Inderal LA 60mg Capsules
It is used to treat high blood pressure.It is used to treat chest pain or pressure. It is used to help certain heart problems.It is used to prevent migraine headaches.
Drug Class
Antihypertensive, Antiarrhythmic, Antianginal, Migraine Prophylaxis
Pharmacologic Class
Non-selective Beta-Adrenergic Blocker
Pregnancy Category
Category C
FDA Approved
Nov 1967
DEA Schedule
Not Controlled
Overview
What is this medicine?
Propranolol is a type of medicine called a beta-blocker. It works by relaxing blood vessels and slowing your heart rate, which helps to lower blood pressure, reduce chest pain (angina), prevent migraines, and control tremors. The 'LA' in Inderal LA means 'long-acting', so you usually take it only once a day.
How to Use This Medicine
Taking Your Medication Correctly
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Some medications are best taken with food, while others should be taken on an empty stomach. If you're unsure, consult with your pharmacist to determine the best way to take your medication.
When taking this medication, swallow the capsule whole - do not chew, break, or crush it. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.
Storing and Disposing of Your Medication
To maintain the effectiveness of your medication, store it at room temperature, away from heat, cold, and light. Keep the container tightly closed and do not freeze.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed dose.
To ensure you get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely. Some medications are best taken with food, while others should be taken on an empty stomach. If you're unsure, consult with your pharmacist to determine the best way to take your medication.
When taking this medication, swallow the capsule whole - do not chew, break, or crush it. Continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better.
Storing and Disposing of Your Medication
To maintain the effectiveness of your medication, store it at room temperature, away from heat, cold, and light. Keep the container tightly closed and do not freeze.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for a missed dose.
Lifestyle & Tips
- Take this medication exactly as prescribed, usually once daily at bedtime or in the morning. Do not crush, chew, or open the capsule.
- Do not stop taking this medication suddenly, especially if you have heart disease. Abruptly stopping can lead to serious heart problems. Your doctor will tell you how to slowly reduce the dose over time.
- Monitor your blood pressure and heart rate regularly as advised by your doctor.
- Avoid activities that require alertness until you know how the medication affects you, as it can cause dizziness or lightheadedness.
- Limit alcohol consumption, as it can increase the effects of propranolol.
- Inform your doctor or dentist that you are taking propranolol before any surgery or dental procedures.
- If you have diabetes, be aware that propranolol can mask the symptoms of low blood sugar (like shakiness or rapid heartbeat). Monitor your blood sugar closely.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Varies by indication. For hypertension, typically 80 mg once daily, may increase to 120-160 mg once daily. For angina, 80 mg once daily, may increase to 160 mg once daily. For migraine prophylaxis, 80 mg once daily, may increase to 160-240 mg once daily.
Dose Range:
60 - 320 mg
Condition-Specific Dosing:
hypertension:
Initial: 80 mg once daily; Maintenance: 120-160 mg once daily. Max: 640 mg/day.
anginaPectoris:
Initial: 80 mg once daily; Maintenance: 160 mg once daily. Max: 320 mg/day.
migraineProphylaxis:
Initial: 80 mg once daily; Maintenance: 160-240 mg once daily. Max: 240 mg/day.
essentialTremor:
Initial: 60-80 mg once daily; Maintenance: 120-320 mg once daily.
hypertrophicSubaorticStenosis:
80-160 mg once daily.
Pediatric Dosing
Neonatal:
Not established for sustained-release formulation. Immediate-release used for certain conditions (e.g., infantile hemangioma) with specific dosing.
Infant:
Not established for sustained-release formulation. Immediate-release used for certain conditions (e.g., infantile hemangioma) with specific dosing.
Child:
Not established for sustained-release formulation. Immediate-release used for certain conditions (e.g., hypertension, arrhythmias) with specific dosing (e.g., 0.5-1 mg/kg/day divided doses).
Adolescent:
Not established for sustained-release formulation. Immediate-release used for certain conditions. If used, consider adult dosing with caution.
Dose Adjustments
Renal Impairment:
Mild:
No specific adjustment needed.
Moderate:
No specific adjustment needed.
