📌 COMPOSITION

Each F/C tablet contains: Propranolol HCl 10 mg, 40 mg.

📌 DESCRIPTION

Indranol (Propranolol) is a beta‑1 and beta‑2 receptor blocker in cardiac, blood vessel, liver and kidney tissues, in which it prevents the association of adrenaline and noradrenaline with these receptors, hence it reduces the contraction of cardiac muscle and reduces the demand for oxygen during exertion and rest. It also reduces the conductivity of cardiac muscle and reduces arterial pressure. Propranolol decreases renin release in the blood, leading to a decrease in blood vessel constriction. Propranolol prevents expansion of arteries that feed the cerebrum. Propranolol is absorbed rapidly from the GIT, and the maximum plasma concentration is reached after 2 hours of dose administration. Propranolol is metabolised in the liver and excreted by the kidneys.

📌 INDICATIONS & DOSAGE

Adults and children above 12 years:

• Treatment of hypertension: Initial dose is 80 mg twice daily; the dose may be increased weekly according to the patient's response to 160-320 mg per day.
• Treatment of arrhythmia, hypertrophic cardiomyopathy and adjunctive management of thyrotoxicosis due to hyperactivity of the thyroid gland: 10-40 mg 3-4 times per day.
• Anxiety: 40 mg before anxious situations. For long‑term anxiety: 40 mg 2-3 times per day.
• Prophylactic management of angina pectoris, tremor and prophylaxis of migraine: Initial dose is 40 mg 2-3 times per day; the dose may be increased weekly according to the patient's response to 120-240 mg per day in the case of angina pectoris, and may be increased to 80-160 mg per day in the case of migraine and tremor.
• Prophylaxis of myocardial infarction: Treatment should be started 5-21 days after the attack, with an initial dose of 40 mg 4 times daily for 2-3 days, then increased to 80 mg twice daily.
• High blood pressure due to a tumour in the adrenal gland (phaeochromocytoma), used in addition to alpha blockers: 60 mg for 3 days before an operation; in non‑operable malignant cases: 30 mg daily.
• Prophylaxis of bleeding due to portal hypertension and oesophageal varices: Initial dose is 40 mg twice daily; the dose may be increased to 80-160 mg twice daily.

Children below 12 years:

0.25-0.5 mg/kg 3-4 times per day.

📌 RESTRICTIONS ON USE

Contraindications

• Hypersensitivity to Propranolol.
• Patients with second‑ and third‑degree heart failure or those in cardiogenic shock.
• Patients with uncontrolled cardiac failure or phaeochromocytoma.
• Patients with asthma, hypoglycaemia, metabolic acidosis, hypotension, peripheral arterial disturbances, bradycardia, or severe pain in the chest at rest (Prinzmetal's angina).

Precautions

• Caution should be taken in patients with first‑degree heart block or with heart weakness.
• Caution should be taken in patients with severe heart failure.
• Caution should be taken in patients with myasthenia gravis or liver and kidney dysfunction.
• If cessation of treatment is necessary, it should be gradual over 10-14 days; however, caution must be exercised since it does not always prevent rebound effects. In case of preparation for surgery, therapy should be discontinued for at least 24 hours.
• Caution should be taken in patients with thyrotoxicosis, in which treatment with Propranolol may hide the symptoms of the disease.

Use in Pregnancy and Lactation

Indranol should not be used during pregnancy or breastfeeding.

📌 DRUG INTERACTIONS

Caution should be taken when Propranolol is used concomitantly with the following drugs:

• Parenteral administration of adrenaline may lead, in rare cases, to vasoconstriction, hypertension and bradycardia.
• Quinidine or amiodarone may increase the effect of arterial conductivity.
• Digoxin may increase AV conduction.
• Verapamil or diltiazem may cause hypotension and bradycardia.
• Propranolol may increase the level of warfarin and theophylline in the plasma when they are administered together.
• Antimigraine drugs may cause contraction of blood vessels, so administration should be separated by 2 hours.
• Barbiturates and rifampicin may decrease Propranolol concentration, whereas it increases with hydralazine, chlorpromazine and cimetidine.
• Administration of NSAIDs may cause an increase in blood pressure, especially in patients with uncontrolled hypertension.

📌 ADVERSE EFFECTS

Propranolol may cause some adverse effects, but not necessarily in every patient. The common effects: feeling tired, bradycardia, cold fingers and toes, numbness in the fingers and sleep disturbance. Breathing difficulties in asthmatic patients, dizziness, visual disturbances, skin rash and myocardial depression may rarely occur.

📌 OVERDOSAGE

Symptoms of overdose: Dizziness, vomiting, bronchospasm, confusion, hypotension, bradycardia, pulmonary oedema. Cardiogenic shock and respiratory depression may also develop, and in severe cases coma may occur.

Treatment: First, monitor vital signs and airway. Gastric lavage can be considered in the first hour of overdose ingestion. Atropine is given in case of bradycardia; glucagon or isoprenaline can be given to control severe hypotension or cardiogenic shock. Salbutamol is beneficial in case of bronchospasm.

📌 STORAGE INSTRUCTIONS

Store below 30°C in a dry place.

📌 PHARMACEUTICAL FORMS

• Indranol 10 mg tablets: Pack of different sizes.
• Indranol 40 mg tablets: Pack of different sizes.