Propranolol 20mg/5ml Solution

Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks beta-1 and beta-2 adrenergic receptors. This blockade leads to decreased heart rate, decreased myocardial contractility, reduced cardiac output, and lowered blood pressure. It also inhibits renin release from the kidneys. Beta-2 blockade can cause bronchoconstriction and inhibit glycogenolysis.

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
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. 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 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 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.

To ensure safe treatment, 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

Do not start, stop, or change the dosage of any medication without first consulting your doctor to confirm 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.

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, rise slowly from a sitting or lying position, and be cautious when climbing stairs.

Monitoring and Lab Tests
Follow your doctor's instructions for checking blood pressure and heart rate. Be aware that this medication may affect 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 have undergone surgery.

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. 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 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 epinephrine may be less effective while taking this medication. Ensure you have the correct strength of epinephrine.

Pregnancy and Breastfeeding
Inform your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. You and your doctor will need 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, and hypotension.
• MAO inhibitors (e.g., phenelzine, selegiline) - risk of severe hypertension.

• Clonidine (risk of rebound hypertension upon clonidine withdrawal if propranolol is not tapered first).
• Other antiarrhythmics (e.g., amiodarone, disopyramide, quinidine) - additive negative inotropic/chronotropic effects.
• Insulin and oral hypoglycemics - may mask signs of hypoglycemia (tachycardia, tremors) and prolong hypoglycemic episodes.
• Sympathomimetics (e.g., epinephrine, norepinephrine, pseudoephedrine) - risk of severe hypertension and bradycardia due to unopposed alpha-adrenergic stimulation.
• NSAIDs (e.g., ibuprofen, naproxen) - may reduce the antihypertensive effect of propranolol.
• Ergot alkaloids (e.g., ergotamine, dihydroergotamine) - increased risk of peripheral ischemia.

• CYP450 inhibitors (e.g., cimetidine, fluoxetine, paroxetine, ritonavir) - may increase propranolol plasma levels.
• CYP450 inducers (e.g., rifampin, phenobarbital, phenytoin) - may decrease propranolol plasma levels.
• Alcohol - may increase propranolol plasma levels and enhance hypotensive effects.
• Alpha-1 blockers (e.g., prazosin, doxazosin) - increased risk of first-dose hypotension.
• Digoxin - additive bradycardic effects.
• Lidocaine - propranolol may reduce lidocaine clearance, increasing toxicity risk.

• Antacids (aluminum hydroxide, magnesium hydroxide) - may decrease propranolol absorption (separate administration by 2 hours).

• Dizziness
• Lightheadedness
• Fatigue
• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Shortness of breath
• Wheezing
• Cold extremities
• Depression
• Insomnia
• Masked signs of hypoglycemia (in diabetics)

Propranolol crosses the placenta. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. There are reports of adverse effects on the fetus/neonate including bradycardia, hypoglycemia, and intrauterine growth restriction. Neonates of mothers treated with propranolol should be carefully monitored for signs of beta-blockade for several days after birth.

Propranolol is excreted into breast milk. The amount is generally low, but there is a potential for adverse effects in the breastfed infant (e.g., bradycardia, hypotension, hypoglycemia). Monitor the infant for signs of beta-blockade. Use with caution, especially in preterm or unstable infants. Consider alternative agents if possible.

Dosing must be carefully individualized and titrated based on weight, age, and indication. The 20mg/5ml oral solution is particularly useful for precise pediatric dosing. Close monitoring for adverse effects (especially bradycardia, hypotension, hypoglycemia, and bronchospasm) is crucial. Specific formulations (e.g., Hemangeol) are approved for infantile hemangioma.

Geriatric patients may be more sensitive to the effects of beta-blockers and may have reduced renal or hepatic function, requiring lower initial doses and slower titration. Increased risk of bradycardia, hypotension, and CNS effects (e.g., dizziness, confusion). Monitor closely for adverse effects.

• Always taper propranolol slowly over 1-2 weeks when discontinuing, especially in patients with ischemic heart disease, to avoid rebound angina, myocardial infarction, or arrhythmias.
• Propranolol can mask the signs of hypoglycemia (e.g., tachycardia, tremors) in diabetic patients. Educate patients to monitor blood glucose more closely.
• Use with extreme caution in patients with bronchospastic diseases (e.g., asthma, COPD) due to non-selective beta-2 blockade, which can cause bronchoconstriction.
• Avoid concomitant use with non-dihydropyridine calcium channel blockers (verapamil, diltiazem) due to risk of severe bradycardia and heart block.
• The oral solution is particularly useful for precise dose titration, especially in pediatric patients or those requiring very low doses.
• Patients may experience cold extremities due to peripheral vasoconstriction; advise on appropriate clothing.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, labetalol)
• Calcium channel blockers (e.g., amlodipine, nifedipine, verapamil, diltiazem)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin receptor blockers (e.g., losartan, valsartan)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• Alpha-blockers (e.g., prazosin, doxazosin)
• Central alpha-agonists (e.g., clonidine)

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 emergency medical attention. When seeking help, be prepared to provide details about the overdose, including the medication taken, the amount, and the time it occurred.