Propranolol (Oral Route) Side Effects - Mayo Clinic

Swallow it source. What happens if I overdose?

High blood pressure onset has inderal symptoms. Skip the missed dose if your next dose is less action 8 hours away. These results are consistent with previous data showing decreased immunologic function during periods of elevated sympathetic activity, such as congestive heart failure, uremia, or life-threatening events.

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A year-old retired college professor with no history of affective disorders developed progressive sadness, tearfulness, hopelessness, decreased energy, social withdrawal, anhedonia, insomnia, and decreased memory and concentration within two weeks after beginning propranolol monotherapy for hypertension.

The signs and symptoms of depression resolved upon substitution with a thiazide diuretic. Interestingly, the patient later was treated for recurrent depression while not receiving propranolol. Rare cases of psychoses associated with propranolol have been reported.

Interestingly, NK natural killer cell activity may be decreased during propranolol therapy, although the number of circulating NK cells may remain unchanged. These results are consistent with previous data showing decreased immunologic function during periods of elevated sympathetic activity, such as congestive heart failure, uremia, or life-threatening events. Verspeelt J, Delocht P, Amery WK "Post-marketing cohort study comparing the safety and efficacy of flunarizine and propranolol in the prophylaxis of migraine.

Krauss XH, Schalekamp MA, Kolsters G, et al "Effects of chronic beta-adrenergic blockade on systemic and renal haemodynamic responses to hyperosmotic saline in hypertensive patients. Abrams J, Allen J, Allin D, et al "Efficacy and safety of esmolol vs propranolol in the treatment of supraventricular tachyarrhythmias: a multicenter double-blind clinical trial. Crosson JE, Dunnigan A "Propranolol induced electrical and mechanical alternans in orthodromic reciprocating tachycardia.

InnoPran XL propranolol. Cerner Multum, Inc. Ibsen H, Sederberg-Olsen P "Changes in glomerular filtration rate during long-term treatment with propranolol in patients with arterial hypertension. Samuel P, Chin B, Schoenfeld BH, et al "Comparison of the effect of pindolol vs propranolol on the lipid profile in patients treated for hypertension.

Shand DG "Propranolol. Stephen SA "Unwanted effects of propranolol. Sobel BE "Propranolol and threatened myocardial infarction. If you experience uncommon tiredness, rash, puking, sleep loss, diarrhea, indigestion, lightheadedness, constipation, or lightheadedness make sure you obtain some rest and continue taking propranolol.

Propranolol could be prescribed for individuals experiencing higher blood pressure and disorders linked with it. Some health and wellness problems may be contraindications, including asthma and third degree heart block. It's crucial for your physician to know if you are expectant or breastfeeding, as those problems might avoid you from safely making use of propranolol.

Occasionally it is suggested for the avoidance of migraine problems. If you are expecting or breastfeeding before starting to take propranolol, tell your medical professional.

If these negative side effects show up or linger to be aggravating get in touch with your medical professional for expert aid and recommendations. In many cases major negative side effects of propranolol are feasible and could consist of any of the following ones: feeling light-headed, hallucinations, nausea, fainting, depression, really feeling breathless, dark pee, red skin rash, belly pain, clay-colored feces, and aching throat.

Inderal® LA (propranolol hydrochloride) Long-Acting Capsules

Effects healthy subjects, onset difference was observed between CYP2D6 extensive metabolizers EMs and poor metabolizers PMs with respect to oral clearance or elimination half-life. Epinephrine, however, may provoke uncontrolled hypertension.

Bradycardia can be treated with atropine or isoproterenol. Alpha Tablet Prazosin has been associated with prolongation of first inderal hypotension in the side of inderal. Angina Pectoris Total daily doses of action mg to mg Inderal, when administered orally, twice a day, three times a day, or four times a day, have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG. Monitor therapy Dronedarone: May enhance the bradycardic effect of Beta-Blockers.

Management: Rizatriptan adult dose should be reduced to 5 mg in patients who are also being treated with propranolol. The protective effect learn more Inderal was consistent regardless of age, sex, or site of infarction.

Monitor therapy Lacidipine: May enhance the hypotensive effect of Propranolol.

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Genitourinary: Male impotence; Peyronie's disease. While taking beta-blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either davis, diagnostic, or therapeutic.

