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

Media Articles Related to Propranolol

Propranolol Could Improve Working Memory In Autism
Source: Autism News From Medical News Today [2013.04.18]
People with an Autism Spectrum Disorder (ASD) often have trouble communicating and interacting with others because they process language, facial expressions and social cues differently. Previously, researchers found that propranolol, a drug commonly used to treat high blood pressure, anxiety and panic, could improve the language abilities and social functioning of people with an ASD...

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Published Studies Related to Propranolol

The study of antiarrhythmic medications in infancy (SAMIS): a multicenter, randomized controlled trial comparing the efficacy and safety of digoxin versus propranolol for prophylaxis of supraventricular tachycardia in infants. [2012]
CONCLUSIONS: There was no difference in SVT recurrence in infants treated with

Status of propranolol for treatment of infantile hemangioma and description of a randomized clinical trial. [2011.10]
OBJECTIVES: Our primary objective was to review the current use of propranolol for treatment of infantile hemangioma (IH), specifically regarding 1) the age at initiation of therapy, 2) the method of initiation, 3) the use of other adjuvant therapy, 4) the duration of therapy and relapse rate, 5) the adverse events, and 6) the outcome. Our secondary objective was to describe a randomized, controlled, single-blinded trial comparing propranolol to prednisolone for treatment of IH... CONCLUSIONS: Propranolol is an attractive alternative to other treatments for IH. Despite apparent widespread use of this medication, the data are limited, and prospective studies are lacking for this indication. The relatively high rate of adverse effects supports the need for careful monitoring of patients on this therapy. Fastidious reporting of adverse events and objective evaluation of early and late outcomes are necessary to improve our understanding of the use of propranolol for this indication.

A randomized controlled trial of propranolol for infantile hemangiomas. [2011.08]
OBJECTIVE: Propranolol hydrochloride is a safe and effective medication for treating infantile hemangiomas (IHs), with decreases in IH volume, color, and elevation... CONCLUSION: Propranolol hydrochloride administered orally at 2 mg/kg per day reduced the volume, color, and elevation of focal and segmental IH in infants younger than 6 months and children up to 5 years of age.

Endoscopic variceal band ligation compared with propranolol for prophylaxis of first variceal bleeding. [2011.04]
Administration of nonselective beta-blockers in prophylaxis of first variceal bleeding is not suitable for all patients. Thus, we evaluated endoscopic variceal band ligation (EVBL) in primary prevention of bleeding in patients with cirrhosis and large esophageal varices... In conclusion, EVBL was an effective and safe alternative to propranolol in primary prophylaxis of bleeding in patients with large esophageal varices.

Effect of propranolol on word fluency in autism. [2011.03]
OBJECTIVE AND BACKGROUND: Autism is characterized by repetitive behaviors and impaired socialization and communication. Preliminary evidence showed possible language benefits in autism from the beta-adrenergic antagonist propranolol. Earlier studies in other populations suggested propranolol might benefit performance on tasks involving a search of semantic and associative networks under certain conditions. Therefore, we wished to determine whether this benefit of propranolol includes an effect on semantic fluency in autism... CONCLUSIONS: Results are consistent with a selective beneficial effect of propranolol on flexibility of access to semantic and associative networks in autism, with no observed effect on phonological networks. Further study will be necessary to understand potential clinical implications of this finding.

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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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Reports of Suspected Propranolol Side Effects

Completed Suicide (58),  Toxicity TO Various Agents (56),  Cardiac Arrest (51),  Hypotension (39),  Overdose (30),  Cardiogenic Shock (27),  Multi-Organ Failure (21),  Respiratory Arrest (21),  Hypoglycaemia (20),  Bradycardia (20), more >>

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 26 year old female patient
		Rating
Overall rating:
Effectiveness:		Moderately Effective
Side effects:		No Side Effects
		Treatment Info
Condition / reason:		panic attacks
Dosage & duration:		20mg taken once a month for the period of once a month
Other conditions:		nervousness, panic attacks
Other drugs taken:		none
		Reported Results
Benefits:		I felt less anxious when doing presentations. I took it before I was ready to perform to prevent a panic attack. I felt like it calmed me down
Side effects:		I didn't feel like I had any. I felt the same before and after taking the drug.
Comments:		I was prescribed the medicine to decrease "panic attack" symptoms. I am a very nervous person.

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.