Beta blocker.

It is a nonselective beta - adrenergic receptor blocking agent, it specifically competes with beta-adrenergic receptor stimulating agents for available receptor sites and when the sites are blocked, the chronotropic, intropic, and vasodilator responses to beta - adrenergic stimulation are decreased proportionately.

Propranolol is used in the management of hypertension, phaeochromocytoma, angina pectoris, myocardial infarction and cardiac arrhythmias. It is also used in hypertrophic subaortic stenosis. It is used to control symptoms of sympathetic overactiuity in the management of hyperthyroidism, anxiety disorders, and tremor. Other indications include the prophylaxis of migraine and upper gastro - intestinal bleeding in patients with portal hypertension.

Propranolol is contraindicated in cardiogenic shock, sinus bradycardia and greater than first degree block, bronchial asthma, congestive heart failure unless the failure is secondary to a tachyarrhythmia.
Beta - adrenergic blockade may prevent the appearance of certain premonitory signs and symptoms of acute hypoglycemia in labile insulin - dependent diabetes. Beta blockade may mask certain clinical signs of hyperthyroidism, therefore, abrupt withdrawal of Propranolol may be followed by an exacerbation of symptoms of hyperthyroidism. Propranolol should be used with caution in patients with impaired hepatic or renal function.

Category - C

Propranolol is excreted in human milk. Caution should be exercised when Propranolol is administered to a nursing woman.

Coadministration of catecholamin - depleting drugs such as reserpine with Propranolol may produce an excessive reduction of resting sympathetic nervous activity. Coadministration of a calcium - channel blocking drug, especially intravenous verapamil with Propranolol may depress myocardial contractility or atrioventricular conduction. Blunting of the antihypertensive effect of Propranolol by NSAIDs has beeb reported. Alominium hydroixde gel and Ethanol reduce intestinal absorption of Propranolol. Cimetidine decreases the hepatic metabolism of Propranolol.

Bradycardia, congestive heart failure, intensification of AV block, hypotention, paresthesia of hands;light - headedness , mental depression; Gastrointestinal symptoms; Allergic reactions; Bronchospasm; Agranulocytosis, nonthrombo cytopenic purpura, thrombocytopenic purpura.

In hypertension Propranolol is given in initial doses of 40 mg to 80 mg twice daily increased as required to a usual range of 160 to 320 mg daily.
In angina, initial doses of Propranolol 40 mg given 2 or 3 times daily are increased as required to a usual range of 120 to 240 mg daily.
Propranolol is administered within 5 to 21 days of myocardial infarction in doses of 40 mg given four times daily for 2 or 3 days followed by 80 mg twice daily.
Propranolol may be given in doses of 30 to 160 mg daily in divided doses in the long - term management of cardiac arrhythmias.
In hyperthyroidism Propranolol is given in doses of 10 to 40 mg 3 or 4 times daily.
Propranolol has been used in the treatment of hypertension in children in initial doses of 1 mg per kg body - weight daily in divided doses by mouth. For arrhythmias, phaeochromocytoma, and hyperthyroidism, the suggested dose is 250 to 500 μg per kg 3 or 4 times daily.