Hypertension. Treatment of angina (except vasospastic - Prinzmetal). Secondary and primary prevention of myocardial infarction in patients with coronary artery disease. Control of supraventricular and ventricular arrhythmias. Prophylaxis of migraine. Treatment of spontaneous tremor. Reduction of situational and generalized anxiety, especially of the somatic type. Prophylaxis of bleeding from the upper gastrointestinal tract in patients with portal hypertension and esophageal varices. Supportive treatment in hyperthyroidism and thyroid gland. Treatment of hypertrophic cardiomyopathy (with narrowing of the outflow and / or intraventricular pathway). Perioperative management of pheochromocytoma (in combination with the α-adrenolytic drug).
Composition:
1 tabl contains 10 mg or 40 mg propranolol hydrochloride.
Action:
Non-selective β-blocker, blocking β-adrenergic receptors1 and β2. It does not have sympathomimetic activity, decreases the sinus node stimulatory activity, relieves the conduction in the atrioventricular node, prolongs the refractory period, relieves heart activity, reduces ejection volume, acts hypotensive and anti-arrhythmic, reduces the oxygen consumption by the myocardium. After oral administration, it is well absorbed from the gastrointestinal tract. In 80-95%, it binds to plasma proteins. It is metabolized in the liver and excreted in the urine. T0,5 propranolol is 3-6 h.
Contraindications:
Hypersensitivity to the components of the preparation. Bronchial asthma and bronchial spasms. Bradycardia. Cardiogenic shock. Uncontrolled heart failure. Hypotension. Metabolic acidosis. Long-term starvation. Severe peripheral circulation disorders. Heart block IIst. or III. Prinzmetal Princelality. Sick node syndrome. Untreated phaeochromocytoma. Conditions where there is a risk of unbalanced hypoglycaemia, including malnutrition, cachexia, chronic liver disease, diabetes or the use of drugs that suppress the full response to catecholamines.
Precautions:
Use with caution in patients with controlled heart failure with low functional heart reserve, heart block Ist, diabetes, renal or hepatic impairment. Propranolol may mask the symptoms of thyrotoxicosis. Patients using propranolol may not respond to adrenaline given at the usual dose to treat the symptoms of a hypersensitivity reaction. Treatment should be discontinued 24 h before the planned treatment. In patients with portal hypertension, propranolol increases the risk of developing encephalopathy. Propranolol may slow the heartbeat, in some patients when the symptoms get worse, the dose should be reduced. Due to the lactose content, patients with rare hereditary galactose intolerance, Lapp lactase deficiency or malabsorption of glucose-galactose should not take the preparation. Due to the sucrose content, it should not be used in patients with rare hereditary forms of fructose intolerance, sucrase-isomaltase deficiency or with malabsorption of glucose-galactose.
Pregnancy and lactation:
The preparation can be used during pregnancy only if the expected benefit to the mother outweighs the potential risk to the fetus. Propranolol reduces the blood flow through the placenta, causing fetal death, miscarriage or premature delivery. In the newborn can occur, among others hypoglycemia, bradycardia, cardio-pulmonary complications. Propranolol is excreted in breast milk - breastfeeding during breast-feeding is not recommended.
Side effects:
Bradycardia, worsening of heart failure, hypotension, orthostatic hypotension, cold and bruising of limbs, disturbances of peripheral circulation, heart block intensity, severity of intermittent claudication, Raynaud's disease, feeling of bewilderment, mood changes, dizziness, nightmares, hallucinations, psychoses, sleep disorders , paraesthesia, hyperglycaemia, hypoglycemia (in newborns, children, elderly patients, undergoing hemodialysis, treated with antidiabetic agents, long-term fasted or with chronic liver disease), gastrointestinal dysfunction, purpura, thrombocytopenia, alopecia, dry eye, psoriasis-like skin reactions , worsening of psoriasis, rash, bronchospasm in patients with bronchial asthma, visual disturbances, fatigue, increase in antinuclear antibodies, occurrence or worsening of myasthenia gravis.
Dosage:
Individual, depending on the patient's condition. Orally.Adults. Hypertension: the starting dose is 80 mg 2 times a day, the dose can be increased at weekly intervals, depending on the patient's response. The daily dose is 160-320 mg. If a further reduction in blood pressure is necessary, an additional diuretic or other antihypertensive should be used.Angina (except for Prinzmetal angina), prophylaxis of migraine, spontaneous tremor: the starting dose is 40 mg 2-3 times a day, it can be increased by the same dose at weekly intervals, depending on the patient's response; usually in migraine and spontaneous tremor 80-160 mg per day, in angina 120-240 mg daily.Situational and generalized anxiety, especially of the somatic type: in acute situational anxiety 40 mg per day, generalized anxiety requiring chronic treatment 40 mg twice daily. The dose can be increased to 40 mg 3 times a day. After 6-12 months of using the preparation, a patient's condition should be checked.Control of supraventricular and ventricular arrhythmia, hypertrophic cardiomyopathy (with stenosis and / or intraventricular stenosis), supportive treatment for hyperthyroidism and thyroid crisis10-40 mg 3 times a day.Secondary and primary prevention of myocardial infarction in patients with coronary artery disease: treatment should start between 5-21 days after the onset of myocardial infarction, the initial dose is 40 mg 4 times daily or 80 mg twice daily for 2-3 days.Prophylaxis of bleeding from the upper gastrointestinal tract in patients with portal hypertension and esophageal varices: the dose should be adjusted to achieve a reduction in the heart rate by approx. 25%. Initially 40 mg twice daily, then the dose should be increased to 80 mg 2 times a day, depending on the therapeutic effect. The maximum dose is 160 mg 2 times a day.Perioperative management of pheochromocytoma (in combination with an alpha-blocker): before surgery 60 mg a day for 3 days; inoperable, malignant tumors 30 mg per day.Children. Prophylaxis of migraine: 7-12 y. 20 mg 2-3 times a day; from 13 years of age as in adults. Elderly patients should be started on the lowest dose.
(C)
