Propranolol indications for use. Propranolol is a drug for the treatment of cardiovascular diseases.

Propranolol belongs to β-blockers. It is prescribed for high blood pressure and arrhythmias. Propranolol should not be used in children and patients who are breastfeeding. During the period of gestation, it can only be used when there is no other alternative, since the β-blocker has a negative effect on the child.

Dosage form

Tablets in a dosage of 10 mg and 40 mg.

Description and composition

Propranolol is a non-selective β-blocker. Decreases after taking it. blood pressure, improves myocardial function, decreases the frequency and strength of heart contractions.

The drug may contain 10 mg or 40 mg of propranolol.

Pharmacological group

Propranolol is a non-selective beta-blocker. It has antianginal, antihypertensive and antiarrhythmic effects.

After oral administration, propranolol is rapidly absorbed. Up to 93% of the dose taken is protein bound. The maximum concentration in the blood is reached 60-90 minutes after taking propranolol. In the liver, the active substance is metabolized. It is excreted in the urine, the half-life can vary from 3 to 5 hours.

Indications for use

for adults

Propranolol is used in the following pathologies:

• high blood pressure;
• arrhythmia;
• cardiac ischemia;
• pheochromocytoma;
• cirrhosis of the liver;
• cardiopsychoneurosis;
• hyperthyroidism;
• weakness of labor activity;
• hypertrophic cardiomyopathy;
• myocardial dystrophy;
• tachyarrhythmia;
• essential tremor;
• withdrawal state.

Propranolol can be used to prevent migraines.

for kids

The drug is not used in pediatrics.

During pregnancy, propranolol can be used only under strict indications. It should be borne in mind that it can have a negative effect on the fetus, cause intrauterine growth retardation, hypoglycemia, and bradycardia.

Propranolol is not compatible with breastfeeding.

Contraindications

Propranolol should not be taken if the patient has the following pathologies:

• bronchial asthma and COPD;
• severe form of bradycardia;
• violation of peripheral circulation;
• arterial hypotension;
• sinoatrial and atrioventricular blockade;
• Raynaud's syndrome;
• unspecified and decompensated heart failure;
• cardiogenic shock;
• chronic pathologies of the liver;
• acidosis;
• acute myocardial infarction;
• individual intolerance to the composition of the drug.

Propranolol should not be taken in combination with MAO inhibitors, anesthetic agents that inhibit myocardial function, and also against the background of insulin therapy.

Applications and doses

for adults

Propranolol is taken before meals.

The treatment regimen is selected by the doctor individually, depending on the specific diagnosis.

At high blood pressure propranolol is prescribed 40 mg twice a day. If this dosage is not enough, then it should be drunk 40 mg 3 times or 80 mg 2 times a day. The daily dosage should not exceed 320 mg.

Patients with angina, impaired heart rate propranolol is prescribed at an initial dosage of 20 mg 3 times a day, then the daily dosage is increased to 80-120 mg, which should be taken 2 or 3 times. The daily dosage for these pathologies should not exceed 240 mg.

For patients with essential tremor, as well as for the prevention of migraine, β-blocker is prescribed 40 mg three times a day.

With thyrotoxicosis, propranolol is prescribed as an adjuvant, 40 mg 3-4 times a day.

In order to prevent recurrent myocardial infarction, treatment is started between 5 and 21 days after the experienced myocardial infarction. Within 2-3 days, propranolol is drunk 40 mg 3 times a day, then 80 mg twice a day. If necessary, the daily dosage may be increased to 240 mg.

Patients suffering from impaired liver and kidney function should take the β-blocker at a lower dosage.

In kidney disease, the time interval between taking the next dose of propranolol may be increased.

for kids

The drug is not intended for persons under 18 years of age.

for pregnant women and during lactation

During therapy, propranolol is taken in the minimum effective dosages.

