Propranolol 10mg Tablets

Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks both beta-1 (β1) and beta-2 (β2) adrenergic receptors. Blocking β1 receptors in the heart leads to decreased heart rate, decreased myocardial contractility, and decreased cardiac output, thereby lowering blood pressure and reducing myocardial oxygen demand. Blocking β2 receptors in the bronchi and peripheral vasculature can lead to bronchoconstriction and vasoconstriction, respectively. It also has membrane-stabilizing activity (quinidine-like effect) at high doses and lacks intrinsic sympathomimetic activity (ISA). Its antihypertensive effect is also attributed to reduction of renin release from the kidneys, 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 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)
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, tiredness, or 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 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 blood 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. Please 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

To ensure your safety, always verify with your doctor that it is safe to take this medication with your existing health conditions and other medications. Never start, stop, or change the dosage of any medication without consulting your doctor first.

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 tasks that require alertness. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying position, and be cautious when climbing stairs.

Monitoring and Lab Tests
Follow your doctor's instructions for checking 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.

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 or even a 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 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.

• Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) - risk of severe bradycardia, heart block, and hypotension.
• MAO inhibitors (within 14 days of use) - risk of severe hypertension.
• Diazoxide (IV) - risk of severe hypotension.

• Other antiarrhythmics (e.g., amiodarone, quinidine, flecainide) - increased risk of bradycardia, heart block, and myocardial depression.
• Digoxin - increased risk of bradycardia.
• Alpha-1 blockers (e.g., prazosin, doxazosin) - risk of profound first-dose hypotension.
• Insulin and oral hypoglycemics - can mask symptoms of hypoglycemia (tachycardia, tremors) and prolong hypoglycemic episodes.
• NSAIDs (e.g., ibuprofen, naproxen) - may reduce the antihypertensive effect of propranolol.
• Clonidine - risk of rebound hypertension upon clonidine withdrawal if propranolol is not tapered first.
• Ergot alkaloids (e.g., ergotamine) - increased peripheral vasoconstriction and ischemia.

• Cimetidine - increases propranolol plasma levels (inhibits metabolism).
• Alcohol - may increase propranolol levels and enhance hypotensive effects.
• Phenytoin, phenobarbital, rifampin - decrease propranolol plasma levels (induce metabolism).
• Theophylline - propranolol may decrease theophylline clearance.
• Lidocaine - propranolol may decrease lidocaine clearance.
• Antacids (e.g., aluminum hydroxide, magnesium hydroxide) - may decrease propranolol absorption.
• SSRIs (e.g., fluoxetine, paroxetine) - may increase propranolol levels (CYP2D6 inhibition).

• Not available (interactions are generally categorized as moderate or higher due to clinical significance).

• Dizziness
• Lightheadedness
• Fatigue
• Shortness of breath
• Wheezing
• Cold hands/feet
• Bradycardia (slow pulse)
• Depression
• Sleep disturbances
• Masked symptoms of hypoglycemia (in diabetics)

Propranolol is classified as Pregnancy Category C. Use 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 at birth.

Propranolol is excreted into breast milk. The American Academy of Pediatrics considers propranolol to be 'compatible with breastfeeding' with caution. Monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, hypotension, drowsiness, hypoglycemia).

Dosing is highly individualized and often off-label for specific conditions like infantile hemangioma, hypertension, or certain arrhythmias. Close monitoring of heart rate, blood pressure, and blood glucose is essential. Pediatric patients may be more sensitive to the effects of beta-blockade.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Monitor for adverse effects and drug interactions more closely.

• Propranolol is a highly lipophilic beta-blocker, meaning it readily crosses the blood-brain barrier, which contributes to its efficacy in conditions like migraine prophylaxis, essential tremor, and anxiety.
• Due to its non-selective nature (blocking both beta-1 and beta-2 receptors), it should be used with extreme caution or avoided in patients with bronchospastic diseases (e.g., asthma, COPD) as it can cause bronchoconstriction.
• It is important to educate patients about the black box warning regarding abrupt discontinuation, especially in those with ischemic heart disease.
• Food significantly increases the bioavailability of propranolol, so consistent administration with meals is recommended to maintain stable drug levels.
• Propranolol can mask the signs of hypoglycemia (e.g., tachycardia, tremors) in diabetic patients, making blood glucose monitoring crucial.
• It is often used off-label for performance anxiety due to its ability to reduce physical symptoms like palpitations and tremors.

• 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, verapamil, diltiazem)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• Alpha-blockers (e.g., prazosin, terazosin)
• Central alpha-agonists (e.g., clonidine)
• 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 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 details about the medication taken, the amount, and the time it occurred.