Inderal LA 160mg Capsules

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-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 or seek immediate 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
Unusual burning, numbness, or tingling sensations
Feeling cold in the arms or legs
Changes in skin color (pale, blue, gray, purple, or red) on the 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)
+ 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. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention:

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. 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, such as 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 conditions, 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 your safety, inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
Your complete medical history, including any health problems you have or have had

Do not start, stop, or change 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.

To ensure your safety, avoid driving and other activities that require alertness until you understand how this medication affects you. When getting up from a sitting or lying down position, rise slowly to minimize the risk of dizziness or fainting. Be cautious when climbing stairs.

Regularly monitor your blood pressure and heart rate as instructed by your doctor. Be aware that this medication may interfere with certain laboratory tests, so inform all your healthcare providers and lab personnel that you are taking this medication.

Before consuming alcohol, discuss the potential risks with your doctor. If you smoke, talk to your doctor about the potential interactions with this medication. Smoking may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia, particularly in individuals with diabetes, children, and those who are fasting or experiencing nausea and vomiting.

If you have diabetes, it is crucial to closely monitor your blood sugar levels. If you have any questions or concerns, consult your doctor.

Do not abruptly stop taking this medication, as this may lead to worsened chest pain or even a heart attack, especially in individuals with certain types of heart disease. To minimize the risk of side effects, your doctor will guide you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, seek medical attention immediately.

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 your doctor for guidance.

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

If you have a history of severe allergic reactions, discuss the potential risks with your doctor. You may be more susceptible to an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, inform your doctor, as this medication may reduce the effectiveness of epinephrine.

If you are pregnant, plan to become pregnant, or are breastfeeding, consult your doctor to discuss the potential benefits and risks 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 (though less direct interaction, caution with adrenergic agents)
• Thioridazine - increased thioridazine levels, risk of QT prolongation and arrhythmias

• Other beta-blockers (additive effects)
• Clonidine (risk of rebound hypertension upon clonidine withdrawal)
• Digoxin (additive bradycardia)
• Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
• Alpha-1 blockers (e.g., prazosin) - risk of severe orthostatic hypotension
• Fingolimod (risk of severe bradycardia)
• Amiodarone (risk of bradycardia, heart block)
• Propafenone, Quinidine, Fluoxetine, Paroxetine (CYP2D6 inhibitors - increased propranolol levels)

• NSAIDs (may reduce antihypertensive effect)
• Sympathomimetics (e.g., epinephrine, norepinephrine, pseudoephedrine) - risk of hypertension and bradycardia
• Cimetidine (increased propranolol levels)
• Alcohol (increased propranolol levels)
• Rifampin, Phenobarbital, Phenytoin (CYP inducers - decreased propranolol levels)
• Lidocaine (increased lidocaine levels)
• Theophylline (mutual inhibition of clearance)

• Antacids (may decrease absorption of immediate-release, less relevant for LA)
• Cholestyramine/Colestipol (may decrease absorption)

• Bradycardia (slow pulse)
• Hypotension (dizziness, lightheadedness, fainting)
• Fatigue, weakness
• Cold hands/feet
• Bronchospasm (wheezing, shortness of breath)
• Symptoms of heart failure (dyspnea, edema, weight gain)
• Masked hypoglycemia (sweating, tremor, palpitations may be absent)
• Depression, sleep disturbances
• 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. Neonates exposed to beta-blockers in utero may be at 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'. The risk to the infant is generally low, but monitor for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding, hypoglycemia).

Safety and effectiveness of sustained-release propranolol (Inderal LA) have not been established in pediatric patients. Immediate-release propranolol is used off-label in pediatric populations for various indications (e.g., hypertension, migraine prophylaxis, infantile hemangioma), with dosing based on weight and indication. Close monitoring for adverse effects is crucial.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Renal and hepatic function should be assessed, as age-related decline in these functions may necessitate dose adjustments.

• Propranolol LA is a once-daily formulation, improving adherence compared to immediate-release.
• Always taper propranolol gradually over 1-2 weeks to avoid rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with ischemic heart disease.
• Non-selective beta-blockers like propranolol should be used with extreme caution or avoided in patients with asthma, severe COPD, or other bronchospastic diseases due to the risk of bronchoconstriction.
• Can mask symptoms of hypoglycemia in diabetic patients, except for sweating.
• May cause cold extremities due to peripheral vasoconstriction.
• Effective for performance anxiety due to its ability to block peripheral adrenergic symptoms (e.g., tremor, palpitations).

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, bisoprolol)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
• Calcium Channel Blockers (e.g., amlodipine, nifedipine, felodipine)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• For migraine prophylaxis: Topiramate, Valproic acid, CGRP inhibitors
• For essential tremor: Primidone

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 this 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 details about the overdose, including the medication taken, the amount, and the time it occurred.