Side effects

Taking medication can cause the following side effects:

• slowing of the heartbeat, heart failure, lowering blood pressure, AV blockade, decreased levels of leukocytes and platelets, thrombocytopenic purpura, impaired peripheral circulation;
• impotence, vertigo, headaches, insomnia, drowsiness, nightmares, decreased speed of mental and motor reactions, depression, emotional lability, agitation, excessive fatigue, short-term memory loss, hallucination, disorientation in space and time, weakness, sensitivity disorder;
• dry eye syndrome, visual impairment, keratoconjunctivitis;
• abdominal pain, liquid stool nausea, impaired taste and liver function, ischemic colitis, thrombosis of the mesenteric artery;
• pathological hair loss, rashes, itching, hyperhidrosis, exacerbation of psoriasis, hyperemia skin, exanthema;
• laryngospasm, bronchospasm, runny nose, nasal congestion, retrosternal pain, cough, dyspnea, respiratory distress syndrome;
• increased activity of liver enzymes, levels of lactate dehydrogenase, bilirubin, lowering blood sugar levels;
• withdrawal syndrome, decreased libido, erectile dysfunction, Peyronie's disease, joint pain, decreased thyroid function, allergies, lupus syndrome, fever.

Interaction with other drugs

When prescribing hypoglycemic agents against the background of therapy, the likelihood of hypoglycemia increases.
With the appointment of propranolol and digitalis, severe bradycardia is possible.

When using drugs for inhalation anesthesia during therapy, the likelihood of a drop in blood pressure and depression of myocardial function increases.

Hydralazine, diltiazem increases the content of propranolol in the blood, which can cause severe bradycardia, doxorubicin increases the cardiotoxicity of the beta-blocker.

Propranolol can increase the concentration of phenindione, imipramine in the blood.

NSAIDs can weaken the antihypertensive effect of a β-blocker, while clonidine, on the contrary, enhance.

Propranolol cannot be combined with certain other drugs, so the patient must report all medications taken.

special instructions

During therapy, exacerbation of psoriasis is possible.

After long-term treatment the dosage of the drug should be reduced gradually under the supervision of a physician.

Patients suffering from pheochromocytoma may be prescribed propranolol after a course of α-blockers.

A few days before the use of anesthesia, the intake of a β-blocker should be canceled or a drug for anesthesia should be selected that has a minimal negative inotropic effect.

During therapy, care should be taken when driving a car.

Overdose

• slowing of the heartbeat;
• drop in blood pressure;
• dizziness, which may result in fainting;
• arrhythmia;
• difficulty breathing;
• convulsions;
• blueness of fingers and palms.

With a pronounced decrease in heart rate, epinephrine is administered intravenously. With their low efficiency, a pacemaker is temporarily indicated. If the victim has ventricular extrasystole, then they are prescribed. With a decrease in blood pressure and in the absence of symptoms of pulmonary edema, plasma-substituting solutions are administered intravenously; if they are ineffective, epinephrine, dopamine, dobutamine are prescribed. When bronchospasm occurs, β2-agonists and theophylline are administered by inhalation or parenterally.

Storage conditions

Propranolol is stored in a place protected from children, moisture and sunlight.

Analogues

Propranolol can be replaced with the following medicines:

1. - the original drug containing propranolol. It has been proven effective in clinical trials. The medicine is produced in tablets, which are contraindicated in children and nursing patients. During pregnancy, the drug can be taken only if the benefit to the mother outweighs the harm to the fetus, 2-3 days before the expected birth, the drug should be discontinued.
2. contains as active substance propranolol. The drug is produced by several companies. On sale, the drug is available in tablets of 10 mg and 40 mg. They are contraindicated in persons under 18 years of age, materials that support breast-feeding. During gestation, it can be prescribed according to strict indications.
3. Hemangiol contains as active substance propranolol. The medicine is produced in the form of an oral solution, which is convenient for patients who have difficulty swallowing tablets. Hemangiol should not be prescribed to persons under 18 years of age, to patients who are breastfeeding. During pregnancy, the solution can be taken when the benefit to the woman exceeds potential harm for the fetus.
4. Retard is used for the same pathologies as propranolol. The drug is produced in tablets with a delayed release of the active substance, which allows you to take it 1 time per day. You can prescribe the medicine to adult patients, including women in position.

Price

The cost of propranolol is an average of 13 rubles. Prices range from 11 to 15 rubles.

The drug Propranolol belongs to the pharmacological group of non-selective adrenoblockers, which means its ability to block receptors in the area of ​​the heart muscle and blood vessels that respond to the release of adrenaline and norepinephrine.

