What is Propranolol?
Non-selective β-blocker, blocking β1 and β2 adrenergic receptors. It does not have sympathomimetic activity, decreases the sinus node stimulatory activity, relieves the conduction in the atrioventricular node, prolongs the refractory period, relieves heart activity, reduces ejection volume, acts hypotensive and anti-arrhythmic, reduces the oxygen consumption by the myocardium. After oral administration, it is well absorbed from the gastrointestinal tract. In 80-95%, it binds to plasma proteins. It is metabolized in the liver and excreted in the urine. T0.5 propranolol is 3-6 h.
Hypertension. Treatment of angina (except vasospastic – Prinzmetal). Secondary and primary prevention of myocardial infarction in patients with coronary artery disease. Control of supraventricular and ventricular arrhythmias. Prophylaxis of migraine. Treatment of spontaneous tremor. Reduction of situational and generalized anxiety, especially of the somatic type. Prophylaxis of bleeding from the upper gastrointestinal tract in patients with portal hypertension and esophageal varices. Supportive treatment in hyperthyroidism and thyroid gland. Treatment of hypertrophic cardiomyopathy (with narrowing of the outflow and / or intraventricular pathway). Perioperative management of pheochromocytoma (in combination with the α-adrenolytic drug).
What is Propranolol?
Hypersensitivity to the components of the preparation. Bronchial asthma and bronchial spasms. Bradycardia. Cardiogenic shock. Uncontrolled heart failure. Hypotension. Metabolic acidosis. Long-term starvation. Severe peripheral circulation disorders. Heart block IIst. or III. Prinzmetal Princelality. Sick node syndrome. Untreated phaeochromocytoma. Conditions where there is a risk of unbalanced hypoglycaemia, including malnutrition, cachexia, chronic liver disease, diabetes or the use of drugs that suppress the full response to catecholamines.
Use with caution in patients with controlled heart failure with low functional heart reserve, heart block Ist, diabetes, renal or hepatic impairment. Propranolol may mask the symptoms of thyrotoxicosis. Patients using propranolol may not respond to adrenaline given at the usual dose to treat the symptoms of a hypersensitivity reaction. Treatment should be discontinued 24 h before the planned treatment. In patients with portal hypertension, propranolol increases the risk of developing encephalopathy. Propranolol may slow the heartbeat, in some patients when the symptoms get worse, the dose should be reduced.
The preparation can be used during pregnancy only if the expected benefit to the mother outweighs the potential risk to the fetus. Propranolol reduces the blood flow through the placenta, causing fetal death, miscarriage or premature delivery. In the newborn can occur, among others hypoglycemia, bradycardia, cardio-pulmonary complications. Propranolol is excreted in breast milk – breastfeeding during breast-feeding is not recommended.
Bradycardia, worsening of heart failure, heart block, purpura, thrombocytopenia, confusion, dizziness, paresthesia, dry eyes, visual disturbances, bronchospasm, digestive tract disorders, alopecia, psoriasis-like reactions, psoriasis severity, rash, occurrence or worsening of myasthenia gravis, hypoglycemia (in newborns, children, elderly patients, undergoing hemodialysis, treated with antidiabetic agents, long-term fasted or with chronic liver disease), orthostatic hypotension, cold and bruising of the extremities, severity of intermittent claudication, Raynaud’s disease, fatigue, psychosis, hallucinations, changes mood, sleep disturbances, nightmares, increased titre of antinuclear antibodies.
Propranolol increases the hypoglycaemic effect of insulin and oral antidiabetic agents. Use with grade I medication (disopyramide) carefully. Digitalis glycosides may prolong atrioventricular conduction time. When used concomitantly with calcium channel blockers that exhibit inotropic negative activity (weapamil, diltiazem), may increase their effect, especially in patients with left ventricular insufficiency and / or disturbances in the sinoatrial and atrioventricular conduction (risk of severe hypotension, bradycardia and insufficiency) heart’s). At the same time, β-blockers and calcium channel blockers should not be given intravenously (a 48-hour interval should be observed between discontinuation of the drug from one of these groups and use on the other). Drugs from the calcium channel blockers of dihydropyridine derivatives (nifedipine) increase the risk of hypotension, and in patients with asymptomatic heart failure may cause its manifestation.