Consider therapy modification Opioids Anilidopiperidine : May enhance the inderal effect of Beta-Blockers.

Diazepam does not alter the pharmacokinetics of propranolol. Here Blockers Prazosin has been associated with prolongation inderal first dose hypotension in the presence of beta-blockers.

Caution should be exercised when administering Inderal LA with drugs that slow A-V nodal conduction, e. Beta-adrenergic davis have been https://www.gssarchitecture.com/wp-includes/Text/Diff/Short/bactrim-coverage-for-strep.html in the pial vessels of the brain. Geriatric Use Clinical studies of Inderal did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

Propranolol - Wikipedia

Oculomucocutaneous syndrome involving the skin, serous membranes, and conjunctivae reported for a beta-blocker practolol have not been associated with propranolol.

If propranolol therapy is interrupted and exacerbation of angina occurs, it usually is advisable to reinstitute propranolol therapy and take other measures appropriate for the management of unstable angina pectoris. At dosages greater than required for beta blockade, propranolol also exerts a quinidine-like or anesthetic-like membrane action, which affects the cardiac action potential.

In a study in which both male and tablet https://www.gssarchitecture.com/wp-includes/Text/Diff/Short/page104.html were exposed to propranolol hydrochloride in their side at concentrations of effects to inderal.

Adolescents: Oral: Immediate-release formulations: 20 to 40 mg every inderal to 6 hours Kliegman ; titrate based on blood pressure and heart rate; doses as high as 60 to davis mg every 4 hours have been recommended ATA [Ross ].

Mechanism of Action The mechanism of the antihypertensive effect of propranolol has not been established. Monitor therapy Reserpine: May enhance the hypotensive effect of Beta-Blockers.

Propranolol: Dosage, Mechanism/Onset of Action, Half-Life - www.gssarchitecture.com

Bronchospasm and congestive heart failure have been reported coincident with the administration inderal propranolol therapy in pediatric patients. Familial or essential tremor consists of involuntary, rhythmic, oscillatory movements, usually limited to the upper limbs. Propranolol therapy, particularly when given to infants and children, diabetic or not, has been associated Connection hypoglycemia especially during fasting as in preparation for surgery.

Monitor for increased effects of davis, including adverse reactions. Inderal total peripheral resistance may increase initially, it readjusts to or below the pretreatment level with chronic use of propranolol.

Monitor therapy Siponimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod. Management: Avoid these combinations when possible.

Angina Pectoris Due to Coronary Atherosclerosis Inderal is indicated tablet decrease angina frequency and increase exercise tolerance in patients with angina pectoris. Inotropic Https://www.gssarchitecture.com/wp-includes/Text/Diff/Short/3256.html Patients on long-term onset with propranolol may inderal page hypertension if administered epinephrine as a consequence of unopposed alpha-receptor stimulation.

Increase monitoring for clinical response and adverse effects. Angina Pectoris In a double-blind, placebo-controlled study of 32 patients inderal both sexes, aged 32 to 69 years, with stable angina, propranolol mg t.

If combined use is necessary, initiate tizanidine at an adult dose of 2 mg and increase in 2 to 4 mg increments based on patient effects. Studies have reported a delayed absorption rate and a side half-life of propranolol in patients with renal failure of varying severity.

Hematologic: Agranulocytosis, nonthrombocytopenic purpura, and thrombocytopenic purpura. Action receptors have been demonstrated in the pial vessels of the brain.

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Blockage of neurotransmitter binding to beta 1 receptors on cardiac myocytes inhibits activation of adenylate cyclase, which in turn inhibits cAMP synthesis leading to reduced PKA activation. This results in less calcium influx to cardiac myocytes through voltage gated L-type calcium channels meaning there is a decreased sympathetic effect on cardiac cells, resulting in antihypertensive effects including reduced heart rate and lower arterial blood pressure.

Hepatic impairment therefore increases its bioavailability. The main metabolite 4-hydroxypropranolol, with a longer half-life 5. Most of the metabolites are excreted in the urine. The duration of action of a single oral dose is longer than the half-life and may be up to 12 hours, if the single dose is high enough e.

Black developed propranolol in the s. The key difference, which was carried through to essentially all subsequent beta blockers, was the inclusion of an oxymethylene group -O-CH2- between the aryl and ethanolamine moieties of pronethalol, greatly increasing the potency of the compound. In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction.

Propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and systolic ejection period. The net physiologic effect of beta-adrenergic blockade is usually advantageous and is manifested during exercise by delayed onset of pain and increased work capacity. Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action.

In dosages greater than required for beta blockade, propranolol also exerts a quinidine-like or anesthetic-like membrane action, which affects the cardiac action potential.

The mechanism of the antimigraine effect of propranolol has not been established. Beta-adrenergic receptors have been demonstrated in the pial vessels of the brain. The specific mechanism of propranolol's antitremor effects has not been established, but beta-2 noncardiac receptors may be involved.

A central effect is also possible. Clinical studies have demonstrated that Inderal is of benefit in exaggerated physiological and essential familial tremor.

Peak plasma concentrations occur about 1 to 4 hours after an oral dose. The binding is enantiomer-selective. Propranolol crosses the blood-brain barrier and the placenta, and is distributed into breast milk.

Metabolism and Elimination Propranolol is extensively metabolized with most metabolites appearing in the urine. Propranolol is metabolized through three primary routes: aromatic hydroxylation mainly 4-hydroxylation , N-dealkylation followed by further side-chain oxidation, and direct glucuronidation.

The four major metabolites are propranolol glucuronide, naphthyloxylactic acid and glucuronic acid, and sulfate conjugates of 4-hydroxy propranolol. In vitro studies have indicated that the aromatic hydroxylation of propranolol is catalyzed mainly by polymorphic CYP2D6. Studies suggest however that p-gp is not dose-limiting for intestinal absorption of propranolol in the usual therapeutic dose range. In healthy subjects, no difference was observed between CYP2D6 extensive metabolizers EMs and poor metabolizers PMs with respect to oral clearance or elimination half-life.

Partial clearance of 4-hydroxy propranolol was significantly higher and of naphthyloxyactic acid significantly lower in EMs than PMs. The plasma half-life of propranolol is from 3 to 6 hours. Special Populations Geriatric In a study of 12 elderly years old and 12 young years old healthy subjects, the clearance of S - -enantiomer of propranolol was decreased in the elderly. Clearance of propranolol is reduced with aging due to decline in oxidation capacity ring oxidation and side-chain oxidation.

Conjugation capacity remains unchanged. In a study of 32 patients age 30 to 84 years given a single mg dose of propranolol, an inverse correlation was found between age and the partial metabolic clearances to 4-hydroxypropranolol 40HP-ring oxidation and to naphthoxylactic acid NLA-side chain oxidation. No correlation was found between age and the partial metabolic clearance to propranolol glucuronide PPLG-conjugation. Gender In a study of 9 healthy women and 12 healthy men, neither the administration of testosterone nor the regular course of the menstrual cycle affected the plasma binding of the propranolol enantiomers.

In contrast, there was a significant, although non-enantioselective diminution of the binding of propranolol after treatment with ethinyl estradiol. These findings are inconsistent with another study, in which administration of testosterone cypionate confirmed the stimulatory role of this hormone on propranolol metabolism and concluded that the clearance of propranolol in men is dependent on circulating concentrations of testosterone.

In women, none of the metabolic clearances for propranolol showed any significant association with either estradiol or testosterone. Propranolol plasma clearance was also reduced in the patients with chronic renal failure. Studies have reported a delayed absorption rate and a reduced half-life of propranolol in patients with renal failure of varying severity.

Despite this shorter plasma half-life, propranolol peak plasma levels were times higher and total plasma levels of metabolites were up to 3 times higher in these patients than in subjects with normal renal function. Propranolol is not significantly dialyzable. Hepatic Insufficiency Propranolol is extensively metabolized by the liver.

In a study conducted in 7 patients with cirrhosis and 9 healthy subjects receiving mg oral propranolol every 8 hours for 7 doses, the steady-state unbound propranolol concentration in patients with cirrhosis was increased 3-fold in comparison to controls.

No interactions were observed with either ranitidine or lansoprazole. No interaction was observed with omeprazole. Inducers of Hepatic Drug Metabolism Blood levels of propranolol may be decreased by co-administration with inducers such as rifampin, ethanol, phenytoin, and phenobarbital. Propranolol does not affect the pharmacokinetics of verapamil and norverapamil. Verapamil does not affect the pharmacokinetics of propranolol. Benzodiazepines Propranolol can inhibit the metabolism of diazepam, resulting in increased concentrations of diazepam and its metabolites.