Propranolol serves to normalize the level of excitability of cells in the myocardial node, reduce the amount of oxygen necessary for the normal functioning of the heart muscle, normalize heart rate, relax the walls of blood vessels while increasing their lumen.

The drug is indicated for long-term treatment of high blood pressure and to reduce intraocular pressure. Propranolol has a protective effect on the heart muscle, with long-term use can reduce the likelihood of a heart attack and death in case of disruption of work of cardio-vascular system in 50% of cases.

The drug is characterized by a positive effect when used to eliminate the consequences of the onset of menopause and contributes to an increase in the frequency of voluntary and provoked contractions of the muscles involved in labor.

In addition, the active ingredients medicinal product can cause peripheral circulatory disorders, bradycardia, different kinds heart failure. The negative effect of the components of the drug Propranolol notes the instruction when used for the treatment of people who have had diseases respiratory tract such as bronchospasm or acute asthma.

Analogues of the drug contain an active substance identical to propranolol and are prescribed based on contraindications and when negative consequences taking the original medication. In certain doses, the drug is able to have a sedative effect on the body, so when taking it, you should refrain from driving and participating in processes that require concentration.

Pharmacological group

Blocking beta 1 and beta 2 adrenoreceptors vascular walls leads to their relaxation. This, in turn, causes a decrease in blood pressure, a decrease in the amount of oxygen necessary for the work of the myocardium and increases the flow of essential nutrients to the organs.

Describes Propranolol instructions for use, which characterizes it as a means of hypotensive, antiarrhythmic and antianginal effects:

1. The antiarrhythmic effect is provided by reducing the sensitivity of myocardial cells, reducing the response of the heart muscle to the action external factors, provoking a violation of the rhythm of pulsations. The positive effect of this property is to reduce the ability of platelets to attach to the walls of blood vessels and the formation of their agglomerations and at the same time prevent the activity of the enzyme responsible for blood clotting with an increase in the amount of adrenaline in the blood.
2. The antianginal effect when using the drug is to reduce the amount of oxygen necessary for the heart muscle to work in a normal rhythm. The use of the drug Propranolol helps to eliminate tachycardia, reduce heart rate, has a preventive effect, preventing the possibility of occurrence and attacks of angina pectoris. This property of the drug Propranolol provides a decrease in the rate of involuntary excitation of the sinus pacemaker, the elimination of tachycardia and excessive susceptibility of the elements of the sympathetic system.
3. The hypotensive effect is achieved after a few weeks with regular use of the drug due to the ability of Propranolol to lower the level of blood pressure, by provoking an increase in the lumen of the vessels while eliminating their spasm. Normalization of blood pressure and an increase in the lumen of the vessels leads to a decrease in the amount of blood supplied as a result of venous return, which helps to reduce the load on the heart and normalize the functioning of the peripheral blood supply system. The hypotensive effect causes a decrease in the sensitivity of receptors in the aortic arch, which leads to the absence of their activation with a decrease in blood pressure.

Additional effects achieved when using the drug Propranolol include:

• reducing the likelihood of the formation of atherosclerotic plaques and eliminating existing ones, which reduces the severity and hypertension;
• improving the cognitive and physical abilities of a person, increasing the overall tone of the body;
• the possibility of using the drug Propranolol in the field of gynecology and obstetrics in order to activate uterine contractions, reduce blood loss during childbirth and in the postpartum period.

Causes of arterial hypertension

Release form

The main form of release for the drug Propranolol is represented by tablets in which propranolol acts as the active substance. The trade name of the drug is Propranolol, instructions for use, in addition, notes the second name medication, produced under the brand name Propranolol Nycomed. Each tablet, depending on the type of issuing company, may contain

• 160 mg of active substance.

The type of additional components included in the composition depends on the manufacturer. A complete list of components of the drug Propranolol and its analogues is contained in the instructions for use.

Mechanism of action

The mechanism of action of the drug Propranolol is based on a decrease in the amount of calcium ions entering the cell based on non-selective blocking of 1 and 2 adrenoreceptors. A decrease in the conductivity and sensitivity of cells leads to a decrease in the frequency of myocardial contractions and the frequency of pulsations.

Instructions for use

The period of preservation of the effect of the active substance is 5 years from the time indicated by the manufacturer on the package.

