Inderal XL 80mg Capsules

Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks both beta-1 (β1) and beta-2 (β2) adrenergic receptors. This blockade leads to decreased heart rate, myocardial contractility, and cardiac output (β1 blockade). It also inhibits renin release from the kidneys. β2 blockade can cause bronchoconstriction and peripheral vasoconstriction. The antihypertensive effect is thought to be due to reduced cardiac output, inhibition of renin release, and central nervous system 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
+ Trouble 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
+ Feeling weak
+ Shaking
+ Fast 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
Swelling in the arms or legs
Confusion
Hallucinations (seeing or hearing things that are not there)
Memory problems or loss
Depression or mood changes
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, 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 or seek medical attention if they bother you or persist:

Dizziness
Drowsiness
Fatigue
Weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Sleep disturbances
* Vivid or unusual dreams

Reporting 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-related 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
All your health problems

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.

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 interfere with certain lab 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 low blood sugar, particularly in people with diabetes, children, and those who are fasting or experiencing vomiting.

Special Considerations
If you have diabetes, closely monitor your blood sugar levels. Do not stop taking this medication abruptly, as this can lead to worsened chest pain or even heart attack, especially if you have certain types of heart disease. To avoid side effects, your doctor will guide you on how to gradually stop taking this medication. Seek immediate medical attention if you experience new or worsening chest pain or other heart problems.

Thyroid and Blood Pressure Considerations
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. If you have high blood pressure, consult your doctor before using over-the-counter 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 and Emergency Treatment
If you have a history of severe allergic reactions, discuss with your doctor the potential risks of 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.

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

• Non-dihydropyridine Calcium Channel Blockers (e.g., verapamil, diltiazem): Increased risk of severe bradycardia, heart block, and heart failure.
• Other Beta-Blockers (including ophthalmic): Additive effects leading to severe bradycardia or hypotension.
• Clonidine: Risk of rebound hypertension upon abrupt withdrawal of clonidine if propranolol is not also tapered.
• Digoxin: Increased risk of bradycardia.
• Amiodarone: Increased risk of bradycardia and AV block.
• Insulin and Oral Hypoglycemics: May mask symptoms of hypoglycemia (e.g., tachycardia, palpitations) and prolong hypoglycemic episodes.
• MAO Inhibitors: Potential for significant hypertension or bradycardia.

• NSAIDs (e.g., ibuprofen, naproxen): May reduce the antihypertensive effect of propranolol.
• CYP450 Inhibitors (e.g., fluoxetine, paroxetine, quinidine, cimetidine, ritonavir): May increase propranolol plasma concentrations.
• CYP450 Inducers (e.g., rifampin, phenobarbital, phenytoin): May decrease propranolol plasma concentrations.
• Alpha-1 Blockers (e.g., prazosin, doxazosin): Increased risk of orthostatic hypotension.
• Sympathomimetics (e.g., epinephrine, norepinephrine): May cause unopposed alpha-adrenergic stimulation leading to hypertension and bradycardia.
• Ergot Alkaloids: Increased risk of peripheral ischemia due to unopposed alpha-adrenergic vasoconstriction.

• Alcohol: May increase propranolol levels.
• Antacids (e.g., aluminum hydroxide, magnesium hydroxide): May decrease propranolol absorption.

• Dizziness or lightheadedness (especially upon standing)
• Fatigue or lethargy
• Shortness of breath or wheezing (especially in patients with asthma/COPD)
• Cold hands or feet (Raynaud's phenomenon)
• Depression or mood changes
• Sleep disturbances or nightmares
• Bradycardia (slow pulse)
• Signs of heart failure (e.g., swelling in ankles/feet, sudden weight gain, increased shortness of breath)

Propranolol is classified as Pregnancy Category C. While studies in animals have shown adverse effects, there are no adequate and well-controlled studies in pregnant women. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus.

Propranolol is excreted into breast milk. The American Academy of Pediatrics considers it 'compatible with breastfeeding' but advises monitoring the infant. The risk category is L3 (Moderately Safe).

Safety and effectiveness of Inderal XL in pediatric patients have not been established. Immediate-release propranolol is used off-label for certain pediatric conditions (e.g., infantile hemangioma, certain arrhythmias), but specific dosing for the extended-release formulation is not well-defined for general pediatric use.

Elderly patients may be more sensitive to the effects of beta-blockers and may experience increased adverse effects (e.g., bradycardia, dizziness, orthostatic hypotension). Initiate therapy with lower doses and titrate slowly, monitoring closely for adverse reactions and therapeutic response. Renal and hepatic function should be considered.

• Always taper propranolol slowly over 1-2 weeks to avoid rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with ischemic heart disease.
• Propranolol is non-selective, meaning it blocks both beta-1 and beta-2 receptors. This can lead to bronchoconstriction, so it should be used with extreme caution or avoided in patients with asthma, COPD, or other bronchospastic diseases.
• Can mask symptoms of hypoglycemia (e.g., tachycardia, tremors) in diabetic patients, making it harder to recognize low blood sugar. Educate diabetic patients to monitor blood glucose closely.
• May exacerbate symptoms of peripheral vascular disease (e.g., Raynaud's phenomenon) due to beta-2 blockade leading to vasoconstriction.
• Take Inderal XL consistently, preferably with food, to ensure consistent absorption and reduce variability.
• Patients should be advised to report any new or worsening shortness of breath, swelling, or significant fatigue, which could indicate heart failure.

• Other Beta-Blockers (e.g., Metoprolol, Atenolol, Carvedilol, Bisoprolol)
• ACE Inhibitors (e.g., Lisinopril, Enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
• Calcium Channel Blockers (e.g., Amlodipine, Nifedipine, Diltiazem, Verapamil)
• Diuretics (e.g., Hydrochlorothiazide, Furosemide)
• Alpha-Blockers (e.g., Prazosin, Doxazosin)

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 details. 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 information about the medication taken, the amount, and the time it happened.