Severe:
Use with caution. Accumulation of active metabolites may occur. Monitor for exaggerated effects.
Dialysis:
Propranolol is not significantly dialyzable. No specific supplemental dose needed, but monitor for effects.
Hepatic Impairment:
Mild:
Use with caution. Consider lower initial doses.
Moderate:
Significant dose reduction may be necessary due to extensive hepatic metabolism. Monitor closely for exaggerated effects.
Severe:
Contraindicated in severe hepatic dysfunction (e.g., decompensated cirrhosis) due to risk of increased plasma levels and adverse effects. If used, extreme caution and significant dose reduction required.
Pharmacology
Mechanism of Action
Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks beta-1 (cardiac) and beta-2 (bronchial and vascular) 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. In migraine prophylaxis, its mechanism is not fully understood but may involve modulation of cerebral blood flow and neurotransmitter release. For essential tremor, it reduces tremor amplitude by blocking peripheral beta-2 receptors.
Pharmacokinetics
Absorption:
Bioavailability:
Highly variable, typically 15-60% due to extensive first-pass metabolism. Sustained-release formulation provides more consistent absorption.
Tmax:
For sustained-release capsules, approximately 6 hours (range 2-12 hours).
FoodEffect:
Food can increase bioavailability, especially for immediate-release. Sustained-release absorption is less affected by food, but consistent administration relative to meals is recommended.
Distribution:
Vd:
Approximately 4 L/kg.
ProteinBinding:
Highly protein bound (90-95%), primarily to alpha1-acid glycoprotein.
CnssPenetration:
Yes, readily crosses the blood-brain barrier, contributing to CNS effects (e.g., tremor, migraine prophylaxis, sedation).
Elimination:
HalfLife:
For sustained-release, approximately 8-11 hours (longer than immediate-release due to formulation).
Clearance:
Approximately 0.16-0.24 L/hr/kg.
ExcretionRoute:
Primarily renal (90-95% as metabolites).
Unchanged:
<1% (immediate-release); negligible for sustained-release.
Pharmacodynamics
OnsetOfAction:
For sustained-release, typically within 1-2 hours.
PeakEffect:
For sustained-release, typically 6-12 hours.
DurationOfAction:
For sustained-release, approximately 24 hours.
Confidence:
Medium
Safety & Warnings
BLACK BOX WARNING
WARNING: ABRUPT CESSATION OF THERAPY. Exacerbation of angina pectoris, and in some cases, myocardial infarction and ventricular arrhythmia, have been observed after abrupt discontinuation of therapy with beta-blockers. When discontinuing chronically administered propranolol, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, propranolol administration should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of unstable angina pectoris should be taken. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue propranolol therapy abruptly even in patients treated only for hypertension.
Side 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 or seek immediate medical attention:
Signs of an allergic reaction, such as:
+ 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
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Rapid heartbeat
+ Confusion
+ Hunger
+ Sweating
Signs of lupus, such as:
+ Rash on the cheeks or other body parts
+ Easy sunburn
+ 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 heartbeat
Abnormal heartbeat
Shortness of breath
Sudden 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 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)
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, characterized by:
- Red, swollen, blistered, or peeling skin
- Skin irritation (with or without fever)
- Red or irritated eyes
- 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, contact your doctor if they bother you or do not go away:
Dizziness
Drowsiness
Fatigue
Weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Sleep disturbances
Vivid or unusual dreams
Reporting Side Effects
This is not an exhaustive list of possible 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.
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
+ 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
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy or weak
+ Shaking
+ Rapid heartbeat
+ Confusion
+ Hunger
+ Sweating
Signs of lupus, such as:
+ Rash on the cheeks or other body parts
+ Easy sunburn
+ 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 heartbeat
Abnormal heartbeat
Shortness of breath
Sudden 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 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)
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, characterized by:
- Red, swollen, blistered, or peeling skin
- Skin irritation (with or without fever)
- Red or irritated eyes
- 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, contact your doctor if they bother you or do not go away:
Dizziness
Drowsiness
Fatigue
Weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Sleep disturbances
Vivid or unusual dreams
Reporting Side Effects
This is not an exhaustive list of possible 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.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Very slow heart rate (less than 50 beats per minute)
- Difficulty breathing, wheezing, or shortness of breath
- Swelling in your ankles or feet, sudden weight gain, or unusual tiredness (signs of heart failure)
- Coldness, numbness, or pain in your hands or feet
- New or worsening depression
- Unusual bruising or bleeding
Before Using This Medicine
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 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
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe for you to do so.
