Propranolol (Propranolol Hydrochloride) - Summary

PROPRANOLOL SUMMARY

PROPRANOLOL HYDROCHLORIDE TABLETS, USP
10 mg, 20 mg, 40 mg and 80 mg

Propranolol hydrochloride is a synthetic beta-adrenergic receptor blocking agent chemically described as (+)-1-(isopropylamino)-3-(1-naphthyloxy)-2-propanol hydrochloride.

Cardiac Arrhythmias

Intravenous administration is usually reserved for life-threatening arrhythmias or those occurring under anesthesia.

1. Supraventricular arrhythmias
   Intravenous propranolol is indicated for the short-term treatment of supraventricular tachycardia, including Wolff-Parkinson-White syndrome and thyrotoxicosis, to decrease ventricular rate. Use in patients with atrial flutter or atrial fibrillation should be reserved for arrythmias unresponsive to standard therapy or when more prolonged control is required. Reversion to normal sinus rhythm has occasionally been observed, predominantly in patients with sinus or atrial tachycardia.
2. Ventricular tachycardias
   With the exception of those induced by catecholamines or digitalis, propranolol is not the drug of first choice. In critical situations when cardioversion techniques or other drugs are not indicated or are not effective, propranolol may be considered. If, after consideration of the risks involved, propranolol is used, it should be given intravenously in low dosage and very slowly, as the failing heart requires some sympathetic drive for maintenance of myocardial tone. (See DOSAGE AND ADMINISTRATION). Some patients may respond with complete reversion to normal sinus rhythm, but reduction in ventricular rate is more likely. Ventricular arrhythmias do not respond to propranolol as predictably as do the supraventricular arrhythmias.
   Intravenous propranolol is indicated for the treatment of persistent premature ventricular extrasystoles that impair the well-being of the patient and do not respond to conventional measures.
3. Tachyarrhythmias of digitalis intoxication
   Intravenous propranolol is indicated to control ventricular rate in life-threatening digitalis-induced arrhythmias. Severe bradycardia may occur. (See OVERDOSAGE).
4. Resistant tachyarrhythmias due to excessive catecholamine action during anesthesia
   Intravenous propranolol is indicated to abolish tachyarrhythmias due to excessive catecholamine action during anesthesia when other measures fail. These arrhythmias may arise because of release of endogenous catecholamines or administration of catecholamines. All general inhalation anesthetics produce some degree of myocardial depression. Therefore, when propranolol is used to treat arrhythmias during anesthesia, it should be used with extreme caution, usually with constant monitoring of the ECG and central venous pressure. (See WARNINGS).

NEWS HIGHLIGHTS

Published Studies Related to Propranolol

Propranolol decreases tachycardia and improves symptoms in the postural tachycardia syndrome: less is more. [2009.09.01]
CONCLUSIONS: Low-dose oral propranolol significantly attenuated tachycardia and improved symptoms in POTS. Higher-dose propranolol did not further improve, and may worsen, symptoms.

Addition of propranolol and isosorbide mononitrate to endoscopic variceal ligation does not reduce variceal rebleeding incidence. [2009.09]
BACKGROUND & AIMS: Endoscopic variceal ligation (EVL) and propranolol are standard secondary prophylaxis therapies for variceal bleeding. Addition of isosorbide mononitrate (ISMN) to propranolol improves its hemodynamic efficacy; we investigated whether a combination of EVL and propranolol/ISMN was more effective than EVL alone for secondary prophylaxis... CONCLUSIONS: EVL alone is sufficient to prevent variceal rebleeding in cirrhotic and noncirrhotic patients with history of variceal bleeding. Addition of propranolol and ISMN to EVL does not reduce the incidence of variceal rebleeding but increases severe adverse effects. Risk factors for rebleeding include ascites, low serum albumin, and high hepatic venous pressure gradients.

The beta-adrenergic antagonist propranolol partly abolishes thermogenic response to bioactive food ingredients. [2009.08]
A combination of tyrosine, capsaicin, catechins, and caffeine has been shown to possess a thermogenic effect in humans. The present objective was to investigate whether the thermogenic response to the bioactive combination (BC) could be diminished or abolished by propranolol... The 50% reduction of the thermogenic response by propranolol indicates that beta-adrenergic pathways are partly responsible for the thermogenic response.

Zolmitriptan compared to propranolol in the treatment of acute neuroleptic-induced akathisia: a comparative double-blind study. [2009.07]
Neuroleptic-induced akathisia (NIA) is a common, sometimes incapacitating adverse effect of anti-psychotic medication... Further placebo-controlled studies are warranted.

