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Propranolol hydrochloride - Inderal, Propranolol Intensol

Pregnancy Category C

Drug classes
Beta-adrenergic blocking agent (nonselective beta-blocker)
Antianginal drug
Antiarrhythmic drug
Antihypertensive drug

Mechanism of action
Competitively blocks beta-adrenergic receptors in the heart and juxtoglomerular apparatus. They lead to decreased heart rate decreasing the work load by the heart. They do not produce coronary vasodilatation but lead to a shift and redistribution of coronary circulation to the ischemic areas. It decreases the release of renin from the kidney, thus lowering blood pressure.

Indications
Hypertension alone or with other drugs, especially diuretics
Angina pectoris caused by coronary atherosclerosis
IHSS to manage associated stress-induced angina, palpitations, and syncope
Cardiac arrhythmias, especially supraventricular tachycardia, and ventricular tachycardias induced by digitalis or catecholamines
Myocardial infarction, prevention of reinfarction in clinically stable patients 1-4 wk after MI
Pheochromocytoma, an adjunctive therapy after treatment with an alpha-adrenergic blocker to manage tachycardia before or during surgery or if the pheochromocytoma is inoperable.

Prophylaxis for migraine headache
Management of acute situational stress reaction (stage fright)
Treatment of essential tremor, familial or hereditary
Unlabeled uses: recurrent GI bleeding in cirrhotic patients, schizophrenia, tardive dyskinesia, acute panic symptoms, vaginal contraceptive

Contraindications
Contraindicated in the presence of allergy to beta-blocking agents, sinus bradycardia, second- or third-degree heart block, cardiogenic shock, CHF, bronchial asthma, bronchospasm, COPD, pregnancy (neonatal bradycardia, hypoglycemia, and apnea have occurred in human infants whose mothers received propranolol, and low birth weight occurs with chronic maternal use during pregnancy), lactation.

Use caution in the presence of hypoglycemia and diabetes, thyrotoxicosis,
hepatic dysfunction.

Adverse effects
CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech
GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis
CV: Bradycardia, CHF, cardiac arrhythmias, sinoartial or AV nodal block, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension
Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis
GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequency
MS: Joint pain, arthralgia, muscle cramp
EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision
Dermatologic: Rash, pruritus, sweating, dry skin
Allergic reactions: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm, respiratory distress
Other: Decreased exercise tolerance, development of ANAs, hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline phosphatase, and LDH

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