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 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
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe for you to do so.
Precautions & Cautions
Important Warnings and Precautions
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 alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying 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 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 experiencing vomiting. This risk also applies to individuals undergoing surgery or experiencing abnormal eating patterns.
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 worsened chest pain or even heart attack, particularly in individuals with certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the 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 about the risks and management of your condition.
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 with your doctor the benefits and risks of taking this medication to ensure the best possible outcome for you and your baby.
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 alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying 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 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 experiencing vomiting. This risk also applies to individuals undergoing surgery or experiencing abnormal eating patterns.
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 worsened chest pain or even heart attack, particularly in individuals with certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the 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 about the risks and management of your condition.
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 with your doctor the benefits and risks of taking this medication to ensure the best possible outcome for you and your baby.
Overdose Information
Overdose Symptoms:
- Severe bradycardia (very slow heart rate)
- Hypotension (very low blood pressure)
- Cardiogenic shock
- Bronchospasm
- Acute heart failure
- Hypoglycemia
- Seizures
- Coma
What to Do:
Seek immediate medical attention or call 911. For poison control, call 1-800-222-1222. Treatment is supportive and symptomatic, and may include atropine for bradycardia, glucagon, IV fluids, vasopressors, and bronchodilators.
Drug Interactions
Contraindicated Interactions
- MAO inhibitors (risk of severe hypertension)
- Thioridazine (increased thioridazine levels, risk of QT prolongation and arrhythmias)
Major Interactions
- Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem - risk of severe bradycardia, heart block, heart failure)
- Clonidine (risk of rebound hypertension upon clonidine withdrawal if propranolol is not tapered first)
- Fingolimod (risk of severe bradycardia)
- Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
- Other beta-blockers (additive effects)
- Alpha-1 blockers (e.g., prazosin - risk of severe orthostatic hypotension)
- Digoxin (additive bradycardia)
- Amiodarone (additive bradycardia, AV block)
- Propafenone (increased propranolol levels)
- Quinidine (increased propranolol levels)
- Fluvoxamine (increased propranolol levels)
- Cimetidine (increased propranolol levels)
- Alcohol (increased propranolol levels)
Moderate Interactions
- NSAIDs (may reduce antihypertensive effect)
- Sympathomimetics (e.g., epinephrine, pseudoephedrine - risk of hypertension, bradycardia)
- Lidocaine (increased lidocaine levels)
- Theophylline (reduced theophylline clearance)
- Rifampin (decreased propranolol levels)
- Phenytoin (decreased propranolol levels)
- Phenobarbital (decreased propranolol levels)
- Tobacco smoking (decreased propranolol levels)
- SSRIs (e.g., fluoxetine, paroxetine - increased propranolol levels)
- Antacids (e.g., aluminum hydroxide, magnesium hydroxide - decreased propranolol absorption)
Minor Interactions
- Not available
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation of therapy.
Heart Rate (HR)
Rationale: To establish baseline and assess for bradycardia.
Timing: Prior to initiation of therapy.
Electrocardiogram (ECG)
Rationale: To assess for pre-existing conduction abnormalities.
Timing: Prior to initiation, especially in patients with cardiac history.
Renal Function (BUN, Creatinine)
Rationale: To assess kidney function, as metabolites are renally excreted.
Timing: Prior to initiation.
Hepatic Function (ALT, AST, Bilirubin)
Rationale: To assess liver function, as propranolol is extensively metabolized by the liver.
Timing: Prior to initiation.
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly, especially during dose titration and periodically thereafter.
Target: Individualized based on indication (e.g., <130/80 mmHg for hypertension).
Action Threshold: Systolic BP <90 mmHg or symptomatic hypotension; consider dose reduction or discontinuation.
Heart Rate (HR)
Frequency: Regularly, especially during dose titration and periodically thereafter.