Comparison of ketanserin, buspirone and propranolol on arousal, pupil size and autonomic function in healthy volunteers. [2009.07]
RATIONALE: The human pupil may be a suitable physiological test system for the assessment of excessive daytime sleepiness (EDS), but pupillometric assessment could be confounded by medication for comorbid hypertension and mood disorders. OBJECTIVES: We examined the profile of the 5HT-2/alpha1/H1 antagonist ketanserin, the 5HT1a agonist buspirone and the beta adrenoceptor antagonist propranolol on pupillary and other measures of arousal... CONCLUSIONS: Ketanserin but not propranolol had a fully sedative profile and may confound pupillometric assessment of EDS. Beta adrenergic receptors do not appear to participate in arousal and pupillary functions, while 5HT1a receptors reduce pupil size without affecting arousal. Pupil size may not be used unequivocally as an index of the level of alertness in the case of drug-induced changes, when drugs interfere with the central pupil control mechanism in ways that are unrelated to their effects on arousal.

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Clinical Trials Related to Propranolol

Effect of Prophylaxy of Amiodarone and Propranolol and Amiodarone With Propranolol in Prevention of Atrial Fibrillation Post Coronary Artery Bypass Graft [Completed]

Bioavailability Study of Propranolol Under Fasting Conditions [Completed]
To compare the single-dose bioavailability of Propranolol 160 Mg ER capsules with Inderal-La

Bioavailability Study of Propranolol Under Fed Conditions [Completed]
To compare the single-dose bioavailability of Propranolol 160 Mg ER Capsules with Inderal-La

Propranolol Administration and Prevention of Child PTSD in Child Trauma Victims [Completed]
Twenty-nine pediatric injury patients (ages 10-18) at risk for PTSD were randomly assigned to receive either propranolol or placebo in a double-blind placebo controlled design. Medication was initiated within 12 hours of hospital admission. At 6-weeks, child PTSD symptoms and heart rate (HR) during trauma recall were assessed. We hypothesized that participants who received propranolol would report fewer PTSD symptoms and have lower heart rates than those who received placebo.

Hemodynamic Effects of Chronic Administration of Spironolactone and/or Propranolol in Alcoholic Cirrhotic Patients [Terminated]
The aim of this study was assesment of splanchnic and systemic hemodynamic effects of chronic administration (2 month) of spironolactone or propranolol, alone or in association in alcoholic cirrhotic patients. The patients were randomized in 4 groups (aldactone 150 mg/day, propranolol 160 mg/day, aldactone 150 mg/day + propranolol 160 mg/day, placebo). Systemic and splanchnic hemodynamic effect were evaluated by hepatic venous pressure gradient measurements before and after 2 month of treatment.

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PATIENT REVIEWS / RATINGS / COMMENTS

Propranolol review by 32 year old male patient
		Rating
Overall rating:
Effectiveness:		Considerably Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		tremor
Dosage & duration:		10mg taken 4 times daily for the period of 3 months
Other conditions:		migraine
Other drugs taken:		none
		Reported Results
Benefits:		reduction in visible tremor, caused by stress and kinetic movement. 100% reduction in headaches during period.
Side effects:		initial few days, tiredness was evident
Comments:		four 10mg tablets taken daily throughout period. The medication is a beta blocker and has various medical uses. Including the treatment of high blood pressure, tremor and reduction of migraine. You are advised not to take alcohol whilst taking this medicine.

Propranolol review by 19 year old female patient
		Rating
Overall rating:
Effectiveness:		Highly Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		rapid heart rate
Dosage & duration:		20mg taken 2x a day for the period of 5 weeks
Other conditions:		none
Other drugs taken:		none
		Reported Results
Benefits:		I have suffered of rapid heart rate for sometime because of my thyroid problem. I was given this medicine to get my heart rate controlled. First few weeks the medicine did not seem to work for me but my doctor increased the dosage to 20mg twice a day, then that was the time I started to feel my heart rate slow down. The medicine is definitely effective but I guess the effect of it depends on the individual as it requres a certain dosage for it to work effectively.
Side effects:		I started feeling dizzy whenever I get up from sitting position to standing. I have informed my doctor about this and I was informed that this is a possible side effect of the drug.
Comments:		Details as above.

Propranolol review by 19 year old female patient
		Rating
Overall rating:
Effectiveness:		Highly Effective
Side effects:		Mild Side Effects
		Treatment Info
Condition / reason:		rapid heart rate
Dosage & duration:		20mg taken 2x a day for the period of 5 weeks
Other conditions:		none
Other drugs taken:		none
		Reported Results
Benefits:		I have suffered of rapid heart rate for sometime because of my thyroid problem. I was given this medicine to get my heart rate controlled. First few weeks the medicine did not seem to work for me but my doctor increased the dosage to 20mg twice a day, then that was the time I started to feel my heart rate slow down. The medicine is definitely effective but I guess the effect of it depends on the individual as it requres a certain dosage for it to work effectively.
Side effects:		I started feeling dizzy whenever I get up from sitting position to standing. I have informed my doctor about this and I was informed that this is a possible side effect of the drug.
Comments:		Details as above.