Inderal (Propranolol)

Inderal (Propranolol) is a drug that belongs to the class of Beta-blockers. These medications influence the work of the heart and blood circulation, slowing down the heart rate and reducing stress on the heart. Thus, Inderal is recommended for the treatment of such conditions as heart attack, angina, tremors, impaired heart rhyme, hypertension and other cardiovascular disorders. Additionally, the medication is used for the migraine treatment.

Inderal's active ingredient is Propranolol hydrochloride - white solid crystalline substance, easily soluble in water or ethyl alcohol, with molecular weight of 295.80.

Originally the brand-name medication was produced by Wyeth Pharmaceuticals. Today the company is off-patent, however, there are generic versions of the drug, currently manufactured by a number of pharmaceutical companies. The medication is sold in the forms of tablets, liquid solution, injections and as a long-acting form - Inderal LA.

Inderal tablets are available in the following strengths: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg. Inderal liquid form is presented as Propranolol 20 mg per 5 mL, Propranolol 40 mg per 5 mL. You can also opt for propranolol injections 1 mg per mL.

All forms of the medication must be kept out of children's reach, in a dark dry place at room temperature. Prevent the tablets from the exposure to humidity and light.


Uses

Inderal uses
Inderal uses
 
Certain natural chemicals, occurring in the human organism, such as epinephrine, affect the work of the heart and blood circulatory system. Inderal blocks the work of these chemicals, relieving the heart strain, slowing down heart beats and lowering blood pressure. The medication is used as a beta blocker to treat or prevent the following conditions and disorders:
  • Circulatory conditions and cardiovascular diseases: hypertension, arrhythmia.
  • Heart diseases: angina, stroke and heart attack. It's recommended for the recovery period after a heart attack.
  • Symptoms of neurological disorders: tremors - involuntary muscle contractions, causing shaking.
  • Kidney conditions: prevention of serious kidney disorders, caused by long-term hypertention.

Additional uses


Inderal may also be recommended to treat the symptoms of anxiety and hyperthyroidism. The drug's approved professional labeling doesn't list this particular usage of the medication, however, your healthcare provider may recommend you Inderal for these specific applications.


Dosage

Inderal dosage
Inderal dosage
 

How to take Inderal?


The medication must be taken exactly as prescribed by your healthcare provider in order to achieve the maximal positive effect from your therapy. Pay attention also to the following recommendations:
  • Inderal tablets are taken orally - by mouth, on empty stomach with a glass of plain water. Take the prescribed dosage in the morning, approximately at the same time every day to provide even levels of the medication's active ingredient in your blood.
  • If you forget to take your current dose of Inderal, take the next one when you remember. If a time gap between the doses is too long, i.e. it's the time for your next dose, skip the tablet you've missed and go on with your schedule without taking a double dose.
  • In order to decrease the risks of serious side effects, you shouldn't change your dosage or stop taking the medication without your physician's recommendations.
  • In you have any uncertainties, related to the drug's usage or the dosage, prescribed to you, clarify them with a healthcare professional and don't stop your therapy if your healthcare provider hasn't instructed you to.

The choice of dosage


Every specific medical condition and an array of other factors determine the choice of Inderal dosage. The dosage, your healthcare provider prescribes to you, depends on:
  • The condition you need to be treated or prevented
  • The state of your health, including other conditions
  • Other drugs you need to be taking and their compatibility with Inderal
  • The reaction of your organism to the medication
  • Your age

Conditions and dosages



Hypertension
40 mg twice a day is the recommended starting dose. The starting dose is prescribed to determine the response of your organism to the medication, development of any side effects or their absence. Taking into account these factors, your healthcare provider may increase or decrease your dosage of Inderal. In case of low efficiency of the starting dosage, you may be prescribed additionally a diuretic medication to boost the effect from Inderal usage and achieve optimal control over your blood pressure.

120 mg - 240 mg a day, split between 2 doses - 60 mg and 120 mg relatively twice a day is a typical dosage of Inderal, prescribed in most cases. 640 mg a day or 320 mg twice a day is recommended in difficult cases of hypertension. This dosage is needed to lower blood pressure to the recommended level.

The recommended dosages may be split between 3 smaller doses if your organism has specific susceptibility towards the drug, wearing out its effect too soon. However, such adjustments can be made only after your doctor's instructions. Most people still take Inderal twice a day.

Recovery after a heart attack
180 mg - 240 mg daily, divided into smaller doses 3-4 times a day. Your doctor will instruct you in more details. The specific dosage can vary depending on your condition. Besides, your dosage may be increased after it becomes evident how your body responds to the treatment. Take the medication exactly as prescribed.

Angina (chest pain)
80 mg - 320 mg for the total daily dosage is recommended to treat the symptoms of angina. Your healthcare provider will specify the dosage for you and instruct to take it two, three, or four times a day.

Atrial fibrillation
10 mg - 30 mg is the prescribed amount for this condition. In this case the dosage is usually split for three or four doses, taken in the morning before breakfast, in the afternoon and in the evening before going to bed. In case of emergency, irregular heart beats can be quickly stabilized with an injection of Inderal.