Since Propranolol has a number of specific side effects, some features of the drug should be taken into account when prescribing and using it, the main of which include:

1. The use of Propranolol reduces the amount of tear fluid, which is important to consider when prescribing for patients using contact lenses.
2. Exact adherence to the dosages of Propranolol indicated by the attending physician with their increase, if necessary, as the course of therapy progresses.
3. Periodic examination by the attending physician, the recommended frequency of which is once every 2-3 weeks. Evaluation of the therapy process by a specialist, a survey for complications, delivery general analysis blood, removal ECG indicators, control of sugar levels and the frequency of contraction of the heart muscle. If necessary, it is possible to appoint a doctor for consultations and examinations from other specialists.
4. For the elderly, the danger of using the drug is a high probability of impaired renal function.
5. In practicing smokers, there is a decrease in the effectiveness of the drug.
6. If the risk of severe or MI increases, the drug is discontinued for several weeks, reducing the dosage of Propranolol by ¼ every 4 days.
7. Use should be discontinued before surgery surgical intervention and a few days before anesthesia.

During pregnancy and during lactation, Propranolol is prescribed in rare cases when the effect achieved in the mother's body outweighs the possible risk to the intrauterine development of the fetus. At the same time, the condition of the pregnant woman is monitored with the completion of the course of taking the drug 2-3 days before the expected date of delivery.

Indications

The individual prescription of the drug Propranolol, depending on the stage of the disease and the symptoms of the individual course, is the responsibility of the attending physician if the patient has the following indications for use:

• prolapse mitral valve;
• sinus and ventricular arrhythmias;
• withdrawal syndrome that occurs when you stop using tobacco, drugs and alcohol;
• the need to stimulate labor activity with weakness of uterine contractions;
• elimination of negative effects caused by the onset of menopause;
• aortic and portal hypertension;
• thyrotoxicosis, in which the drug is used as additional funds as part of complex therapy;
• extrasystole;
• migraine;
• panic and anxiety;
• sympathoadrenal crisis;
• hypertrophied dystrophy of the heart muscle;
• narrowing of the aortic lumen.

Dosage

Tablets are produced under trade name Propranolol, and the prescription is printed in Latin.

Each tablet is used as a whole, it is not allowed to use cracking or other types of grinding of the drug. Propranolol is most effective when taken after a meal. After swallowing, it is necessary to drink the tablet with boiled water, kefir or juice.

Norms of medication Propranolol is prescribed by the attending physician in accordance with the individual symptoms and the course of the disease in the patient. Known dosage of the drug Propranolol for the treatment of various disorders:

1. In the treatment of hypertension, several times a day, 40 mg per dose is used with an increase in dosage for 2-4 weeks of the course. One of the possible forms is the use of 80 and 160 mg tablets in more severe cases of the disease, while maintaining the given frequency of use.
2. Thyrotoxicosis, in the treatment of which the single dose of Propranolol is 10 mg, while daily rate the active substance entering the patient's body should not exceed 40 mg / day.
3. When stabilizing the condition after a heart attack and for prevention, the recommended single dose of Propranolol is 20 mg, taken four times a day. When prescribing a dosage of 40 mg, the rate of taking the drug Propranolol remains the same and is reduced to two times a day when using tablets containing 80 mg of the active substance.
4. Migraine therapy includes taking Propranolol 2 times a day, 40 mg at a time.
5. Dosages for children over 12 years of age are the same as for adults. For children of younger age groups, the initial dose of the drug is determined based on body weight at the rate of 0.5–1 mg / kg of body weight per day. The first 7 days Propranolol is used according to the described treatment regimen. After that, the daily dose is increased to therapeutic values ​​​​of 2-4 mg / kg of the child's weight, and the resulting daily amount is divided into several doses per day.

Side effects

The drug Propranolol, as provided for in the instructions for use, is dispensed as prescribed by a doctor upon presentation of a prescription in the established form. The side effects that Propranolol has are conditions that are more likely to occur when taking the drug.

In the event of their occurrence possible ways are:

• reducing the dosage of the drug;
• selection of medicines from the group of analogues;
• cancellation of the course of treatment.

