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Basic Drug Info
Drug Name:Propranolol Hydrochloride
Manufacturer:Baxter Healthcare Corporation
Other Info:Alopecia, LE-like reactions, psoriaform rashes, dry eyes, male impotence, and Peyronie’s disease have been reported rarely. Oculomucocutaneous reactions involving the skin, serous membranes and conjunctivae reported for a beta-blocker (practolol) have not been associated with propranolol.



Clinical Trials:


Indications and Usage

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

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.Tachyarrhythmias of digitalis intoxicationIntravenous propranolol is indicated to control ventricular rate in life-threatening digitalis-induced arrhythmias.

Severe bradycardia may occur.

(See ).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 ).
cardiac arrhythmia -- any variation from the normal rhythm or rate of the heart beat.

Absence of sensation --

Supraventricular tachycardia -- A generic expression for any tachycardia that originates above the BUNDLE OF HIS.

Wolff-Parkinson-White Syndrome -- A form of ventricular pre-excitation characterized by a short PR interval and a long QRS interval with a delta wave. In this syndrome, atrial impulse conducts to the HEART VENTRICLES via an accessory pathway located between the wall of the right or left atria and the ventricles, known as the bundle of Kent. The inherited form can be caused by mutation of PRKAG2 gene encoding a gamma-2 regulatory subunit of AMP-activated protein kinase.

Thyrotoxicosis -- A hypermetabolic syndrome caused by excess THYROID HORMONES which may come from endogenous or exogenous sources. The endogenous source of hormone may be thyroid HYPERPLASIA; THYROID NEOPLASMS; or hormone-producing extrathyroidal tissue. Thyrotoxicosis is characterized by NERVOUSNESS; TACHYCARDIA; FATIGUE; WEIGHT LOSS; heat intolerance; and excessive SWEATING.

Atrial Flutter -- Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES).

Atrial Fibrillation -- Abnormal cardiac rhythm that is characterized by rapid, uncoordinated firing of electrical impulses in the upper chambers of the heart (HEART ATRIA). In such case, blood cannot be effectively pumped into the lower chambers of the heart (HEART VENTRICLES). It is caused by abnormal impulse generation.

Atrial tachycardia -- Any rapid heart rhythm originating in the atria. Atrial fibrillation and atrial flutter are varieties of atrial tachycardia. Atrial tachycardia is an electrical circuit originating in the upper or atrial chambers. This electrical circuit or focus takes over and generates rapid impulses across the atrial chambers. These impulses are transmitted to the ventricular chambers resulting in a rapid rate. These arrhythmias may originate from a variety of places across the atria. They may exist as an isolated problem or be related to an ongoing structural problem within the heart. (NCI)

Tachycardia, Ventricular -- An abnormally rapid ventricular rhythm usually in excess of 150 beats per minute. It is generated within the ventricle below the BUNDLE OF HIS, either as autonomic impulse formation or reentrant impulse conduction. Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).

Ventricular arrhythmia -- Irregular heart beat resulting from a pathologic process in the cardiac ventricles.--2004

Supraventricular arrhythmia -- An arrhythmia originating from centers proximal to the ventricles, namely in the atrium, AV node, or AV junction, in contrast to arrhythmias arising in the ventricles themselves.

Premature ventricular contractions -- A type of cardiac arrhythmia with premature contractions of the HEART VENTRICLES. It is characterized by the premature QRS complex on ECG that is of abnormal shape and great duration (generally >129 msec). It is the most common form of all cardiac arrhythmias. Premature ventricular complexes have no clinical significance except in concurrence with heart diseases.

Contraindications
Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia and greater than first-degree block; 3) bronchial asthma; and 4) in patients with known hypersensitivity to propranolol hydrochloride.
Sinus bradycardia -- A heart rate of less than 60 beats per minute, with its origin in the sinus node. (NCI)

Asthma -- A form of bronchial disorder with three distinct components: airway hyper-responsiveness (RESPIRATORY HYPERSENSITIVITY), airway INFLAMMATION, and intermittent AIRWAY OBSTRUCTION. It is characterized by spasmodic contraction of airway smooth muscle, WHEEZING, and dyspnea (DYSPNEA, PAROXYSMAL).

Hypersensitivity -- Altered reactivity to an antigen, which can result in pathologic reactions upon subsequent exposure to that particular antigen.

Warnings

Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failure, and its inhibition by beta blockade may precipitate more severe failure. Although beta-blockers should be avoided in overt congestive heart failure, some have been shown to be highly beneficial when used with close follow-up in patients with a history of failure who are well compensated and are receiving additional therapies, including diuretics as needed.

Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle.
Branded Drugs
The following US Branded drugs contain Propranolol Hydrochloride


INDERIDE LA 120/50 -- WYETH AYERST LABORATORIES

INDERIDE LA 160/50 -- WYETH AYERST LABORATORIES

INDERIDE LA 80/50 -- WYETH AYERST LABORATORIES

INDERIDE-40/25 -- AKRIMAX PHARMACEUTICALS LLC

INDERIDE-80/25 -- AKRIMAX PHARMACEUTICALS LLC

PROPRANOLOL HYDROCHLORIDE & HYDROCHLOROTHIAZIDE -- DURAMED PHARMACEUTICALS INC SUB BARR LABORATORIES INC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- ACTAVIS ELIZABETH LLC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- BARR LABORATORIES INC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- IVAX PHARMACEUTICALS INC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- MYLAN PHARMACEUTICALS INC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- PLIVA INC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- SANDOZ INC

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- WARNER CHILCOTT DIV WARNER LAMBERT CO

PROPRANOLOL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE -- WATSON LABORATORIES INC

INDERAL LA -- WYETH PHARMACEUTICALS INC

INNOPRAN XL -- SMITHKLINE BEECHAM CORP DBA GLAXOSMITHKLINE

PROPRANOLOL HYDROCHLORIDE INTENSOL -- ROXANE LABORATORIES INC

INDERAL -- WYETH AYERST LABORATORIES

INDERAL -- AKRIMAX PHARMACEUTICALS LLC


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