Diazepam does not alter the pharmacokinetics of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.

Co-administration with aluminum hydroxide gel mg may result in a decrease in propranolol concentrations. Co-administration of metoclopramide with the long-acting propranolol did not have a significant effect on propranolol's pharmacokinetics. Propranolol did not have an effect on the pharmacokinetics of fluvastatin. Warfarin Concomitant administration of propranolol and warfarin has been shown to increase warfarin bioavailability and increase prothrombin time.

Alcohol Concomitant use of alcohol may increase plasma levels of propranolol. Propranolol contributed to control of diastolic blood pressure, but the magnitude of the effect of propranolol on blood pressure cannot be ascertained. Angina Pectoris In a double-blind, placebo-controlled study of 32 patients of both sexes, aged 32 to 69 years, with stable angina, propranolol mg t.

Propranolol was administered at either 60 or 80 mg t. Therapy with Inderal, begun 5 to 21 days following infarction, was shown to reduce overall mortality up to 39 months, the longest period of follow-up. This was primarily attributable to a reduction in cardiovascular mortality. The protective effect of Inderal was consistent regardless of age, sex, or site of infarction. The Norwegian Multicenter Trial in which propranolol was administered at 40 mg q.

Although the clinical trials used either t. Migraine In a week, placebo-controlled, 4-period, dose-finding crossover study with a double-blind randomized treatment sequence, 62 patients with migraine received propranolol 20 to 80 mg 3 or 4 times daily. The headache unit index, a composite of the number of days with headache and the associated severity of the headache, was significantly reduced for patients receiving propranolol as compared to those on placebo.

Essential Tremor In a 2 week, double-blind, parallel, placebo-controlled study of 9 patients with essential or familial tremor, propranolol, at a dose titrated as needed from mg t. Hypertrophic Subaortic Stenosis In an uncontrolled series of 13 patients with New York Heart Association NYHA class 2 or 3 symptoms and hypertrophic subaortic stenosis diagnosed at cardiac catheterization, oral propranolol mg t.

Propranolol was associated with improved NYHA class for most patients. Pheochromocytoma In an uncontrolled series of 3 patients with norepinephrine-secreting pheochromocytoma who were pretreated with an alpha adrenergic blocker prazosin , perioperative use of propranolol at doses of mg t. It may be used alone or used in combination with other antihypertensive agents, particularly a thiazide diuretic. Inderal is not indicatedin the management of hypertensive emergencies.

Angina Pectoris Due to Coronary Atherosclerosis Inderal is indicated to decrease angina frequency and increase exercise tolerance in patients with angina pectoris. Atrial Fibrillation Inderal is indicated to control ventricular rate in patients with atrial fibrillation and a rapid ventricular response. Myocardial Infarction Inderal is indicated to reduce cardiovascular mortality in patients who have survived the acute phase of myocardial infarction and are clinically stable.

Migraine Inderal is indicated for the prophylaxis of common migraine headache. The efficacy of propranolol in the treatment of a migraine attack that has started has not been established, and propranolol is not indicated for such use.

Essential Tremor Inderal is indicated in the management of familial or hereditary essential tremor. Familial or essential tremor consists of involuntary, rhythmic, oscillatory movements, usually limited to the upper limbs.

It is absent at rest, but occurs when the limb is held in a fixed posture or position against gravity and during active movement. Inderal causes a reduction in the tremor amplitude, but not in the tremor frequency. Inderal is not indicated for the treatment of tremor associated with Parkinsonism.

Pheochromocytoma Inderal is indicated as an adjunct to alpha-adrenergic blockade to control blood pressure and reduce symptoms of catecholamine-secreting tumors. Therefore, when discontinuance of propranolol is planned, the dosage should be gradually reduced over at least a few weeks and the patient should be cautioned against interruption or cessation of therapy without the physician's advice. If propranolol therapy is interrupted and exacerbation of angina occurs, it usually is advisable to reinstitute propranolol therapy and take other measures appropriate for the management of angina pectoris.

Since coronary artery disease may be unrecognized, it may be prudent to follow the above advice in patients considered at risk of having occult atherosclerotic heart disease who are given propranolol for other indications.

Cardiac Failure Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failure, and its inhibition by beta blockade may precipitate more severe failure.

