COMPOSITION : 

Each f/c tablet contains : Propranolol HCl 10mg, 40mg.

DESCRIPTION :

Indranol (Propranolol) is Beta 1and Beta 2 receptors blocker in cardiac, blood vessels , liver and kidney tissues, in which it prevents the association of adrenaline and noradrenaline with these receptors , hence it reduce the contraction of cardiac muscle and reduce the demand to the oxygen during exertion and rest. As it reduce the conductivity of cardiac muscle and reduce the arterial pressure. Propranolol decreases the renin release in blood leading to decrease in the blood vessels contractor, Propranolol prevents expansion of arteries that feed the cerebrum. Propranolol is absorbed rapidly from GIT and the maximum plasma concentration is reached after 2 hours of dose administration . Propranolol is metabolized in the liver and excreted by the kidney. 

INDICATIONS & DOSAGE : 

Adults & children above 12 years: 

- Treatment of hypertension : Initial dose is 80 mg twice daily , the dose may increase 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 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 increase weekly according to the response of patient to 120 - 240 mg per day in case of angina pectoris, and may be increased to 80-160 mg per day in case of migraine and tremor. 

- Prophylaxis of myocardial infarction: the treatment should be started 5 – 21 days after attack with initial dose 40 mg  4 times for 2 – 3 days , then increased to 80 mg twice daily. 

- High blood pressure due to tumor in the adrenal gland (phaeochromocytoma), used in the 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 esophageal varices: Initial dose is 40mg twice daily, the dose 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 :

Contraindication

- Hypersensitivity to Propranolol.

- Patients with second & third degree of heart failure or whose in cardiogenic shock.

- Patients with uncontrolled cardiac failure or phaeochromocytoma.

- Patients with asthma, hypoglycemia, 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 sever 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 gradually 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 the treatment with Propranolol may hide the symptoms of the disease.  

Use in Pregnancy and Lactation

Indranol should not be used during pregnancy or breast feeding.

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 the  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 administrated together. 

- Antimigraine drugs may cause contraction of blood vessels, so  administration should be separated by 2 hours. 

- Barbiturate and rifampicin may decrease Propranolol concentration ,whereas increase with hydralazine, chlorpromazine and cimetidine.  

- Administration of NSAIDs may cause increase in blood pressure , especially in patients with uncontrolled hypertension .  

ADVERSE EFFECTS:

Propranolol may cause some adverse effects but not necessary to each patient.                               The common effect : 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 .   

OVER DOSAGE :

Symptoms of overdose : dizziness, vomiting, bronchospasm, confusion, hypotension, bradycardia, pulmonary edema. 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 30oC, in a dry place.

PRESENTATION :

Indranol tablet 10mg : Pack of different sizes. 

Indranol tablet 40mg : Pack of different sizes.