Propranolol 20mg Tablets

Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively antagonizes beta-1 and beta-2 adrenergic receptors. This leads to decreased heart rate, myocardial contractility, cardiac output, and blood pressure. It also inhibits renin release from the kidneys. Its effects on beta-2 receptors can cause bronchoconstriction and peripheral vasoconstriction. It also has membrane-stabilizing activity (quinidine-like effect) at high doses.

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 medical attention immediately:

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, 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

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult 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 weak 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 (OTC) 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. This will help ensure your safety and prevent any potential interactions with other treatments.

Caution with Daily Activities

Until you know how this medication affects you, avoid driving and engaging in activities that require you to be alert. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down position, and be cautious when climbing stairs.

Monitoring Your Condition

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 your alcohol consumption with your doctor before drinking. If you smoke, talk to your doctor about the potential risks. This medication may mask some symptoms of low blood sugar, such as a 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.

Managing Blood Sugar

If you have diabetes, closely monitor your blood sugar levels. If you have any questions or concerns, consult your doctor.

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 a 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 for guidance.

Interactions with Other Medications

If you have high blood pressure, consult 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 your condition with your doctor. You may be at risk of a 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 affect the efficacy 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) in patients with impaired ventricular function or AV conduction abnormalities (risk of severe bradycardia, heart block, asystole)
• MAO inhibitors (risk of hypertensive crisis)

• Other beta-blockers (additive effects)
• Antiarrhythmics (e.g., amiodarone, digoxin - increased risk of bradycardia, AV block)
• Clonidine (risk of rebound hypertension if clonidine is abruptly withdrawn while on propranolol)
• Insulin and oral hypoglycemics (may mask symptoms of hypoglycemia, prolong hypoglycemic response)
• NSAIDs (may reduce antihypertensive effect of propranolol)
• Alpha-1 blockers (e.g., prazosin - increased risk of orthostatic hypotension)
• Cimetidine (increases propranolol plasma levels)
• Rifampin (decreases propranolol plasma levels)
• Phenytoin, Phenobarbital (may decrease propranolol levels)

• Alcohol (may increase propranolol levels)
• Fluoxetine, Paroxetine (may increase propranolol levels due to CYP2D6 inhibition)
• Thioridazine (increased risk of QT prolongation and arrhythmias)
• Lidocaine (propranolol may reduce lidocaine clearance, increasing toxicity risk)
• Theophylline (propranolol may inhibit theophylline clearance)

• Antacids (may decrease propranolol absorption if taken concurrently)
• Smoking (may decrease propranolol levels)

• Dizziness
• Lightheadedness
• Fatigue
• Shortness of breath
• Wheezing
• Cold hands/feet
• Depression
• Sleep disturbances
• Unusual weight gain
• Swelling in ankles/feet
• Chest pain (especially if abruptly discontinued)

Propranolol is classified as Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Beta-blockers have been associated with fetal growth restriction, bradycardia, and hypoglycemia. Neonates exposed to beta-blockers in utero may be at risk for hypoglycemia, bradycardia, and respiratory depression.

Propranolol is excreted into breast milk. The American Academy of Pediatrics considers propranolol to be compatible with breastfeeding. However, monitor the infant for signs of beta-blockade (e.g., bradycardia, lethargy, hypoglycemia), especially in neonates or premature infants.

Use with caution and individualized dosing. Pediatric patients may be more sensitive to the effects of beta-blockade. Monitor closely for bradycardia, hypotension, and hypoglycemia. Specific indications like infantile hemangioma have specialized dosing protocols.

Start with lower doses and titrate slowly due to increased sensitivity to beta-blockers and potential for decreased renal/hepatic function. Elderly patients may be at increased risk for adverse effects such as bradycardia, hypotension, and central nervous system effects (e.g., confusion, depression).

• Propranolol is a highly lipophilic beta-blocker, which allows it to readily cross the blood-brain barrier, contributing to its efficacy in conditions like migraine prophylaxis, essential tremor, and anxiety.
• Due to its non-selective nature, it is generally contraindicated or used with extreme caution in patients with asthma, severe COPD, or other bronchospastic diseases.
• It can mask the signs of hypoglycemia in diabetic patients, particularly tachycardia, making it harder for patients to recognize low blood sugar.
• Abrupt discontinuation can lead to rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with underlying ischemic heart disease. Tapering is crucial.
• Food increases the bioavailability of propranolol, so consistent administration with food is recommended to maintain stable drug levels.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, labetalol)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
• Calcium Channel Blockers (e.g., amlodipine, nifedipine, verapamil, diltiazem)
• 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 is 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 it's a good idea to check with your pharmacist. If you have any questions or concerns about this medication, don't hesitate to discuss them with 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. Be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.