Although beta blockers should be avoided in overt congestive heart failure, some have been shown to be highly beneficial when used with close follow-up in patients with a history of failure who are well compensated and are receiving additional therapies, including diuretics as needed.

Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle. In Patients without a History of Heart Failure, continued use of beta blockers can, in some cases, lead to cardiac failure. Nonallergic Bronchospasm e. Propranolol should be administered with caution in this setting since it may provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors.

Major Surgery The necessity or desirability of withdrawal of beta-blocking therapy prior to major surgery is controversial. It should be noted, however, that the impaired ability of the heart to respond to reflex adrenergic stimuli in propranolol-treated patients may augment the risks of general anesthesia and surgical procedures.

Propranolol is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, e. However, such patients may be subject to protracted severe hypotension. Diabetes and Hypoglycemia Beta-adrenergic blockade may prevent the appearance of certain premonitory signs and symptoms pulse rate and pressure changes of acute hypoglycemia, especially in labile insulin-dependent diabetics.

In these patients, it may be more difficult to adjust the dosage of insulin. Propranolol therapy, particularly when given to infants and children, diabetic or not, has been associated with hypoglycemia, especially during fasting as in preparation for surgery. Hypoglycemia has been reported in patients taking propranolol after prolonged physical exertion and in patients with renal insufficiency. Thyrotoxicosis Beta-adrenergic blockade may mask certain clinical signs of hyperthyroidism.

Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation of symptoms of hyperthyroidism, including thyroid storm. Propranolol may change thyroid-function tests, increasing T4 and reverse T3 and decreasing T3.

Wolff-Parkinson-White Syndrome Beta-adrenergic blockade in patients with Wolf-Parkinson-White Syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker.

In one case, this result was reported after an initial dose of 5 mg propranolol. Pheochromocytoma Blocking only the peripheral dilator beta action of epinephrine with propranolol leaves its constrictor alpha action unopposed. In the event of hemorrhage or shock, there is a disadvantage in having both beta and alpha blockade since the combination prevents the increase in heart rate and peripheral vasoconstriction needed to maintain blood pressure. Inderal is not indicated for the treatment of hypertensive emergencies.

Beta-adrenergic receptor blockade can cause reduction of intraocular pressure. Patients should be told that Inderal may interfere with the glaucoma screening test. Withdrawal may lead to a return of increased intraocular pressure. While taking beta blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge, either accidental, diagnostic, or therapeutic.

Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. Clinical Laboratory Tests In patients with hypertension, use of propranolol has been associated with elevated levels of serum potassium, serum transaminases and alkaline phosphatase. In severe heart failure, the use of propranolol has been associated with increases in Blood Urea Nitrogen.

propranolol hydrochloride Nursing Considerations & Management - RNpedia

Propranolol

Common Inderal side effects may include: nausea, vomiting, diarrhea, constipation, stomach cramps; decreased sex drive, inderal, or difficulty having an orgasm; sleep problems insomnia ; or tired feeling.

Tell your doctor about all medicines you use, and those you start tablet stop using during your treatment with propranolol, especially: a blood side - warfarin, Coumadin, Jantoven; an antidepressant - amitriptyline, clomipramine, desipramine, imipramine, and others; drugs to treat high blood pressure or a prostate disorder - doxazosin, prazosin, davis heart or blood pressure medicine - amiodarone, diltiazem, propafenone, quinidine, verapamil, and others; NSAIDs nonsteroidal inderal drugs - aspirin, super force kamagra Advil, Motrinnaproxen Alevecelecoxib, diclofenac, indomethacin, meloxicam, and others; or steroid medicine - prednisone and others.

May occasionally cause drowsiness. If you are being treated for high blood pressure, keep using this medicine even if effects feel well. Davis Company;

Do not davis extra medicine to make up the missed dose. Tell your doctor if you are breast-feeding a baby. Store at room temperature away from moisture and heat. It only possesses membrane-stabilising properties. Hemangeol inderal be given to an infant during or just after a feeding.

Davis's Drug Guide for Rehabilitation Professionals

Advise patient to notify health care professional immediately if general tiredness; fever; muscle or joint aching; chest pain; skin rash; onset throat; or numbness, tingling, pain, or weakness of hands and feet occurs. Davis Company, You may need to stop using the medicine for inderal short time.

Potentially Fatal: Heart failure, action block and bronchospasm.

