Inderal 40mg 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 leads to decreased heart rate, decreased myocardial contractility, decreased cardiac output, and reduced blood pressure. It also inhibits renin release from the kidneys. Its anti-migraine effect is thought to be due to its ability to block beta-2 receptors in cerebral vasculature, preventing vasodilation, and potentially central effects.

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, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or 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, including:
+ Dizziness or lightheadedness
+ Headache or feeling sleepy
+ Weakness, shaking, or a rapid heartbeat
+ Confusion, hunger, or sweating
Signs of lupus, such as:
+ A rash on the cheeks or other body parts
+ Easy sunburning
+ Muscle or joint pain
+ Chest pain or shortness of breath
+ Swelling in the arms or legs
Severe dizziness or fainting
New or worsening chest pain
Slow or irregular heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Confusion or hallucinations (seeing or hearing things that are not there)
Memory problems or loss
Depression or other mood changes
Abnormal sensations, such as burning, numbness, or tingling
Feeling cold in the arms or legs
Changes in skin color (pale, blue, gray, purple, or red)
Changes in eyesight
Unexplained bruising or bleeding
Fever, chills, or sore throat
Erectile dysfunction
Severe skin reactions, including:
+ Stevens-Johnson syndrome (SJS)
+ Toxic epidermal necrolysis (TEN)
+ Other severe skin reactions, such as 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

Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects, 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
Sleep disturbances
Vivid or unusual dreams

Reporting Side Effects

This list is not exhaustive, and you may experience other side effects. 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 you experienced, including any symptoms that occurred.
Certain heart conditions, including:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor blood circulation to your 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 medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing treatments and health status. Never start, stop, or adjust the dosage of any medication without first consulting your doctor.

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 know how this medication affects you, avoid driving and other activities that require you to be alert. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position, 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 some symptoms of low blood sugar, such as a 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.

Diabetes Management
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 worsening chest pain and, in some cases, heart attack, especially if you have certain types of heart disease. To avoid side effects, your doctor will instruct 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 a 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, talk to 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 affect the efficacy of epinephrine.

Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, consult with your doctor to discuss the benefits and risks of taking this medication to you and your baby.

• Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) - risk of severe bradycardia, heart block, heart failure.
• MAO inhibitors - risk of severe hypertension (theoretical, due to potential for increased catecholamines).

• Other beta-blockers (additive effects, severe bradycardia/hypotension)
• Antiarrhythmics (e.g., amiodarone, disopyramide, flecainide, quinidine) - increased risk of bradycardia, AV block, myocardial depression.
• Clonidine (risk of rebound hypertension upon clonidine withdrawal if propranolol is not tapered first).
• Digoxin (increased risk of bradycardia, AV block).
• Insulin and oral hypoglycemics (propranolol can mask symptoms of hypoglycemia and prolong hypoglycemic episodes).
• Alpha-1 blockers (e.g., prazosin, doxazosin) - increased risk of first-dose hypotension.
• Phenothiazines (e.g., chlorpromazine, thioridazine) - increased plasma levels of both drugs.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) - increased propranolol levels.
• CYP1A2 inhibitors (e.g., fluvoxamine, cimetidine) - increased propranolol levels.

• NSAIDs (e.g., ibuprofen, naproxen) - may reduce antihypertensive effect of propranolol.
• Sympathomimetics (e.g., epinephrine, pseudoephedrine) - reduced beta-agonist effect, potential for unopposed alpha-stimulation (hypertension, bradycardia).
• Ergot alkaloids (e.g., ergotamine) - increased risk of peripheral ischemia.
• Rifampin, phenobarbital, phenytoin (CYP inducers) - decreased propranolol levels.
• Alcohol (may increase propranolol levels and enhance hypotensive effect).

• Antacids (aluminum/magnesium hydroxide) - may decrease propranolol absorption (separate administration).
• Cholestyramine/colestipol - may decrease propranolol absorption.

• Bradycardia (slow pulse)
• Hypotension (dizziness, lightheadedness, fainting)
• Fatigue, weakness
• Shortness of breath, wheezing, cough (especially in patients with underlying respiratory disease)
• Cold extremities (fingers and toes)
• Insomnia, nightmares
• Depression
• Nausea, vomiting, diarrhea, constipation
• Sexual dysfunction

Propranolol is 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 growth restriction, bradycardia, and hypoglycemia in the neonate. Neonates exposed to beta-blockers in utero should be monitored for signs of bradycardia, hypoglycemia, and respiratory depression for the first few days of life.

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

Dosing is weight-based and varies significantly by indication. Not recommended for routine use in very young infants except for specific conditions like infantile hemangioma. Close monitoring for adverse effects (e.g., bradycardia, hypotension, hypoglycemia) is crucial, especially in younger children.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension. Lower initial doses and slower titration may be necessary. Renal and hepatic function should be assessed, as age-related decline in these functions can affect drug clearance.

• Always taper propranolol gradually over 1-2 weeks when discontinuing, especially in patients with ischemic heart disease, to avoid rebound angina, MI, or arrhythmias.
• Propranolol is non-selective, meaning it blocks both beta-1 and beta-2 receptors. This can lead to bronchospasm in patients with asthma or COPD and can mask symptoms of hypoglycemia in diabetics.
• Food increases the bioavailability of propranolol and can reduce peak plasma concentrations, leading to a smoother effect. Consistent administration with or without food is important.
• Patients should be advised to check their pulse regularly and report any significant slowing or symptoms of bradycardia.
• Due to its lipophilicity, propranolol can cross the blood-brain barrier, which may contribute to CNS side effects like fatigue, insomnia, and nightmares.
• Propranolol is often used off-label for performance anxiety (stage fright) due to its ability to reduce physical symptoms like palpitations and tremor.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, bisoprolol)
• Calcium channel blockers (e.g., amlodipine, nifedipine, verapamil, diltiazem)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• Alpha-blockers (e.g., prazosin, doxazosin)
• Other antiarrhythmics (e.g., amiodarone, sotalol)
• Other migraine prophylactic agents (e.g., topiramate, amitriptyline, CGRP inhibitors)

If your symptoms or health issues persist or worsen, it's 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 be sure to check with your pharmacist for more information. 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 emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it occurred.