Inderal 20mg Tablets

Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks beta-1 (myocardial) and beta-2 (bronchial and vascular smooth muscle) adrenergic receptors. This results in decreased heart rate, myocardial contractility, and cardiac output, leading to reduced blood pressure. It also reduces renin release from the kidneys. Its antiarrhythmic effects are due to reduction of sinus rate, prolongation of AV nodal conduction, and reduction of myocardial excitability. Its migraine prophylactic effect is thought to be related to its ability to block beta-receptors in the cerebral vasculature and/or central nervous system.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar: dizziness, headache, feeling sleepy, weak, shaking, rapid heartbeat, confusion, hunger, or sweating
Signs of lupus: rash on the cheeks or other body parts, easy sunburn, muscle or joint pain, chest pain or shortness of breath, or swelling in the arms or legs
Severe dizziness or fainting
New or worsening chest pain
Slow heartbeat or irregular heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Confusion
Hallucinations (seeing or hearing things that are not there)
Memory problems or loss
Depression or other mood changes
Abnormal burning, numbness, or tingling sensations
Feeling cold in the arms or legs
Changes in skin color (pale, blue, gray, purple, or red) on hands, feet, or other areas
Changes in vision
Unexplained bruising or bleeding
Fever, chills, or sore throat
Erectile dysfunction
Severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other severe skin reactions, characterized by red, swollen, blistered, or peeling skin; skin irritation (with or without fever); red or irritated eyes; or sores in the mouth, throat, nose, or eyes

Other Possible Side Effects

Most people taking this medication will not experience severe side effects, and some may not have any side effects at all. However, if you notice any of the following symptoms, contact your doctor if they bother you or do not go away:

Dizziness, drowsiness, tiredness, or weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Difficulty sleeping
* Strange or vivid dreams

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, including:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor circulation to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
Respiratory issues, such as:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems

This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.

To ensure safe treatment, inform your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
Your complete medical history

Do not start, stop, or adjust the dosage of any medication without first consulting your doctor to confirm that it is safe to do so in conjunction with this medication.

Important Warnings and Cautions

It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you understand how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and be cautious when climbing stairs.

Monitoring and Lab Tests
Follow your doctor's instructions for monitoring your blood pressure and heart rate. Be aware that this medication may affect certain laboratory tests, so inform all your healthcare providers and lab personnel that you are taking this medication.

Interactions with Other Substances
Discuss with your doctor before consuming alcohol. If you smoke, talk to your doctor about the potential risks. This medication may mask symptoms of low blood sugar, such as rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia, especially in people with diabetes, children, and those who are fasting or have undergone surgery.

Managing Diabetes
If you have high blood sugar (diabetes), closely monitor your blood sugar levels while taking this medication.

Stopping the Medication
Do not stop taking this medication abruptly, as this can lead to worsened chest pain or even heart attack, particularly in individuals with certain types of heart disease. To avoid side effects, your doctor will guide you on how to gradually stop taking this medication. If you experience new or worsening chest pain or other heart problems, contact your doctor immediately.

Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as rapid heartbeat. If you have an overactive thyroid and stop taking this medication suddenly, your condition may worsen and become life-threatening. Consult with your doctor if you have any concerns.

Interactions with Other Medications
If you have high blood pressure, consult with your doctor before taking over-the-counter (OTC) products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.

Allergic Reactions
If you have a history of severe allergic reactions, discuss with your doctor the potential risks of anaphylaxis. If you use epinephrine to treat severe allergic reactions, inform your doctor, as this medication may reduce the effectiveness of epinephrine.

Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor to ensure the best possible outcome for you and your baby.

• Cardiogenic shock
• Sinus bradycardia (<45 bpm)
• Second- or third-degree atrioventricular (AV) block
• Sick sinus syndrome (unless a pacemaker is present)
• Decompensated heart failure
• Bronchial asthma or bronchospasm (including history of)
• Severe chronic obstructive pulmonary disease (COPD)

• Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem): Risk of severe bradycardia, heart block, and heart failure.
• Other beta-blockers (e.g., atenolol, metoprolol): Additive effects, increased risk of bradycardia and hypotension.
• Clonidine: Risk of rebound hypertension upon clonidine withdrawal if propranolol is not discontinued several days prior.
• Alpha-1 adrenergic blockers (e.g., prazosin, doxazosin): Increased risk of first-dose hypotension.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine): May significantly increase propranolol plasma concentrations.
• Fingolimod: Increased risk of bradycardia and AV block.

• NSAIDs (e.g., ibuprofen, naproxen): May reduce the antihypertensive effect of propranolol.
• Insulin and oral hypoglycemics: Propranolol may mask symptoms of hypoglycemia (e.g., tachycardia, palpitations) and prolong hypoglycemic episodes.
• Sympathomimetics (e.g., epinephrine, norepinephrine): Antagonistic effects; may lead to hypertension and bradycardia.
• Cimetidine, Hydralazine: May increase propranolol levels.
• Rifampin, Phenobarbital, Phenytoin: May decrease propranolol levels.
• Alcohol: May increase propranolol levels.

• Antacids (aluminum hydroxide, magnesium hydroxide): May decrease propranolol absorption (separate administration by several hours).

• Dizziness
• Lightheadedness
• Fatigue
• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Shortness of breath
• Wheezing
• Cold hands or feet
• Depression
• Sleep disturbances
• Masked symptoms of hypoglycemia (in diabetics)

Propranolol is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Beta-blockers can cause fetal bradycardia, hypoglycemia, and growth restriction. Neonates of mothers treated with propranolol may be at increased risk for hypoglycemia, bradycardia, and respiratory depression.

Propranolol is excreted into breast milk in small amounts. The American Academy of Pediatrics considers it compatible with breastfeeding. Monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding, hypoglycemia), especially in neonates or premature infants.

Dosing must be individualized and carefully titrated based on age, weight, and indication. Children may be more sensitive to the effects of beta-blockade. Close monitoring for adverse effects (e.g., bradycardia, hypotension, hypoglycemia) is essential. Specific formulations (e.g., oral solution for infantile hemangioma) are available for very young children.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension, due to age-related decreases in renal and hepatic function, and increased prevalence of comorbidities. Initiate therapy with lower doses and titrate slowly. Monitor closely for adverse effects.

• Propranolol is highly lipophilic, allowing it to cross the blood-brain barrier, which contributes to its efficacy in conditions like migraine prophylaxis, essential tremor, and anxiety.
• It is a non-selective beta-blocker, meaning it blocks both beta-1 and beta-2 receptors. This can lead to bronchoconstriction (contraindicated in asthma/severe COPD) and masking of hypoglycemia symptoms.
• Abrupt discontinuation, especially in patients with coronary artery disease, can lead to severe rebound effects including angina exacerbation, myocardial infarction, and arrhythmias. Always taper the dose.
• The immediate-release formulation requires multiple daily doses, while extended-release formulations (e.g., Inderal LA, Innopran XL) allow for once-daily dosing, improving adherence.
• Used off-label for performance anxiety ('stage fright') due to its ability to reduce physical symptoms of anxiety like palpitations and tremor.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, labetalol)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
• Calcium Channel Blockers (e.g., amlodipine, nifedipine, verapamil, diltiazem)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• Alpha-blockers (e.g., prazosin, doxazosin)
• Central alpha-agonists (e.g., clonidine)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.