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                           :295.8

%Protein binding                           :80–95

%Excreted unchanged in urine     : <5

Volume of distribution (L/kg)       :4

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

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50     : Dose as in normal renal function

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

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

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

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

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

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

CAV/VVHD      :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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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