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propranolol (Rx)Brand and Other Names:Inderal, Inderal LA, more...InnoPran XL, Hemangeol

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

oral solution

  • 20mg/5mL
  • 40mg/5mL

injectable solution

  • 1mg/mL

tablet

  • 10mg
  • 20mg
  • 40mg
  • 60mg
  • 80mg

capsule, extended-release

  • 60mg
  • 80mg
  • 120mg
  • 160mg
more...

Hypertension

Immediate release

  • 40 mg PO q12hr initially, increasing every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day

Inderal LA

  • 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day

InnoPran XL

  • 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO

Migraine

Prophylaxis

80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr

Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day

Withdraw therapy if satisfactory response not seen after 6 weeks

Angina

80-320 mg/day PO divided q6-12hr

Inderal LA: 80 mg/day PO; not to exceed 320 mg/day

Pheochromocytoma

30-60 mg/day PO in divided doses

Hypertrophic Subaortic Stenosis

20-40 mg PO q6-8hr

Supraventricular Arrhythmia

PO: 10-30 mg q6-8hr

IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg

Once response or maximum dose achieved, do not give additional dose for at least 4 hours

Portal Hypertension

Prevention of variceal bleeding

10-60 mg PO q6-8hr; 10 mg PO q8hr initially; titrate dose to reduce resting heart rate by 25%

Essential Tremor

40 mg PO q12hr initially; maintenance: 120-320 mg/day PO divided q8-12hr

Antipsychotic-Induced Akathisia

30-120 mg PO q8-12hr

Malignant Glioma (Orphan)

Orphan designation for treatment of malignant glioma (plus etodolac)

Sponsor

  • Vicus Therapeutics, LLC; 55 Madison Avenue, Suite 400; Morristown, NJ 07960

Esophageal Variceal Bleeding (Off-label)

20-180 mg PO q12hr; adjust to maximum tolerated dose

Panic Disorder (Off-label)

40-320 mg/day PO

Aggressive Behavior (Off-label)

80-300 mg/day PO

Dosage Forms & Strengths

oral solution

  • 4.28mg/mL (Hemangeol)
  • 20mg/5mL
  • 40mg/5mL

injectable solution

  • 1mg/mL

tablet

  • 10mg
  • 20mg
  • 40mg
  • 60mg
  • 80mg

capsule, extended-release

  • 60mg
  • 80mg
  • 120mg
  • 160mg
more...

Infantile Hemangiomas

Hemangeol: Indicated for treatment of proliferating hemangioma requiring systemic therapy

Initiate treatment at aged 5 weeks to 5 months

Starting dose: 0.6 mg/kg (0.15 mL/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 mL/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 mL/kg) BID 

Administration (infantile hemangiomas)

  • Use supplied oral dosing syringe for administration and give directly into the child’s mouth; if necessary, the product may be diluted in a small quantity of milk or fruit juice and given in a baby’s bottle
  • Administer doses at least 9 hr apart during or after feedings
  • To reduce the risk of hypoglycemia, administer during or right after a feeding; skip the dose if the child is not eating or is vomiting
  • Readjust dose periodically as the child's weight increases
  • Monitor HR and BP for 2 hr after initial dose and after increasing dose
  • If hemangiomas recur, treatment may be reinitiated

Hypertension (Off-label)

0.5-1 mg/kg/day PO divided q6-12hr initially; increase gradually every 5-7 days; usual range: 2-4 mg/kg/day PO divided q12hr  

Arrhythmias (Off-label)

PO: 0.5-1 mg/kg/day divided q6-8hr; may be increased every 3-7 days; usual range: 2-6 mg/kg/day; not to exceed 16 mg/kg/day or 60 mg/day  

IV: 0.01-0.1 mg/kg over 10 minutes; repeat q6-8hr PRN; not to exceed 1 mg for infants or 3 mg for children

Hypercyanotic Spells (Off-label)

PO: 1 mg/kg/day divided q6hr; after 1 week, may be increased by 1 mg/kg/day to maximum of 10-15 mg/kg/day if patient refractory; allow 24 hours between dosing changes 

IV: 0.01-0.2 mg/kg over 10 minutes; not to exceed 5 mg

Thyrotoxicosis (Off-label)

10-40 mg PO q6hr; adjust dose to effect 

Hypertension

Immediate-release: 40 mg PO q12hr initially, increased every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day

Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day

InnoPran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO

Consider lower initial dose

Supraventricular Arrhythmia

PO: 10 mg q6-8hr; may be increased every 3-7 days

IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg

Once response or maximum dose achieved, do not give additional dose for at least 4 hours

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Interactions

Interaction Checker

propranolol and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Aggravated congestive heart failure