Among the most frequently occurring side effects when using the drug Propranolol are:

• for nervous system- the occurrence of a feeling of weakness, drowsiness, lethargy, dizziness, confusion in thoughts, psychosis, convulsions, short-term loss of memory, loss of sense of time and violation of spatial orientation, increased sweating, fever;
• for the sense organs - a violation of taste perception, dryness of the mucous surfaces of the mouth and eyes, pharyngitis, rhinitis;
• for the cardiovascular system - worsening of the course of chronic heart failure, a decrease in contractions of the heart muscle, pain in the retrosternal region, a decrease in blood pressure when moving from a horizontal to a vertical position, a decrease in the level of platelets and leukocytes in the blood plasma;
• for the digestive tract - flatulence, the appearance of pain in the epigastric region, stool disorders, nausea and vomiting, deterioration of the liver, the appearance of yellowness of the skin and sclera, a change in the color of urine to a darker shade;
• for endocrine system- violation of libido and deterioration of potency in men, a decrease in blood glucose levels due to dysfunction thyroid gland in insulin dependent patients;
• allergic manifestations in the form of a rash, urticaria, itching of the surface of the skin;
• for the skin - the transition of psoriasis to the stage of relapse, rash;
• for organs respiratory system- appearance pain in the chest area, respiratory rhythm disturbances, coughing;
• during pregnancy - intrauterine growth retardation, the development of bradycardia.

Contraindications

Propranolol has contraindications to the appointment and use for therapy, which include:

• individual intolerance to the components of the composition;
• the presence of disorders of the peripheral circulatory system;
• bradycardia with a decrease in the frequency of pulsations less than 50-55 beats / min;
• acute or chronic form heart failure;
• weakness of the sinus node;
• decrease in blood pressure;
• Prinzmetal's angina;
• bronchial asthma;
• depression;
• diabetes;
• dysfunction of the kidneys or liver;
• ventricular arrhythmias;
• the presence of psoriasis in the form of remission;
• endarteritis;
• thrombophlebitis;
• hyperthyroidism;
• peripheral vascular disease;
• elderly age;

The scheme of treatment of hypertension

Recipe in Latin

The Latin prescription for Propranolol is written as follows:

Rp: Tabulettae Propranololi 0.01 No. 40 D.S. Inside, 1 tablet 2 times a day.

After the designation "Rp" follows the name of the drug and the form of release of the drug Propranolol (Tabulettae Propranololi). The following numbers indicate the amount of active ingredient and are indicated in grams or milligrams. In the example given, the dosage in grams is 0.01 g or 10 mg. Under the designation No. is the number of tablets in the package, which the pharmacy representative must provide to the patient upon presentation of the prescription. The last digits after the characters "D. S. “denote the individual dosage of the drug for the patient, recommended by the doctor.

Gross formula

Pharmacological group of the substance Propranolol

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Propranolol

Propranolol hydrochloride is a white crystalline powder. Soluble in water and alcohol.

Pharmacology

Blocks beta 1 and beta 2 -adrenergic receptors, has a membrane-stabilizing effect. It inhibits the automatism of the sinoatrial node, suppresses the occurrence of ectopic foci in the atria, AV junction, ventricles (to a lesser extent). Reduces the speed of excitation in the AV connection along the Kent bundle, mainly in the anterograde direction. Reduces heart rate, reduces the strength of heart contractions and myocardial oxygen demand. Lowers cardiac output, renin secretion, blood pressure, renal blood flow and glomerular filtration rate. Suppresses the reaction of baroreceptors of the aortic arch to lower blood pressure.

After taking a single dose, the hypotensive effect lasts for 20-24 hours. A single dose of prolonged forms is equivalent to taking several doses of propranolol hydrochloride. Hypotension stabilizes by the end of the 2nd week of treatment. With prolonged use, it reduces venous return, has a cardioprotective effect (significantly reduces the risk of recurrent myocardial infarction and sudden death by 20-50%). In patients with moderate arterial hypertension- reduces the likelihood of developing coronary artery disease and cerebral strokes. With IHD, it reduces the frequency of attacks, increases exercise tolerance, and reduces the need for nitroglycerin. It is most effective in young patients (up to 40 years old) with a hyperdynamic type of blood circulation and with an increased content of renin. Increases bronchial tone and uterine contractility (reduces bleeding during childbirth and in postoperative period), enhances the secretory and motor activity of the gastrointestinal tract. It inhibits platelet aggregation and activates fibrinolysis. Inhibits lipolysis in adipose tissue, preventing an increase in the level of free fatty acids(At the same time, the concentration of triglycerides in plasma and the coefficient of atherogenicity increase. Suppresses glycogenolysis, the secretion of glucagon and insulin, the conversion of thyroxine to triiodothyronine. Lowers intraocular pressure, reduces the secretion of aqueous humor.

