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Propranolol HCTZ

 

Propranolol / HCTZ (generic Inderal) Review

brand name: Inderal
generic names: Chlorpromazine hydrochloride, Propranolol, Propranolol hydrochloride

Why is Inderal prescribed?

Inderal, a type of medication known as a beta blocker, is used in the treatment of high blood pressure, angina pectoris (chest pain, usually caused by lack of oxygen to the heart due to clogged arteries), changes in heart rhythm, prevention of migraine headache, hereditary tremors, hypertrophic subaortic stenosis (a condition related to exertional angina), and tumors of the adrenal gland. It is also used to reduce the risk of death from recurring heart attack.

When used for the treatment of high blood pressure, it is effective alone or combined with other high blood pressure medications, particularly thiazide-type diuretics. Beta blockers decrease the force and rate of heart contractions, reducing the heart's demand for oxygen and lowering blood pressure.

Label warnings

• Do not stop taking this medication except on your doctor's advice.
  
  

What are Propranolol (Inderal) tablets or extended-release capsules?

Propranolol (Inderal ® ) belongs to a group of medicines called beta-blockers. Beta-blockers reduce the workload on the heart and help it to beat more regularly. Propranolol controls, but does not cure, high blood pressure (hypertension). High blood pressure may not make you feel sick, but it can lead to serious heart problems. Propranolol has a number of other uses; for some of these the sustained-release capsules are not suitable. Propranolol steadies irregular heart rhythms (arrhythmias) and relieves chest pain (angina), and it may be helpful after a heart attack. Propranolol can help prevent migraine headaches; relieve serious tremors (uncontrollable shaking); and help certain problems related to the thyroid gland and adrenal gland. Generic Propranolol (Inderal) tablets and extended-release capsules are available.

Special information if you are pregnant or breastfeeding

The effects of Inderal during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Inderal appears in breast milk and could affect a nursing infant. If Propranolol (Inderal) hydrochloride is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with Propranolol hydrochloride is finished.

Recommended dosage

ADULTS

All dosages of Inderal, for any problem, must be tailored to the individual. Your doctor will determine when and how often you should take this drug. If you are over 65, the doctor will probably start with a relatively low dosage. Remember to take it exactly as directed.

Irregular Heartbeat

The usual dose is 10 milligrams to 30 milligrams 3 or 4 times a day, before meals and at bedtime.

Inderal is also available in a sustained-release formulation, called Inderal LA, for once-a-day dosing.

Angina Pectoris

The usual daily dosage is 80 milligrams to 320 milligrams, 3, divided into 2, or 4 smaller doses. When your treatment is being discontinued, your doctor will reduce the dosage gradually over a period of several weeks.

Heart Attack

The usual daily dosage is 180 milligrams to 240 milligrams divided into smaller doses. The usual maximum dose is 240 milligrams, although your doctor may increase the dose when treating heart attack with angina or high blood pressure.

If treatment is stopped, this drug must be gradually reduced over a 7- to 14-day period.

Inderal will be carefully individualized for use in children and is used only for high blood pressure. Doses in children are calculated by body weight, and range from 2 milligrams to 4 milligrams per 2.2 pounds daily, divided into 2 equal doses. The maximum dose is 16 milligrams per 2.2 pounds per day.

Migraine

The usual starting dosage is 80 milligrams per day divided into smaller doses. Dosages can be increased gradually to between 160 milligrams and 240 milligrams per day. If this dose does not relieve your symptoms in 4 to 6 weeks, your doctor will slowly take you off the drug.

Hypertension

The usual starting dose is 40 milligrams 2 times a day. This dose may be in combination with a diuretic. Dosages are gradually increased to between 120 milligrams and 240 milligrams per day for maintenance. In some cases, a dose of 640 milligrams per day may be needed. Depending on the individual, maximum effect of this drug may not be reached for a few days or even several weeks. Some people may do better taking this medication 3 times a day.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe .

In people with diabetes, Propranolol can prolong the lowering of blood sugar (hypoglycaemia) caused by insulin or other antidiabetic medicines. Individuals should monitor their blood sugar, as Propranolol (Inderal) can also mask the signs of hypoglycaemia.

If Propranolol is taken with calcium channel blockers such as there may be an increased risk of slow heart rate, nifedipine or diltiazem, verapamil, low blood pressure and heart failure. Verapamil and diltiazem must not be given as an injection into a vein (intravenously) within 48 hours of discontinuing Propranolol, and vice versa.

If Propranolol (Inderal) is taken in combination with clonidine to lower blood pressure, there is a risk of a rebound increase in blood pressure if the clonidine is stopped. To avoid this, the Propranolol should be stopped several days before slowly stopping the clonidine.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin may reduce the antihypertensive effects of Propranolol.

Care should be taken if adrenaline is given with Propranolol (Inderal), as this combination can cause severely high blood pressure and slow heart rate.

Anti-arrhythmic medicines such as amiodarone or disopyramide may increase the risk of slow heart rate if they are taken with this medicine.

There is an increased risk of slow heart rate when Propranolol is taken with digoxin.

If Propranolol (Inderal) is taken in combination with ergotamine or dihydroergotamine there may be an increased risk of adverse reactions involving the blood circulation to the extremities.

Administration of Propranolol during an intravenous infusion of lidocaine may increase the blood level of lidocaine by approximately 30%. The combination should be avoided.

If any of the following medicines are taken in combination with Propranolol (Inderal), it may result in a change in the blood level of Propranolol, the other medicine, or both:-

• cimetidine.
  
  
• warfarin
  
  
• rifampicin
  
  
• propafenone
  
  
• hydralazine
  
  
• quinidine
  
  
• theophylline
  
  
• antipsychotics, eg chlorpromazine, thioridazine
  
  
• calcium channel blockers eg isradipine, lacidipine, nisoldipine, nifedipine, nicardipine