Inderal: Expert Beta-Blocker Therapy for Cardiovascular Control
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Synonyms | |||
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Inderal (propranolol hydrochloride) is a non-selective beta-adrenergic blocking agent with established clinical efficacy in managing various cardiovascular and neurological conditions. As a foundational therapy in the beta-blocker class, it operates through competitive antagonism of catecholamines at β₁ and β₂-adrenergic receptors, resulting in decreased heart rate, reduced myocardial contractility, and lowered blood pressure. Its therapeutic profile extends beyond cardiology into migraine prophylaxis and essential tremor management, making it a versatile agent in clinical practice. This product card provides a comprehensive overview of its pharmacological characteristics, approved uses, and essential safety information for healthcare professionals.
Features
- Active ingredient: Propranolol hydrochloride
- Available formulations: Immediate-release tablets (10 mg, 20 mg, 40 mg, 60 mg, 80 mg) and extended-release capsules (60 mg, 80 mg, 120 mg, 160 mg)
- Pharmacological class: Non-selective beta-adrenergic blocking agent
- Half-life: Approximately 3-6 hours (immediate-release); 8-11 hours (extended-release)
- Protein binding: 90-95%
- Metabolism: Extensive hepatic metabolism via CYP2D6 and CYP1A2 isoenzymes
- Excretion: Primarily renal (≥90%) as metabolites
- Onset of action: 1-2 hours (oral administration)
- Duration of effect: 6-12 hours (immediate-release); 24 hours (extended-release)
Benefits
- Provides effective control of hypertension through reduction of cardiac output and suppression of renin-angiotensin-aldosterone system activity
- Manages angina pectoris by decreasing myocardial oxygen demand through reduction in heart rate and contractility
- Offers prophylactic migraine management by preventing cerebral arterial vasodilation and modulating sympathetic nervous system activity
- Controls symptomatic manifestations of hyperthyroidism including tachycardia, tremors, and anxiety
- Reduces mortality post-myocardial infarction through anti-arrhythmic and anti-ischemic effects
- Manages essential tremor through central nervous system beta-adrenergic blockade
Common use
Inderal is FDA-approved for the management of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is indicated for prophylactic treatment of migraine headaches, management of angina pectoris, control of supraventricular tachyarrhythmias, and treatment of hypertrophic subaortic stenosis. Off-label uses include essential tremor, anxiety disorders, portal hypertension, and thyrotoxicosis symptom management. The extended-release formulation is specifically indicated for hypertension, angina, and migraine prophylaxis.
Dosage and direction
Dosage must be individualized based on clinical response. For hypertension: Initial dose 40 mg twice daily (immediate-release) or 80 mg once daily (extended-release), may increase to 120-240 mg daily in divided doses. Maximum dose: 640 mg daily. For angina: 80-320 mg daily in divided doses. For migraine prophylaxis: Initial dose 80 mg daily (extended-release) or 20 mg four times daily (immediate-release), may increase to 160-240 mg daily. Administer with food to enhance bioavailability. Do not crush or chew extended-release capsules. Abrupt discontinuation may precipitate rebound angina or hypertension; taper gradually over 1-2 weeks.
Precautions
Monitor blood pressure and heart rate regularly during dosage titration. Use with caution in patients with compensated heart failure, diabetes mellitus (may mask hypoglycemic symptoms), or hepatic impairment. Periodic assessment of renal function recommended. May exacerbate symptoms of peripheral vascular disease. Caution in patients with history of bronchospasm due to non-selective beta-blockade. May cause fatigue, dizziness, or depression. Not recommended during pregnancy unless potential benefit justifies potential risk. Breastfeeding not recommended due to secretion in breast milk.
Contraindications
Absolute contraindications include cardiogenic shock, sinus bradycardia, greater than first-degree heart block, sick sinus syndrome (without permanent pacemaker), decompensated heart failure, and bronchial asthma. Relative contraindications include severe chronic obstructive pulmonary disease, diabetes mellitus with frequent hypoglycemic episodes, pheochromocytoma (must be used with alpha-blockade), and metabolic acidosis.
Possible side effect
Common adverse reactions (≥1%) include bradycardia (heart rate <50 bpm), fatigue, dizziness, nausea, diarrhea, and cold extremities. Less frequent effects include insomnia, vivid dreams, depression, Raynaud’s phenomenon, and erectile dysfunction. Serious but rare adverse events include heart failure exacerbation, bronchospasm, masking of hypoglycemia in diabetics, and exacerbation of myasthenia gravis. Incidence of side effects is dose-dependent and often diminishes with continued therapy.
Drug interaction
Significant interactions occur with verapamil and diltiazem (additive bradycardia and AV block), clonidine (rebound hypertension upon withdrawal), insulin and oral hypoglycemics (masked hypoglycemia), and CYP2D6 inhibitors (fluoxetine, paroxetine) which may increase propranolol levels. Concomitant use with other negative chronotropic agents requires careful monitoring. NSAIDs may diminish antihypertensive effect. Enhanced hypotensive effect with other antihypertensives.
Missed dose
If a dose is missed, administer as soon as remembered unless it is nearly time for the next scheduled dose. Do not double the dose to make up for a missed administration. For twice-daily regimens, if missed by more than 4 hours, skip and resume normal schedule. For once-daily formulations, take as soon as remembered unless next dose is due within 8 hours.
Overdose
Symptoms include severe bradycardia, hypotension, heart failure, bronchospasm, hypoglycemia, and seizures. Treatment involves gastric lavage if recent ingestion, activated charcoal, and supportive care. Specific antidotes include atropine for bradycardia, glucagon for myocardial depression, and beta-agonists for bronchospasm. Hemodialysis is not effective due to high protein binding. Cardiac monitoring and intensive supportive care are essential.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from moisture and light. Keep in original container with tight closure. Do not store in bathroom medicine cabinet due to humidity variations. Keep out of reach of children and pets. Do not use beyond expiration date printed on packaging.
Disclaimer
This information is intended for healthcare professionals and should not replace clinical judgment. Prescribing decisions should be based on individual patient assessment and current prescribing information. Dosage adjustments may be necessary based on renal or hepatic function, age, and concomitant medications. Always consult full prescribing information before initiation of therapy.
Reviews
Clinical studies demonstrate Inderal’s efficacy with 60-70% of hypertensive patients achieving blood pressure control at doses of 160-320 mg daily. In migraine prophylaxis, 50-60% reduction in frequency observed in 60% of patients. Angina patients show improved exercise tolerance and reduced nitrate requirements. Patient satisfaction surveys indicate high adherence rates due to well-established safety profile, though some report fatigue and cold extremities as limiting factors. Long-term studies confirm maintained efficacy with appropriate dose titration.