Long-term administration (18 months) to rats and mice of doses up to 150 mg/kg/day did not reveal carcinogenic properties and adverse effects on fertility. At a dose of 150 mg / kg / day, 10 times higher than the MRDC, it had an embryotoxic effect (increased incidence of fetal resorption).

When taken orally, it is rapidly and almost completely absorbed from the gastrointestinal tract (90%). Bioavailability is 30-40% (first pass effect), depends on the nature of the food and the intensity of hepatic blood flow, and increases with long-term use (metabolites are formed that inhibit liver enzymes). C max in plasma is noted after 1-1.5 hours or 6 hours (for a prolonged form). Contacts proteins of plasma for 90-95%; T 1/2 is 2-5 hours (10 hours for a prolonged form). The volume of distribution is 3-5 l / kg. Accumulates in the lung tissue, brain, kidneys, heart, passes through the placental barrier, penetrates into breast milk. Exposed to glucuronidation in the liver (99%). It is excreted in the bile into the intestine, deglucuronized and reabsorbed (T 1/2 against the background of a course administration can be extended up to 12 hours). Excreted by the kidneys as metabolites.

The use of the substance Propranolol

Arterial hypertension, angina pectoris, sinus tachycardia (including with hyperthyroidism), supraventricular tachycardia, tachysystolic form of atrial fibrillation, supraventricular and ventricular premature beats, hypertrophic cardiomyopathy, myocardial infarction, mitral valve prolapse, subaortic stenosis, sympathetic-adrenal crisis in patients with diencephalic syndrome, neurocirculatory dystonia, portal hypertension, essential tremor, panic attacks, aggressive behavior, migraine (prevention), auxiliary treatment for pheochromocytoma (only in combination with alpha-blockers), thyrotoxicosis (including preoperative preparation), thyrotoxic crisis, primary weakness of labor, menopausal vasomotor symptoms, withdrawal syndrome; treatment of akathisia caused by antipsychotics.

Contraindications

Hypersensitivity, II-III degree AV block, sinoatrial block, bradycardia (less than 55 bpm), sick sinus syndrome, arterial hypotension, acute and severe chronic heart failure, Prinzmetal's angina, cardiogenic shock, obliterating vascular disease, bronchial asthma .

Application restrictions

Chronic bronchitis, emphysema, diabetes mellitus, hypoglycemia, acidosis, impaired liver and kidney function, psoriasis, spastic colitis, myasthenia gravis, pregnancy, breastfeeding, old age.

Use during pregnancy and lactation

Perhaps if the expected effect of therapy outweighs the potential risk to the fetus. At the time of treatment should stop breastfeeding.

Side effects of Propranolol

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): bradycardia, heart failure, AV blockade, hypotension, peripheral circulatory disorders, thrombocytopenic purpura, leukopenia, agranulocytosis.

From the nervous system and sensory organs: asthenia, dizziness, headache, insomnia, drowsiness, nightmares, decreased rate of mental and motor reactions, emotional lability, depression, agitation, hallucinations, disorientation in time and space, short-term amnesia, impaired sensitivity, paresthesia; dry eyes, visual disturbances, keratoconjunctivitis.

From the digestive tract: nausea, vomiting, abdominal pain, diarrhea or constipation, mesenteric artery thrombosis, ischemic colitis.

From the respiratory system: pharyngitis, pain chest, cough, shortness of breath, bronchospasm and laryngospasm, respiratory distress syndrome.

From the side of the skin: alopecia, rash, pruritus, exacerbation of psoriasis.

Other: withdrawal syndrome, weakening of libido, impotence, Peyronie's disease, arthralgia, allergic reactions, lupus syndrome, hypoglycemia, fever.