            Bradycardia

            Hypotension

            Arthropathy

            Raynaud phenomenon

            Hyper/hypoglycemia

            Depression

            Fatigue

            Insomnia

            Paresthesia

            Psychotic disorder

            Pruritus

            Nausea

            Vomiting

            Hyperlipidemia

            Hyperkalemia

            Cramping

            Bronchospasm

            Dyspnea

            Pulmonary edema

            Respiratory distress

            Wheezing

            Postmarketing Reports

            Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid; agranulocytosis, erythematous rash, fever with sore throat

            Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria

            Musculoskeletal: Myopathy, myotonia

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            Warnings

            Black Box Warnings

            May exacerbate ischemic heart disease after abrupt withdrawal

            Hypersensitivity to catecholamines has been observed during withdrawal

            Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuance

            When discontinuing long-term administration of beta blockers (particularly with ischemic heart disease), gradually reduce dose over 1-2 weeks and carefully monitor

            If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina)

            Warn patients against interruption or discontinuance of beta-blocker therapy without physician advice

            Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension

            Contraindications

            Asthma, COPD

            Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker)

            Cardiogenic shock

            Uncompensated congestive heart failure

            Hypersensitivity

            Overt heart failure

            Sick sinus syndrome without permanent pacemaker

            Infantile hemangioma

            • Premature infants with corrected age <5 weeks
            • Infants weighing <2 kg
            • Hypersensitivity
            • Asthma or history of bronchospasm
            • Heart rate <80 bpm
            • Greater than first-degree heart block
            • Decompensated heart failure
            • Blood pressure <50/30 mm Hg
            • Pheochromocytoma

            Cautions

            Do not use InnoPran XL in pediatric patients

            Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures

            Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions

            Sudden discontinuance can exacerbate angina and lead to myocardial infarction

            Use in pheochromocytoma

            Increased risk of stroke after surgery

            Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported

            Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported

            Exacerbation of myopathy and myotonia has been reported

            Less effective than thiazide diuretics in black and geriatric patients

            May worsen bradycardia or hypotension; monitor HR and BP

            Avoid beta blockers without alpha1-adrenergic receptor blocking activity in patients with prinzmetal variant angina; unopposed alpha-1 adrenergic receptors may worsen anginal symptoms

            May induce or exacerbate psoriasis; cause and effect not established

            Prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations, and sweating May cause or worsen bradycardia or hypotension

            Infantile hemangiomas and PHACE syndrome

            • By dropping blood pressure, propranolol may increase the risk of stroke in patients with PHACE syndrome who have severe cerebrovascular anomalies
            • Investigate infants with large facial infantile hemangioma for potential arteriopathy associated with PHACE syndrome before therapy
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            Pregnancy & Lactation

            Pregnancy category: C; intrauterine growth retardation, small placentas, and congenital abnormalities reported, but no adequate and well-controlled studies conducted

            Lactation: Use is controversial; an insignificant amount is excreted in breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Nonselective beta adrenergic receptor blocker; competitive beta1 and beta2 receptor inhibition results in decreases in heart rate, myocardial contractility, myocardial oxygen demand, and blood pressure

            Class 2 antidysrhythmic

            Absorption

            Bioavailability: 30-70% (food increases bioavailability)

            Onset: Hypertension, 2-3 wk; beta blockade, 2-10 min (IV) or 1-2 hr (PO)

            Duration: 6-12 hr (immediate release); 24-27 hr (extended release)

            Peak plasma time: 1-4 hr (immediate release); 6-14 hr (extended release)

            Distribution

            Protein bound: 68% (newborns); 90% (adults)

            Vd: 4 L/kg in adults

            Metabolism

            Metabolized by hepatic P450 enzymes CYP2D6 and CYP1A2

            Metabolites: 4-hydroxypropranolol (active)

            Elimination

            Half-life: Children, 3.9-6.4 hr; adults, 3.9-6.4 hr (immediate release) or 8-10 hr (extended release)

            Excretion: Urine (96-99%)

            Dialyzable: HD: No

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            Administration

            IV Incompatibilities

            Additive: Bicarbonate

            Syringe: Bicarbonate

            Y-site: Amphotericin B cholesteryl sulfate, diazoxide

            IV Compatibilities

            Solution: Most common solvents

            Additive: Dobutamine, verapamil

            Syringe: Inamrinone, milrinone

            Y-site: Alteplase, fenoldopam, gatifloxacin, heparin, hydrocortisone, sodium succinate, inamrinone, linezolid, meperidine, milrinone, morphine, potassium chloride, propofol, tacrolimus, tirofiban, vitamins B and C

            IV Administration

            IV administration rate should not exceed 1 mg/min

            IV dose is much smaller than oral dose

            Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution

            Continuous IV infusion generally is not recommended

            Storage

            Protect injection from light

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            Images

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            Formulary

            FormularyPatient Discounts

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            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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