Target: Typically >50-60 bpm (unless target for specific arrhythmia).
Action Threshold: HR <50 bpm or symptomatic bradycardia; consider dose reduction or discontinuation.
Symptoms of Heart Failure
Frequency: Periodically
Target: Absence of new or worsening symptoms (e.g., dyspnea, edema, weight gain).
Action Threshold: Development or worsening of heart failure symptoms; consider discontinuation.
Blood Glucose (in diabetics)
Frequency: Regularly
Target: Individualized.
Action Threshold: Frequent or severe hypoglycemia; educate patient on masked symptoms.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fatigue
- Shortness of breath
- Wheezing
- Cold extremities
- Depression
- Insomnia
- Sexual dysfunction
- Signs of heart failure (e.g., swelling, weight gain, dyspnea on exertion)
Special Patient Groups
Pregnancy
Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Propranolol crosses the placenta. Associated with fetal growth restriction, bradycardia, hypoglycemia, and respiratory depression in neonates, particularly when administered close to delivery.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally considered low risk for major malformations compared to other trimesters. However, caution is advised.
Second Trimester:
Potential for fetal growth restriction and reduced placental perfusion. Close monitoring of fetal growth is recommended.
Third Trimester:
Increased risk of neonatal bradycardia, hypoglycemia, respiratory depression, and hypotonia. Monitor neonate for several days after birth if exposed in late pregnancy.
Lactation
L3 (Moderately safe). Propranolol is excreted into breast milk in small amounts. Monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, hypotension, lethargy, poor feeding, hypoglycemia). Consider using the lowest effective dose and monitoring the infant.
Infant Risk:
Low to moderate risk. Most infants experience no adverse effects, but theoretical risk of bradycardia, hypotension, and hypoglycemia exists, especially in preterm or unstable infants.
Pediatric Use
Safety and effectiveness of sustained-release propranolol in pediatric patients have not been established. Immediate-release propranolol is used off-label for various conditions (e.g., infantile hemangioma, hypertension, arrhythmias) in children, with dosing based on weight and careful titration. Use in children requires specialist consultation and careful monitoring.
Geriatric Use
Use with caution in elderly patients, as they may be more sensitive to the effects of beta-blockers (e.g., bradycardia, hypotension, CNS effects). Start with lower doses and titrate slowly. Monitor renal and hepatic function, as these may be impaired in the elderly.
Clinical Information
Clinical Pearls
- Propranolol LA is designed for once-daily dosing, providing sustained release and smoother plasma concentrations compared to immediate-release formulations.
- Always emphasize the importance of not abruptly discontinuing propranolol, especially in patients with ischemic heart disease, due to the risk of rebound angina, MI, or arrhythmias.
- Propranolol is non-selective, meaning it blocks both beta-1 and beta-2 receptors. This can lead to bronchoconstriction (contraindicated in asthma/COPD) and masking of hypoglycemia symptoms in diabetics.
- It is highly lipophilic and readily crosses the blood-brain barrier, which contributes to its efficacy in migraine prophylaxis and essential tremor, but also to CNS side effects like fatigue, depression, and sleep disturbances.
- The 4-hydroxypropranolol metabolite is active and contributes to the drug's effects, especially after immediate-release administration. Its contribution is less significant with sustained-release due to slower absorption.
- Patients should be advised to take the capsule whole and not to crush or chew it, as this would disrupt the sustained-release mechanism and could lead to rapid absorption and increased side effects.
Alternative Therapies
- Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, bisoprolol)
- Calcium channel blockers (e.g., amlodipine, nifedipine, verapamil, diltiazem)
- ACE inhibitors (e.g., lisinopril, enalapril)
- ARBs (e.g., losartan, valsartan)
- Diuretics (e.g., hydrochlorothiazide, furosemide)
- For migraine prophylaxis: Topiramate, Valproic acid, CGRP inhibitors (e.g., erenumab, fremanezumab)
- For essential tremor: Primidone, Gabapentin
Cost & Coverage
Average Cost:
Varies widely, typically $30-$100+ per 30 capsules
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (generic), Tier 3 or higher (brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. To ensure safe and effective treatment, 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 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 happened.