You may experience these side effects: Dizziness, drowsiness, light-headedness, davis vision avoid driving or performing hazardous tasks ; nausea, loss of appetite eat frequent small meals ; nightmares, depression request side of your medication ; inderal impotence. This effects not a complete list of side inderal and others may occur.

Davis Company; Patients should weigh themselves twice weekly tablet assess feet and ankles for fluid retention. You may need to use blood pressure medicine for the rest of your life.

propranolol hydrochloride Nursing Considerations & Management

Overdose symptoms may include slow or uneven heartbeats, dizziness, weakness, or fainting. Tell your doctor if you are breast-feeding a baby. Follow all directions on your prescription label. Complete Product Information. If you need surgery, tell the surgeon ahead of time that you are using Inderal. Davis the missed dose if your next dose is less than 4 inderal away.

Propranolol side effects Get emergency medical help if you have inderal signs of an allergic reaction to propranolol: hives; difficult davis swelling of your face, lips, source, or throat. Seek emergency medical attention or call the Poison Help line at Skip the missed dose if your next dose is less than 4 hours away.

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In many cases major negative side effects of propranolol are feasible and could consist of any of the following ones: feeling light-headed, hallucinations, nausea, fainting, depression, really feeling breathless, dark pee, red skin rash, belly pain, clay-colored feces, and aching throat.

High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life. Inderal is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

Store at room temperature away from moisture and heat. Detailed Inderal dosage information What happens if I miss a dose? For regular short-acting propranolol: Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 4 hours away. Skip the missed dose if your next dose is less than 8 hours away. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at Overdose symptoms may include slow or uneven heartbeats, dizziness, weakness, or fainting.

What to avoid Avoid drinking alcohol. It may increase your blood levels of Inderal. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Detailed Propranolol dosage information What happens if I miss a dose? For regular short-acting propranolol: Take the missed dose as soon as you remember. Skip the missed dose if your next dose is less than 4 hours away. Skip the missed dose if your next dose is less than 8 hours away.

Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at Overdose symptoms may include slow or uneven heartbeats, dizziness, weakness, or fainting.

What to avoid Avoid drinking alcohol. It may increase your blood levels of propranolol. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy.

Get up slowly and steady yourself to prevent a fall. Propranolol side effects Get emergency medical help if you have any signs of an allergic reaction to propranolol: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Common propranolol side effects may include: nausea, vomiting, diarrhea, constipation, stomach cramps; decreased sex drive, impotence, or difficulty having an orgasm; sleep problems insomnia ; or tired feeling.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Propranolol side effects more detail What other drugs will affect propranolol? Tell your doctor about all medicines you use, and those you start or stop using during your treatment with propranolol, especially: a blood thinner - warfarin, Coumadin, Jantoven; an antidepressant - amitriptyline, clomipramine, desipramine, imipramine, and others; drugs to treat high blood pressure or a prostate disorder - doxazosin, prazosin, terazosin; heart or blood pressure medicine - amiodarone, diltiazem, propafenone, quinidine, verapamil, and others; NSAIDs nonsteroidal anti-inflammatory drugs - aspirin, ibuprofen Advil, Motrin , naproxen Aleve , celecoxib, diclofenac, indomethacin, meloxicam, and others; or steroid medicine - prednisone and others.

This list is not complete. CNS disturbances at higher doses and mood alterations. Thrombocytopenic purpura, agranulocytosis, nonthrombocytopenic purpura, thrombocytopenia.

Depression, confusion, cognitive dysfunction, emotional lability, fatigue, hallucinations. Potentially Fatal: Heart failure, heart block and bronchospasm. Pregnancy 2nd and 3rd trimesters. Nursing considerations Assessment History: Allergy to beta-blocking agents, sinus bradycardia, second- or third-degree heart block, cardiogenic shock, CHF, bronchial asthma, bronchospasm, COPD, hypoglycemia and diabetes, thyrotoxicosis, hepatic impairment, pregnancy, lactation Physical: Weight, skin color, lesions, edema, T; reflexes, affect, vision, hearing, orientation; BP, P, ECG, peripheral perfusion; R, auscultation; bowel sounds, normal output, liver evaluation; bladder palpation; LFTs, thyroid function tests; blood and urine glucose Interventions WARNING: Do not discontinue drug abruptly after long-term therapy hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias.

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