Propranolol 60mg 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 leads to decreased heart rate, myocardial contractility, and cardiac output, reducing blood pressure. It also inhibits renin release from the kidneys. In migraine, its mechanism is not fully understood but may involve modulation of cerebral blood flow and neurotransmitter release.

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 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
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
Difficulty getting or maintaining an erection
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 if they bother you or do not go away:

Dizziness, drowsiness, tiredness, or weakness
Upset stomach or vomiting
Stomach pain or cramps
Diarrhea or constipation
Difficulty sleeping
Strange or unusual dreams

Reporting Side Effects

This list is not exhaustive, and you may experience other 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 like 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 medications (prescription, over-the-counter, natural products, and vitamins) and health concerns with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing health conditions and other drugs. Never start, stop, or adjust 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 understand how this medication affects you, avoid driving and other activities 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 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 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 may lead to worsened 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 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 affect the efficacy 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) 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)
• Antiarrhythmics (e.g., amiodarone, disopyramide, quinidine - increased risk of bradycardia, AV block)
• Digitalis glycosides (increased risk of bradycardia, AV block)
• Clonidine (risk of rebound hypertension upon clonidine withdrawal if propranolol is not withdrawn first)
• Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
• Sympathomimetics (e.g., epinephrine, norepinephrine - attenuated pressor response, risk of severe hypertension with alpha-agonists)
• Ergot alkaloids (increased peripheral vasoconstriction)

• NSAIDs (may reduce antihypertensive effect)
• 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)
• Phenytoin, phenobarbital, rifampin (CYP inducers - decreased propranolol levels)
• Alcohol (increased propranolol levels)
• Cimetidine (increased propranolol levels)
• Lidocaine (increased lidocaine levels)
• Theophylline (reduced clearance of theophylline)

• Antacids (may decrease absorption of propranolol)

• Bradycardia (slow heart rate)
• Hypotension (dizziness, lightheadedness, fainting)
• Fatigue, lethargy
• Cold hands and feet (peripheral vasoconstriction)
• Shortness of breath, wheezing (bronchospasm, especially in asthmatics)
• Insomnia, nightmares
• Depression
• Nausea, vomiting, diarrhea, constipation
• Masked symptoms of hypoglycemia (in diabetics)

Propranolol is Pregnancy Category C. Studies in animals have shown adverse effects on the fetus, but there are no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Neonates exposed to beta-blockers in utero may be at risk for bradycardia, hypoglycemia, and respiratory depression.

Propranolol is excreted into breast milk. The American Academy of Pediatrics considers it 'compatible with breastfeeding'. However, monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, lethargy, hypoglycemia). Use with caution, especially in premature or unstable infants.

Dosing must be carefully individualized based on weight, age, and indication. Neonates and infants are particularly sensitive to the effects of beta-blockade. Close monitoring for bradycardia, hypotension, and hypoglycemia is essential. Specific formulations (e.g., oral solution for infantile hemangioma) are available.

Elderly patients may be more sensitive to the effects of propranolol, particularly bradycardia and hypotension. Lower initial doses and slower titration are recommended. Renal and hepatic function should be assessed, as age-related decline in these functions can affect drug clearance.

• Always warn patients about the risk of abrupt discontinuation, especially if they have underlying ischemic heart disease.
• Propranolol is highly lipophilic, leading to significant CNS penetration, which can cause side effects like nightmares, insomnia, and depression.
• It is a non-selective beta-blocker, so it should be used with extreme caution or avoided in patients with asthma, COPD, or other bronchospastic diseases due to the risk of bronchospasm.
• Can mask symptoms of hypoglycemia in diabetic patients, except for sweating.
• Food significantly increases the bioavailability of propranolol; advise consistent administration with respect to meals (e.g., always with food or always on an empty stomach).
• Extended-release formulations (Inderal LA) allow for once-daily dosing, improving adherence.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, bisoprolol)
• Calcium channel blockers (e.g., amlodipine, nifedipine, diltiazem, verapamil)
• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin receptor blockers (ARBs) (e.g., losartan, valsartan)
• Diuretics (e.g., hydrochlorothiazide, furosemide)
• Alpha-blockers (e.g., prazosin, doxazosin)
• 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 medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.