Hypertrophic subaortic stenosis
20 mg - 40 mg, split between 3-4 intakes during the day is the recommended dosage for the treatment of hypertrophic subaortic stenosis.

Migraines
80 mg a day is the total dosage, split into smaller doses, for example 40 mg, taken twice a day. The starting dosage may be increased or decreased, basing on your body response to the medication and side effects. If Inderal turns out to be effective in your case, the number of migraines will decrease within 1-1.5 months, otherwise, your healthcare provider will switch you to another medication, treating migraines. Nevertheless, usage of Inderal shouldn't be stopped abruptly.

Essential tremors
40 mg twice a day is the starting dosage to treat shaking (tremors). The starting dosage is prescribed to monitor the organism's response to the medicine. With time the starting dose may be increased or decreased, taking into account the effectiveness of medication in your case.

Pheochromocytoma
30 mg a day is a total dosage for the patients with pheochromocytoma that can't be operated. This dosage is normally divided to be taken a few times a day, for example 10 mg of Inderal 3 times a day.

If you are expecting a pheochromocytoma surgery, your healthcare provider will suggest a bigger dosage - 60 mg a day total for the three days, preceding the surgery. The total dosage of 60 mg should be split between smaller doses to take during the day.


Warnings and Precautions

A number of medical conditions have contraindications for Inderal usage, while for other diseases and disorders it's recommended to discuss possible risks and benefits from the medication with your doctor before you start your therapy. In order to decrease risks of side effects you should also let your healthcare provider know about all the prescription, non-prescription drugs, vitamins or food supplements, you may be currently taking.

Inform your healthcare provider if you are diagnosed with the following conditions:
Inderal precautions
Inderal precautions
 
  • An allergy to any group of medication, dye, preservative or food
  • Heart diseases (congestive heart failure or a heart attack, happened in the past)
  • Heart rhythm disorders (irregular heart rhythm, a slow heart rate)
  • Circulation problems, blood vessel diseases
  • Wolff-Parkinson-White syndrome
  • Diseases, affecting airways and lungs (asthma, bronchitis, chronic obstructive lung disease, emphysema)
  • Liver and kidney conditions
  • Diabetes
  • Pheochromocytoma
  • Serious problems with vision (glaucoma)
  • Psoriasis
  • Severe depression
  • Overactive thyroid

Additional current details of your life style, like those, listed below, must be also be reported to your healthcare provider before your treatment is prescribed.
Talk to doctor about Inderal
Talk to doctor about Inderal
 
  • You are pregnant or planning on becoming pregnant
  • You are breastfeeding
  • You are planning any surgery in the near future
  • You use alcohol and/or smoke

Inderal contraindications


Inderal is not recommended for you in the following cases:
  • If your heartbeat is too slow (45 beats per minute and less) or specific kinds of irregular heart rhythms
  • If you have cardiogenic shock (a condition when the heart can't function effectively)
  • If you have an allergy to any active or inactive ingredient in the Inderal composition
  • If you suffer from asthma

What else to pay attention to before you start taking Inderal?


If you plan to stop taking Inderal, you should discuss that with your healthcare provider and do that slowly in order to avoid the development of serious complications. Be aware that Inderal sometimes conceals the hyperthyroidism symptoms.

If you are prone to heart failure (have a history of this condition), a long-term therapy with Inderal may trigger reoccurrence of congestive cardiac failure. The alarming symptoms of the condition, such as difficulty breathing, cough, weight gain and swelling in the body, especially in the feet, ankles or legs, must be urgently reported to your doctor.

Inderal may aggravate the course of the heart failure in patients with severe congestive heart failure. However, the medication can still be prescribed to you, if the benefits from its usage overweigh the potential risks.

Inderal may affect your alertness. If you are just beginning your therapy with the medication, be extremely careful when driving or operating any machines with high risks of traumatizing. Better avoid these activities until you are sure you can perform them safely.

People with risks of severe dehydration, for instance, caused by diarrhea, vomiting, diuretics or dialysis may get extremely low blood pressure or a dangerously slow heart rate in the course of their therapy with Inderal. Monitor your blood pressure and report to your doctor if you have such symptoms of low blood pressure as lightheadedness, dizziness and fainting.

Abrupt stoppage of your therapy with the medication is fraught with the development of serious health complications such as severe congestive heart failure, angina and heart attack. The risks in this case are higher than in patients with a history of heart disease.

Inderal may cause low sugar levels in your blood, especially if you have kidney disease, are going through fasting or long-term exercising. Infants and children are also in a risk group in regards to low blood sugar levels. Such symptoms as impaired vision and/or breathing, cold sweating, irritability and trembling, indicate the condition.

Allergic reactions to any active or inactive ingredient of the medication may reveal through such symptoms as skin problems (rashes, peeling, etc.), impaired breathing, swelling in the face or throat, hives or wheezing. An urgent medical attendance is required in case of these complications.

