ISSN 2398-2942      

Propranolol

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Introduction

Name

  • Propranolol.

Class of drug

  • Beta-1 and beta-2 adrenoceptor antagonist.

Uses

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Indications

  • Management of cardiac arrhythmias Heart: dysrhythmia (sinus tachycardia, atrial fibrillation Heart: atrial fibrillation or flutter, supraventricular tachycardia, premature ventricular depolarisation), hypertrophic cardiomyopathy Heart: hypertrophic cardiomyopathy (HCM) or obstructive heart disease.
  • Reversal of the clinical features of thyrotoxicosis prior to surgery in patients with hyperthyroidism.
  • May be used to control the pulse rate in patients with phaeochromocytoma Pheochromocytoma ; always use with phenoxybenzamine Phenoxybenzamine for this indication, as beta-blockade without concurrent alpha-blockade may lead to a hypertensive crisis.

Administration

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Pharmacokinetics

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Precautions

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Interactions

with other drugs



Sympathomimetics, eg epinephrine, phenylpropanolamine, terbutaline
  • The beta-effects may be blocked by propranolol.
  • The unopposed alpha effects of epinephrine and norepinephrine may result in severe hypertension and a decreased heart rate.
Drugs enhancing the hypotensive effect of propranolol
  • Anesthetic agents (those that depress myocardial activity).
  • Anti-hypertensive drugs, eg hydralazine, prazosin.
  • Diazepam.
  • Diuretics.
  • Other anti-arrhythmics.
Calcium channel blockers, eg diltiazem, verapamil
  • There is an increased risk of bradycardia, severe hypotension, heart failure and AV block.
Thyroid hormones
  • The metabolism of propranolol is accelerated thus reducing its effect.
Carbimazole
  • The dose of propranolol may need to be decreased when initiating carbimazole therapy.
Muscle relaxants, eg suxamethonium, tubocurarine
  • Propranolol enhances the effects.
Phenobarbitone, phenytoin or rifampin
  • Hepatic enzyme induction by these drugs may increase the metabolism of propranolol.
Lignocaine
  • There is an increased risk of lignocaine toxicity when administered with propranolol due to a reduction in lignocaine clearance.
Theophylline
  • The bronchodilatory effects may be blocked by propranolol.

Adverse Reactions

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Further Reading

Publications

Refereed papers

Other sources of information

  • Based on Small Animal Formulary. Tennant B (1999) 3rd edn. BSAVA, UK.
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