Propranolol 1mg/ml Inj, 1ml

Propranolol is a non-selective beta-adrenergic receptor blocking agent. It competitively blocks beta-1 (myocardial) 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 reduces renin release from the kidneys. In the CNS, it can reduce sympathetic outflow. Its antiarrhythmic effects are due to reduction of SA nodal automaticity, AV nodal conduction velocity, and myocardial excitability.

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 rapid heartbeat
+ Confusion, hunger, or sweating
Signs of lupus, such as:
+ 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

Most people experience few or no side effects while taking this medication. However, if you notice any of the following symptoms, contact your doctor if they bother you or do not go away:

Dizziness, drowsiness, fatigue, or weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Difficulty sleeping
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. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ Heart block or sick-sinus syndrome (types of abnormal heartbeats)
+ Heart failure (weak heart)
+ Low blood pressure
+ Poor blood flow to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
Respiratory conditions, including:
+ 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
All your health problems, including those not listed above

To ensure your safety, always check with your doctor before starting, stopping, or changing the dose of any 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.

Caution with Daily Activities
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying down position, and exercise caution 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 impact certain lab test results, so inform all your healthcare providers and lab personnel that you are taking this medication.

Interactions with Other Substances
Discuss alcohol consumption with your doctor before drinking. 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, particularly in individuals 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 abruptly stop taking this medication, as this may lead to worsened chest pain or even heart attack, especially in individuals with certain types of heart disease. To avoid adverse effects, your doctor will guide you on how to gradually discontinue the 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 hyperthyroidism and suddenly stop taking this medication, your condition may worsen and become life-threatening. 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 Epinephrine
If you have a history of severe allergic reactions, discuss this with your doctor, as you may be at risk 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) - risk of severe bradycardia, heart block, heart failure
• MAO inhibitors (within 14 days) - risk of hypertensive crisis (theoretical, but caution advised)
• Drugs that prolong QT interval (use with caution)

• Other beta-blockers (additive effects)
• Digoxin (additive bradycardia)
• Clonidine (rebound hypertension upon clonidine withdrawal)
• Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
• Alpha-1 blockers (e.g., prazosin) - risk of profound hypotension
• Amiodarone (additive bradycardia, AV block)
• Fingolimod (severe bradycardia)

• NSAIDs (may reduce antihypertensive effect)
• Sympathomimetics (e.g., epinephrine, norepinephrine, pseudoephedrine) - risk of hypertension, bradycardia
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine) - increased propranolol levels
• CYP1A2 inhibitors (e.g., fluvoxamine) - increased propranolol levels
• CYP2C19 inhibitors (e.g., omeprazole) - increased propranolol levels
• Theophylline (reduced clearance of theophylline)
• Lidocaine (reduced lidocaine clearance)
• Warfarin (potential for increased anticoagulant effect)

• Alcohol (may increase propranolol levels)
• Cimetidine (increased propranolol levels)
• Hydralazine (increased propranolol levels)

• Bradycardia (dizziness, lightheadedness, syncope)
• Hypotension (dizziness, lightheadedness, fatigue)
• Bronchospasm (wheezing, shortness of breath, cough)
• Heart failure exacerbation (dyspnea, edema, weight gain)
• Fatigue, weakness
• Cold extremities
• Depression, sleep disturbances
• Masked hypoglycemia symptoms (sweating, hunger, confusion)

Propranolol crosses the placenta. Use during pregnancy should only be considered if the potential benefit outweighs the potential risk to the fetus. Neonates exposed to propranolol in utero may be at risk for bradycardia, hypoglycemia, and respiratory depression. Monitor neonates for these effects for several days after birth.

Propranolol is excreted into breast milk. While the amount is generally low, monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding, hypoglycemia). Generally considered compatible with breastfeeding with caution.

Use in pediatric patients, especially neonates and infants, requires careful dose titration and close monitoring due to potential for exaggerated response, bradycardia, and hypoglycemia. Dosing is weight-based. IV use is typically reserved for acute, severe conditions like arrhythmias or thyrotoxic crisis.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Increased risk of adverse effects due to age-related decline in renal and hepatic function, and polypharmacy. Monitor closely for adverse effects.

• Always administer IV propranolol slowly (over 10 minutes) to minimize the risk of severe bradycardia or hypotension.
• Have atropine and glucagon readily available for management of severe bradycardia or hypotension.
• Contraindicated in patients with bronchial asthma, severe COPD, sinus bradycardia, AV block (second or third degree), cardiogenic shock, or decompensated heart failure.
• Use with extreme caution in patients with diabetes due to masking of hypoglycemia symptoms and potential for prolonged hypoglycemia.
• In patients with pheochromocytoma, propranolol should only be initiated after adequate alpha-adrenergic blockade has been established to prevent unopposed alpha-stimulation and hypertensive crisis.
• Monitor for signs of heart failure exacerbation, especially in patients with pre-existing cardiac dysfunction.

• Other beta-blockers (e.g., metoprolol, esmolol, labetalol - depending on indication and selectivity)
• Calcium channel blockers (e.g., verapamil, diltiazem for arrhythmias; amlodipine, nifedipine for hypertension)
• ACE inhibitors/ARBs (for hypertension)
• Diuretics (for hypertension, heart failure)
• Antiarrhythmics (e.g., adenosine, amiodarone, digoxin for specific arrhythmias)

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, including the amount taken and the time it happened, to facilitate timely and appropriate care.