Beta blockers may narrow airways and affect the lungs. That's why patients with serious lung diseases, such as asthma, chronic bronchitis, emphysema, chronic obstructive pulmonary disease, should be especially attentive when taking Inderal. If you have one of these conditions, you may develop such side effects as wheezing or difficulty breathing. Inform your healthcare provider as soon as possible if it happens.

According to the evaluation of the drugs in regards to their risks in pregnant women, Inderal belongs to a pregnancy Category C medication, meaning that it may harm the developing fetus. If you are pregnant or plan on becoming pregnant, inform your healthcare provider before Inderal is prescribed to you. It's also important to report to your doctor if you become pregnant in the course of your therapy with the medication.

Breastfeeding women should be aware that Inderal passes through the breast milk to a baby. If you are currently breastfeeding, discuss a possibility to use the medication with your healthcare provider.

Patients with glaucoma should keep in mind that the drug affects intraocular pressure. While you are using Inderal your pressure within the eye will be lower, which can be spotted in screening tests. Once you stop your therapy with the medication, the intraocular pressure will rise again.


Side Effects

Inderal side effects
Inderal side effects
 
Inderal may provoke a row of side effects, ranging in their severity. The following side effects, referred to allergic reactions, require urgent medical help:
  • Hives
  • Impaired breathing
  • Face, lips, tongue or throat edema

Other side effects, listed below, suggest that you contact your doctor as soon as possible if you develop any of them:
  • Lightheadedness and fainting, cold hands and feet
  • Irregular, fast or slow heart rhyme
  • Shortness of breath, caused by the slightest physical load
  • Unexplained weight gain, ankle or feet edema
  • Upper abdominal pain, loss of appetite, nausea, dark-colored urine, clay-colored stools
  • Itching, severe skin conditions, red or purple spreading rashes on the face or body, blisters, peeling, skin or eye yellowing
  • Flu symptoms: fever, sore throat, burning sensation in the eyes, face or tongue edema
  • Confusion, hallucinations, depression

Ask your doctor's medical advice in case you have the following less severe symptoms:
  • Mild digestive disorders: mild nausea, stomach spasms, vomiting, diarrhea and/or constipation
  • Fatigue and/or insomnia
  • Sexual disorders: decreased libido, erectile dysfunction and/or difficulty to achieve orgasm
  • Other side effects may also occur in the course of your treatment with Inderal. If you are alarmed about the way the medication makes you feel, discuss that with your physician. Do not stop taking the drug without advice of a medical professional.


Mechanism of action

Propranolol formula
Propranolol formula
 
Being absorbed into the patient's blood stream, Inderal presents an antiarrhythmic effect and provides control over the ventricular rate during arrhythmias.

Beta-adrenergic receptors, found in the heart, fall into a few subtypes, beta1 and beta2 being the most significant of them. The medication selectively blocks beta receptors, beta1 and beta2, in particular, leaving alpha-adrenergic responses unaffected. The blockage of beta 1 receptor causes decreases in the activity of normal and ectopic pacemaker cells as well in A-V nodal conduction velocity. Restricting activity of cardiac beta1-adrenergic receptors, the medication also weakens the myocardial force of contraction. That may trigger cardiac decompensation in patients, who have minimal cardiac reserve.


History

James W. Black
James W. Black
 
The discovery of the Inderal's active ingredient propranolol was marked out by the Nobel Prize in Medicine in 1988. The substance itself was developed by the Scottish scientist James W. Black.

Propranolol was discovered incidentally and initially used as an untifungal drug. Before discovering the medication James W. Black experimented with antifungal ointments, liasinol in particular.

Phosphoralating liasinol twice, Black obtained a new substance - propranolol. The scientist tried it on rats, initially as an antifungal remedy, finding out its beta blocking properties afterwards.

The combination of the early β-adrenergic antagonists - dichloroisoprenaline and pronethalol has led towards the development of propranolol. To increase the compound's potency of all the next beta blockers, an oxymethylene bridge was inserted into the pronethalol's arylethanolamine structure. This insertion has also removed the carcinogenicity, discovered with pronethalol in animal models.


Generic Inderal

Wyeth Pharmaceuticals was the first company that produced the brand-name medication. Today brand-name Inderal is no longer available, however, you may use its generic form, manufactured by such pharmaceutical firms as Teva Pharmaceuticals, Mylan Laboratories, Pliva, Inc. or Watson Pharmaceuticals. Inderal generics come in the forms of tablets, liquid solution and injections.

Generic Inderal
Generic Inderal
 
You may find the following strengths of Propranolol tablets:
  • 10 mg
  • 20 mg
  • 40 mg
  • 60 mg
  • 80 mg

If you have difficulty with swallowing tablets, you may opt for Propranolol liquid:
  • Propranolol 20 mg per 5 mL
  • Propranolol 40 mg per 5 mL

Propranolol injection is available in the following strength:
  • 1 mg per mL

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