Interaction

It enhances (mutually) the negative effect of verapamil and diltiazem on the myocardium, prolongs the action of non-depolarizing muscle relaxants, and inhibits the excretion of lidocaine. Weaken the hypotensive effect of NSAIDs, glucocorticoids, estrogens, cocaine; enhance - nitrates and other antihypertensive drugs. Heparin, antacids lower plasma levels; cimetidine and phenothiazines - increase. Simultaneous administration with MAO inhibitors is not recommended. Slows down the metabolism of theophylline and increases its concentration in blood plasma.

Overdose

Symptoms: dizziness, bradycardia, arrhythmia, heart failure, hypotension, collapse, shortness of breath, acrocyanosis, convulsions.

Treatment: gastric lavage and the appointment of adsorbing agents, symptomatic therapy: atropine, beta-agonists (isoprenaline, isadrin), sedatives (diazepam, lorazepam), cardiotonic (dobutamine, dopamine, epinephrine) vasopressor drugs, glucagon, etc .; transvenous pacing is possible. Hemodialysis is ineffective.

Routes of administration

In / in, inside, intraconjunctival.

Propranolol Substance Precautions

Treatment should be carried out under regular medical supervision. With prolonged use, the possibility of additional administration of cardiac glycosides should be considered. Reduces compensatory cardiovascular reactions in response to the use of general anesthetics. A few days before anesthesia, it is necessary to stop taking or choose an anesthetic with the least negative inotropic effect. Not recommended for intravenous administration to children. Elderly patients have an increased risk of CNS side effects. In case of impaired liver function, dose reduction and observation in the first 4 days of therapy are recommended. May mask symptoms of hypoglycemia (tachycardia) in patients diabetes taking insulin and other hypoglycemic drugs. It is possible to increase the severity of the hypersensitivity reaction and the lack of effect from the usual doses of epinephrine against the background of an aggravated allergic history. At the time of treatment, it is recommended to exclude the use of alcoholic beverages. Use with caution while driving Vehicle and people whose profession is associated with increased concentration of attention. Stop treatment gradually, over a period of approximately 2 weeks.

Name:

Propranolol (Propranololum)

Pharmacological
action:

Propranolol is beta blocker acting on both beta and beta2-adrenergic receptors (non-selective action).
By weakening the effect of sympathetic impulses on the beta-adrenergic receptors of the heart, Propranolol reduces the strength and frequency of heart contractions.
It reduces the contractility of the myocardium (heart muscle) and the amount of cardiac output.
Myocardial oxygen demand decreases.
Blood pressure decreases under the influence of propranolol.
The tone of the bronchi due to the blockade of beta2-adrenergic receptors increases.
The drug enhances spontaneous and induced uterine contractions.
Reduces bleeding during childbirth and in the postoperative period.

Indications for
application:

Propranolol is used to treat coronary heart disease, heart rhythm disturbances, and some forms of hypertension (persistent high blood pressure).
For ischemic heart disease Propranolol reduces the frequency of angina attacks, increases exercise tolerance, reduces the need for nitroglycerin.
The drug is effective in rest angina pectoris, but especially in exertional angina pectoris.
As an antiarrhythmic agent, Propranolol is used for sinus and paroxysmal tachycardia (palpitations), extrasystole, atrial fibrillation and flutter.
The drug is indicated for patients with ventricular extrasystole after myocardial infarction.

With sinus tachycardia, normalization of the rhythm is usually observed, including in cases of resistance (resistance) to cardiac glycosides.
In hypertension, Propranolol is prescribed mainly in the initial stages of the disease.
The drug is most effective in young patients (up to 40 years old) with a hyperdynamic type of blood circulation and with an increased content of renin.
A decrease in blood pressure is accompanied by a decrease in cardiac output due to a decrease in heart rate and a decrease in stroke volume of the heart.
Peripheral resistance (vascular resistance to blood flow) moderately increases.
The drug does not cause orthostatic hypotension (drop in blood pressure when moving from a horizontal to a vertical position).

