Drug name: Propranolol

Therapeutic effects:

Propranolol is a competitive antagonist of both beta1-and beta2-adrenergic receptors (a nonselective beta-blocker). It has antihypertensive, antianginal and antiarrhythmic effects. The drug reduces the sinus node automaticity, slows heart rate and AV conduction, decreases myocardial contractility, reduces myocardial oxygen demand. Propranolol reduces the excitability of cardiomyocytes, reduces the occurrence of ectopic foci, has a membrane stabilizing effect. Its hypotensive effect stabilizes by the end of the 2nd week of treatment. The drug also increases the tone of bronchi.

Propranolol, like other beta-blockers, has negative inotropic effect, thus it is contraindicated in uncontrolled heart failure.

Indications:

Propranolol is used to treat the following conditions:

• Angina of effort, unstable angina, progressive angina pectoris
• Silent myocardial ischemia
• Acute myocardial infarction (long-term prophylaxis during the rehabilitation period)
• Hypertension, control of essential and renal hypertension
• Neurocirculatory dystonia
• Control of most forms of cardiac arrhythmias
• Heart failure
• Hypertrophic (obstructive) cardiomyopathy
• Cardioglycoside intoxication
• Hyperthyroidism, thyrotoxicosis, thyrotoxic crisis
• Anxiety, fear, tachycardia with anxiety
• Familial tremor
• Migraine (prevention)
• Pheochromocytoma (only in combination with alpha-blockers)

Side-effects:

• Cardiovascular system, hematopoiesis, hemostasis: bradycardia, heart failure, AV block, hypotension, impaired peripheral circulation, thrombocytopenic purpura, leukopenia, agranulocytosis
• Nervous system and sensory organs: asthenia, dizziness, headache, insomnia, somnolence, nightmares, reduced rate of mental and motor responses, emotional lability, depression, agitation, hallucinations, disorientation in time and space, short-term amnesia, disturbance of sensitivity, paresthesia, dry eyes, visual disturbances, keratoconjunctivitis
• Digestive tract: nausea, vomiting, abdominal pain, diarrhea or constipation, mesenteric artery thrombosis, ischemic colitis
• Respiratory system: pharyngitis, chest pain, coughing, wheezing, bronchial and laryngospasm, respiratory distress syndrome
• Skin: alopecia, rash, itching, exacerbation of psoriasis
• Other: withdrawal syndrome, low libido, impotence, Peyronie's disease, arthralgia, allergic reactions, lupus syndrome, hypoglycemia, fever

Drug interactions:

Propranolol may affect the action of the following drugs:

• Calcium antagonists
• MAO inhibitors
• Nitrates and other hypotensive drugs
• Cardiac glycosides
• Neuromuscular nondepolarizing agents
• Local anesthetics, e.g. Lidocaine
• NSAIDs
• Glucocorticoids
• Estrogens
• Antacids
• Heparin
• Histamine H2-receptor antagonists (cimetidine)
• Cocaine
• Phenothiazines
• Antiasthmatic drugs

Cautions and restrictions:

Propranolol must not be used in the following conditions:

• Atrioventricular (AV) block of 2nd and 3rd degree
• Sinoatrial (sinoauricular) blockade
• Bradycardia (heart rate less than 55 beats per minute)
• Sick sinus syndrome
• Hypotension
• chronic heart failure B-C stages, acute heart failure, cardiogenic shock
• Prinzmetal's angina
• Vasomotor rhinitis
• A history of asthma or bronchospasm, obstructive airways disease
• Decompensated lesions of peripheral blood circulation (Raynaud's disease and other obliterative vascular diseases)
• Metabolic acidosis
• After prolonged fasting
• Hypersensitivity of propranolol

Propranolol should be used with caution if any condition below applies:

• Chronic bronchitis
• Emphysema
• Diabetes
• Hypoglycemia
• Acidosis
• Abnormal liver and / or kidneys function
• Psoriasis
• Spastic colitis
• Myasthenia gravis
• Pregnancy, lactation
• Elderly patients

Additional information:

Store the drug at a room temperature in a dry, dark place. Shelf life is 5 years.