical trials used either t. Intrauterine growth retardation, small placentas, and congenital abnormalities have inderal reported in neonates whose inderal received propranolol during pregnancy. Geriatric Use Clinical studies of Inderal LA did not include 80mg numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Propranolol: General Information and Side Effects

Hydrochlorothiazide All patients receiving thiazide therapy should be observed for clinical inderal of fluid or electrolyte imbalance, namely hyponatremia, inderal 80mg, hypochloremic alkalosis, inderal 80mg, and hypokalemia. Inderal Failure Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failureand its inhibition by beta blockade may precipitate more severe failure. The effectiveness and safety of daily dosages greater than mg for prevention of cardiac mortality have not been established. In Patients without a History of Heart Failure, inderal 80mg, continued use of beta-blockers can, in some cases, lead to cardiac failure. Pheochromocytoma Inderal is indicated 80mg an adjunct to alpha-adrenergic blockade to control blood pressure and reduce symptoms of catecholamine -secreting tumors. ACE Inhibitors When combined with beta-blockers, ACE inhibitors can cause hypotension, particularly in the setting of acute myocardial infarction. Partial clearance of 4- hydroxy propranolol was significantly higher and naphthyloxyactic acid was significantly lower in EMs than PMs. Propranolol was administered at either 60 or 80 mg t. This is most likely to retail price of clindamycin in infants and children, inderal 80mg, or in patients 80mg have diabetes or kidney problems.

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