Propranolol 80mg 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. Beta-2 blockade can cause bronchoconstriction and peripheral vasoconstriction. Its anti-migraine effect is thought to be due to its ability to block beta-receptors in the cerebral vasculature and/or central nervous system.

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 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
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, tiredness, 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, 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 modify 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 down 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 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 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.

Special Considerations
If you have diabetes, closely monitor your blood sugar levels. 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 discontinue the medication. If you experience new or worsening chest pain or other heart problems, contact your doctor immediately.

Thyroid and Blood Pressure Considerations
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. If you have high blood pressure, 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 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 this medication may reduce the effectiveness of epinephrine.

Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, consult with 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 nodal conduction abnormalities (risk of severe bradycardia, heart block, heart failure)
• MAO inhibitors (risk of hypertensive crisis)

• Other beta-blockers (additive effects)
• Clonidine (risk of rebound hypertension upon clonidine withdrawal if propranolol is not tapered)
• Digoxin (additive bradycardia)
• Insulin and oral hypoglycemics (masking of hypoglycemia symptoms, prolonged hypoglycemia)
• Sympathomimetics (e.g., epinephrine, norepinephrine, pseudoephedrine) (risk of hypertension, bradycardia)
• Fingolimod (risk of severe bradycardia)
• Prazosin (risk of first-dose syncope)
• Amiodarone (risk of bradycardia, AV block, cardiac arrest)

• NSAIDs (may reduce antihypertensive effect)
• Phenytoin, phenobarbital, rifampin (may decrease propranolol levels)
• Cimetidine, fluoxetine, paroxetine, quinidine (may increase propranolol levels)
• Alcohol (may increase propranolol levels)
• Lidocaine (propranolol may decrease lidocaine clearance)
• Theophylline (propranolol may decrease theophylline clearance)
• Ergot alkaloids (increased peripheral vasoconstriction)

• Antacids (may decrease propranolol absorption if taken concurrently)

• Bradycardia (slow pulse)
• Hypotension (dizziness, lightheadedness, fainting)
• Fatigue, lethargy
• Cold hands and feet
• Bronchospasm (wheezing, shortness of breath) in susceptible individuals
• Worsening of heart failure symptoms (e.g., swelling, weight gain, dyspnea)
• 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 crosses the placenta and has been associated with fetal/neonatal bradycardia, hypoglycemia, and intrauterine growth restriction. Neonates of mothers treated with propranolol should be closely monitored for signs of beta-blockade for several days after birth.

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), especially in neonates or premature infants.

Dosing is individualized based on weight and indication. Safety and efficacy for some indications (e.g., hypertension) are established. For infantile hemangioma, a specific liquid formulation (Hemangeol) is approved. Close monitoring for adverse effects, especially hypoglycemia and bradycardia, is crucial.

Elderly patients may be more sensitive to the effects of beta-blockers, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Renal and hepatic function should be assessed, as age-related decline in these functions can affect drug clearance.

• Always taper propranolol slowly over 1-2 weeks to avoid rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with coronary artery disease.
• Propranolol is highly lipophilic, leading to significant CNS penetration, which can contribute to side effects like fatigue, depression, and sleep disturbances.
• Non-selective beta-blockade can worsen bronchospasm in patients with asthma or COPD; use with extreme caution or avoid in these populations.
• Can mask signs of hypoglycemia in diabetic patients, requiring careful blood glucose monitoring.
• The 80mg tablet is a common strength for maintenance therapy across various indications, but initial dosing often starts lower (e.g., 40mg BID).
• Food increases propranolol's bioavailability; advise patients to take it consistently with or without food to maintain stable drug levels.

• Other beta-blockers (e.g., metoprolol, atenolol, carvedilol, bisoprolol)
• 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)
• Alpha-blockers (e.g., prazosin, doxazosin)
• For migraine prophylaxis: Topiramate, Amitriptyline, CGRP inhibitors
• For essential tremor: Primidone

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