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Generic Inderal ( Propranolol )
Inderal (propranolol hydrochloride) is a non‑selective beta‑adrenergic receptor blocker indicated for the management of hypertension, angina pectoris, cardiac arrhythmias, myocardial infarction prophylaxis, migraine prophylaxis, essential tremor, and certain anxiety states. Propranolol competitively blocks beta‑1 and beta‑2 adrenergic receptors, reducing heart rate, myocardial contractility, cardiac output, and renin release, thereby lowering blood pressure and myocardial oxygen demand. Its anti‑migraine effect is thought to involve reduction of cerebral blood flow and stabilization of vascular tone. Inderal is available in immediate‑release and long‑acting formulations; the 10 mg, 20 mg, 40 mg, and 80 mg tablets are immediate‑release strengths.
Usual adult dose: For hypertension, the initial dose is 40 mg twice daily, which may be increased gradually at weekly intervals to a maintenance range of 120 mg to 240 mg per day in divided doses; the maximum daily dose is 640 mg. For angina pectoris, the starting dose is 10 mg to 20 mg three to four times daily, titrated upward as needed. For migraine prophylaxis, the usual dose is 80 mg per day in divided doses; if ineffective, the dose may be increased to 160 mg to 240 mg per day. For essential tremor, doses typically range from 40 mg to 120 mg twice daily. For anxiety‑related symptoms, 10 mg to 40 mg may be taken two to four times daily as needed, but this use should be limited. Propranolol should be taken with food at the same time each day. Abrupt discontinuation should be avoided because of the risk of rebound hypertension or worsening angina; the dose should be tapered over 1 to 2 weeks.
Dosage form: Immediate‑release tablets: 10 mg (orange, round), 20 mg (blue, round), 40 mg (green, round), and 80 mg (yellow, round). Also available as extended‑release capsules (Inderal‑LA) and oral solution. The immediate‑release strengths allow flexible dose titration.
Onset of action: The antihypertensive effect begins within 1 to 2 hours after oral administration, with peak plasma concentrations at 1 to 1.5 hours. For migraine prophylaxis, maximal benefit may not be seen until 4 to 6 weeks of continuous therapy. Heart rate reduction and relief of angina symptoms occur rapidly after dosing.
Duration of action: The elimination half‑life of propranolol is 3 to 6 hours, but the pharmacological effect often lasts longer, especially with regular dosing. Immediate‑release tablets are typically given two to four times daily; the extended‑release form allows once‑daily dosing. Abrupt withdrawal after prolonged use can cause rebound symptoms.
Alcohol recommendation: Alcohol should be avoided or limited during treatment with propranolol. Alcohol can potentiate the blood‑pressure‑lowering and central nervous system depressant effects, increasing the risk of dizziness, fainting, and impaired coordination. Chronic heavy alcohol use may also reduce the effectiveness of propranolol. Patients should be counselled about these interactions, particularly when first starting therapy.
Most common side effects: Fatigue, dizziness, lightheadedness, bradycardia, cold extremities, sleep disturbances, and gastrointestinal upset (nausea, diarrhea). Sexual dysfunction and mood changes may occur. Propranolol can mask the symptoms of hypoglycemia (except sweating) in diabetic patients, so glucose monitoring should be intensified. It is contraindicated in patients with asthma, severe bradycardia, second‑ or third‑degree heart block, cardiogenic shock, or untreated pheochromocytoma. Caution is required in patients with peripheral vascular disease or Raynaud’s phenomenon. If a dose is missed, it should be taken as soon as remembered, but two doses should not be taken at the same time. Inderal is available only by prescription in Canada and must be initiated and monitored by a healthcare professional.
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