propranolol hydrochloride

CLINICAL USE

Beta-adrenoceptor blocker:Hypertension Phaeochromocytoma Angina Arrhythmias Anxiety Migraine prophylaxis

DOSE IN NORMAL RENAL FUNCTION

Hypertension: 40–160 mg twice daily Phaeochromocytoma: 60 mg daily for 3 days before surgery, or 30 mg daily if unsuitable for surgeryAngina: 120–240 mg daily in divided doses Arrhythmias: 10–40 mg 3–4 times daily Anxiety: 40 mg 1–3 times daily Prophylaxis after an MI: 40 mg 4 times daily then 80 mg twice dailyMigraine and essential tremor: 80–160 mg dailyIV: 1 mg over 1 minute repeated after 2 minutes to a maximum of 10 mg (5 mg with anaesthesia)

PHARMACOKINETICS

Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :295.8

%Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :80–95

%Excreted unchanged in urine &nbsp &nbsp : <5

Volume of distribution (L/kg) &nbsp &nbsp &nbsp :4

half-life – normal/ESRD (hrs)&nbsp &nbsp &nbsp :2–6/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 &nbsp &nbsp : Dose as in normal renal function

10 to 20 &nbsp &nbsp : Start with small doses and increase according to response

<10 &nbsp &nbsp &nbsp &nbsp &nbsp : Start with small doses and increase according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Not dialysed. Dose as in GFR <10 mL/min

HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL/min

HDF/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect; risk of bupivacaine toxicity increased

Analgesics: NSAIDs antagonise hypotensive effect

Anti-arrhythmics: increased risk of myocardial depression and bradycardia; increased risk of bradycardia, myocardial depression and AV block with amiodarone; concentration increased by propafenone

Antibacterials: metabolism increased by rifampicin

Antidepressants: enhanced hypotensive effect with MAOIs; concentration increased by fluvoxamine; concentration of imipramine increasedAntihypertensives; enhanced hypotensive effect; increased risk of withdrawal hypertension with clonidine; increased risk of first dose hypotensive effect with post-synaptic alpha-blockers such as prazosin

Antimalarials: increased risk of bradycardia with mefloquineAntipsychotics enhanced hypotensive effect with phenothiazines; concentration of both drugs increased with chlorpromazine

Calcium-channel blockers: increased risk of bradycardia and AV block with diltiazem; hypotension and heart failure possible with nifedipine and nisoldipine; asystole, severe hypotension and heart failure with verapamil

Diuretics: enhanced hypotensive effect

Moxisylyte: possible severe postural hypotensionPropranolol hydrochloride.618 PROPRANOLOL HYDROCHLORIDe

Sympathomimetics: severe hypertension with adrenaline and noradrenaline and possibly with dobutamineTropisetron: increased risk of ventricular arrhythmias – use with caution

ADMINISTRATION

Reconstition

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Route

Oral, IV

Rate of Administration

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Comments

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OTHER INFORMATION

Non-selective active metabolites accumulate in renal impairment. Consider metoprolol or atenololMay reduce renal blood flow in severe renal impairment.

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