Propranolol 40mg Tablets

Propranolol is a non-selective beta-adrenergic receptor blocker. It competitively blocks beta-1 (myocardial) and beta-2 (bronchial and vascular smooth muscle) adrenergic receptors. This results in decreased heart rate, myocardial contractility, and cardiac output, leading to reduced blood pressure. It also inhibits renin release from the kidneys. For migraine, the mechanism is not fully understood but may involve blockade of beta-receptors in the cerebral vasculature or central nervous system effects. For tremor, it likely involves blockade of peripheral beta-2 receptors.

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
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. Many people experience no side effects or only mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor:

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. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ 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, including:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems

This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing treatments and health status. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.

Important Warnings and Precautions

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. Be cautious when climbing stairs.

Monitoring and Lab Tests
Follow your doctor's instructions for monitoring your blood pressure and heart rate. This medication may affect certain laboratory tests, so it is crucial to 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 signs of low blood sugar, such as a 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 surgery, abnormal eating habits, or vomiting.

Diabetes Management
If you have high blood sugar (diabetes), closely monitor your blood sugar levels while taking this medication.

Stopping the Medication
Do not abruptly stop taking this medication, as this may 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 guide 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 signs 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 with your doctor.

Interactions with Over-the-Counter Products
If you have high blood pressure and are taking this medication, consult with 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
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.

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

• Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) in patients with impaired ventricular function or AV nodal conduction abnormalities (risk of severe bradycardia, heart block, heart failure)
• MAO inhibitors (risk of severe hypertension)

• Other beta-blockers (additive effects)
• Clonidine (risk of rebound hypertension upon clonidine withdrawal)
• Digoxin (additive bradycardia)
• Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
• Sympathomimetics (e.g., epinephrine, norepinephrine, isoproterenol) (antagonism, risk of severe hypertension with alpha-agonists)
• Fingolimod (risk of severe bradycardia)
• Prazosin (risk of orthostatic hypotension)

• NSAIDs (may reduce antihypertensive effect)
• Cimetidine, fluoxetine, paroxetine, quinidine (CYP2D6 inhibitors, may increase propranolol levels)
• Phenobarbital, rifampin, phenytoin (CYP inducers, may decrease propranolol levels)
• Alcohol (may increase propranolol levels)
• Lidocaine (increased lidocaine levels)
• Theophylline (mutual antagonism)

• Antacids (may decrease propranolol absorption)
• Cholestyramine, colestipol (may decrease propranolol absorption)

• Bradycardia (slow heart rate)
• Hypotension (dizziness, lightheadedness, fainting)
• Fatigue, lethargy
• Cold extremities
• Bronchospasm (shortness of breath, wheezing, cough)
• Worsening heart failure (edema, dyspnea, weight gain)
• Depression, sleep disturbances
• Masked symptoms of hypoglycemia (in diabetics)

Propranolol is Pregnancy Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. It has been associated with fetal growth restriction, bradycardia, and hypoglycemia in neonates.

Propranolol is excreted into breast milk. While generally considered compatible with breastfeeding, monitor the infant for signs of beta-blockade (e.g., bradycardia, hypotension, lethargy, hypoglycemia). Use the lowest effective dose.

Dosing is weight-based and varies by indication. Close monitoring for adverse effects (especially bradycardia, hypotension, hypoglycemia) is crucial. Specific formulations (e.g., Hemangeol for infantile hemangioma) are available for pediatric use.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Monitor renal and hepatic function, as these may be impaired in the elderly.

• Propranolol is a non-selective beta-blocker, meaning it affects both beta-1 (heart) and beta-2 (lungs, blood vessels) receptors. This makes it effective for a wide range of conditions but also increases the risk of bronchospasm in patients with asthma or COPD.
• Always emphasize the importance of gradual withdrawal to patients to prevent rebound phenomena, especially in those with underlying ischemic heart disease.
• It's highly lipophilic, which contributes to its CNS effects (e.g., fatigue, depression, sleep disturbances) but also makes it effective for conditions like migraine prophylaxis and essential tremor.
• Food significantly increases its bioavailability, so consistent administration with respect to meals is important for stable drug levels.
• Be mindful of drug interactions, particularly with other agents that slow heart rate or affect blood pressure, and with CYP450 inhibitors/inducers.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol)
• Calcium channel blockers (e.g., amlodipine, nifedipine, verapamil, diltiazem)
• ACE inhibitors (e.g., lisinopril, enalapril)
• ARBs (e.g., losartan, valsartan)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• For migraine prophylaxis: Topiramate, Valproic acid, CGRP inhibitors
• For essential tremor: Primidone

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