There are data on the use in hypertension ( moderate and at severe forms) propranolol in combination with the alpha-blocker phentolamine.
It is also recommended the use of propranolol in sympathoadrenal crises (rapid and sharp rise in blood pressure) in patients with diencephalic syndrome (dysfunction of medulla oblongata), as well as for the prevention of migraine attacks.
Propranolol slows down heart rate and improves the condition of patients with thyrotoxicosis (thyroid disease).
It potentiates (enhances) the action of thyreostatic drugs (drugs for the treatment of thyroid diseases) and can be used to treat cardiovascular and neuropsychiatric disorders in patients with diffuse toxic goiter(thyroid disease).
In patients with thyrotoxic goiter subject to surgical treatment and intolerant of thyreostatic drugs, it is used for preoperative preparation.

Mode of application:

Assign propranolol inside(regardless of meal times). Usually begin in adults with a dose of 20 mg (0.02 g) 3-4 times a day.
With insufficient effect and good tolerance, gradually increase the dose by 40-80 mg per day (at intervals of 3-4 days) to a total dose of 320-480 mg per day (in some cases up to 640 mg) with the appointment of equal doses in 3-4 doses . Usually propranolol is used for a long time (under close medical supervision).
Discontinuation of propranolol (and other beta-blockers) in coronary heart disease should be gradual.
With sudden discontinuation of the drug, it is possible aggravation of anginal syndrome (angina pectoris) and myocardial ischemia, worsening of tolerance (resistance) to physical activity, bronchospasm (narrowing of the lumen of the bronchi), as well as a change in the rheological characteristics (viscosity characteristics / fluidity /) of the blood.

Long-term use of beta-blockers in patients ischemic disease hearts must be combined with the appointment of cardiac glycosides.
Propranolol is used in obstetric and gynecological practice to initiate and enhance labor activity with its primary weakness and for the prevention of postpartum complications associated with impaired uterine contractility.
Propranolol is prescribed for obstetrics and labor induction at a dose of 20 mg 4-6 times at intervals of 30 minutes (80-120 mg per day).
In case of hypoxia (impaired blood supply) of the fetus, the dose is reduced.
For the prevention of postpartum complications, 20 mg is prescribed 3 times a day for 3-5 days.

Side effects:

When using propranolol, it is possible side effects in the form of nausea, vomiting, diarrhea (diarrhea), bradycardia (rare pulse), general weakness, dizziness; allergic reactions (skin itch), bronchospasm are sometimes observed.
Possible phenomena of depression (depressed state).
In connection with the blockade of beta2-adrenergic receptors of peripheral vessels, the development of Raynaud's syndrome (narrowing of the lumen of the vessels of the extremities) is possible.
With prolonged use the drug, it is necessary to carefully monitor the function of the cardiovascular system, general condition sick.
Moderate bradycardia that occurs during treatment is not an indication for discontinuation of the drug; with severe bradycardia, reduce the dose.

Contraindications:

Patients with sinus bradycardia;
- incomplete or complete atrioventricular blockade (impaired conduction of excitation through the heart);
- with severe right and left ventricular heart failure;
- at bronchial asthma and tendency to bronchospasm;
- in diabetes mellitus with ketoacidosis (acidification due to excess ketone bodies in the blood);
- during pregnancy;
- with violations of peripheral arterial blood flow.

Caution is needed when simultaneous use of hypoglycemic (lowering blood sugar) agents (danger of hypoglycemia / sharp decrease in blood sugar /).
In patients with diabetes treatment should be carried out under the control of blood glucose. You can not take propranolol simultaneously with antipsychotics and tranquilizers.
It is necessary to take into account the possibility of inhibition of attention and reaction rate when taking propranolol (and other beta-blockers) by operators, drivers of transport and persons of similar professions.

Name: Propranolol (Propranololum)

Pharmacological effect:
Propranolol is considered a beta-blocker, acting on both beta and beta2-adrenergic receptors (indiscriminate action).
Weakening the effect of sympathetic impulses on the beta-adrenergic receptors of the heart, Propranolol lowers the strength and frequency of heart contractions. It reduces the contractility of the myocardium (heart muscle) and the amount of cardiac output. Myocardial oxygen demand decreases.
Arterial pressure under the action of propranolol decreases. The tone of the bronchi due to the blockade of beta2-adrenergic receptors increases.
The drug enhances spontaneous and induced uterine contractions. Reduces bleeding during childbirth and in the postoperative period.

Propranolol - indications for use:

Propranolol - method of application:

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Propranolol - release form:

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Important!
Before using the medicine, you should consult your doctor. This manual is for informational purposes only.