Propranolol (Cardiovascular)

Propranolol is used alone or in combination with other medications to treat high blood pressure. It is also used to treat irregular heartbeats, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremor, and hypertrophic subaortic stenosis (a heart muscle disease). Propranolol is also used to prevent angina (chest pain), migraine headaches, and to improve survival after a heart attack. Propranolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Propranolol comes as a tablet, solution (liquid),and as an extended-release (long-acting) capsule to take by mouth. The extended-release propranolol capsule (brand name: Inderal LA) usually is taken once a day. The extended-release capsule (Innopran XL, Inderal XL) is usually taken at bedtime and should consistently be taken either always with or always without food each time. Immediate-acting propranolol tablets or solution may be taken two, three, or four times a day. Take propranolol at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take propranolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release capsules whole; do not split, chew, or crush them.

Your doctor may start you on a low dose of propranolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Propranolol helps control your condition but will not cure it. Continue to take propranolol even if you feel well. Do not stop taking propranolol without talking to your doctor. If you suddenly stop taking propranolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking propranolol,

• tell your doctor and pharmacist if you are allergic to propranolol, any other medications, or any ingredients in propranolol tablets, oral solution, or extended-release capsules. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• The following nonprescription or herbal products may interact with propranolol: antacids containing aluminum (Maalox, Mylanta, others), cimetidine (Tagamet HB); and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn, others). Be sure to let your doctor and pharmacist know that you are taking this medication before you start taking propranolol. Do not start this medication while taking propranolol without discussing with your healthcare provider.
• tell your doctor if you have a slow or irregular heartbeat, heart failure, or asthma or other lung disease. Your doctor may tell you not to take propranolol.
• tell your doctor if you have or have ever had: heart, liver, or kidney disease; diabetes; pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heart rate) or hyperthyroidism (an overactive thyroid gland). Also tell your doctor if you have ever had a serious allergic reaction to a food or any other substance.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking propranolol, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking propranolol.
• ask your doctor about the safe use of alcoholic beverages while you are taking propranolol. Alcohol may increase the amount of propranolol in your body.
• tell your doctor if you use tobacco products. Cigarette smoking may decrease the effectiveness of this medication.
• you should know that propranolol may increase the risk of hypoglycemia (low blood sugar) and prevent the warning signs and symptoms that would tell you that your blood sugar is low. Let your doctor know if you are unable to eat or drink normally or are vomiting while you are taking propranolol. You should know the symptoms of low blood sugar and what to do if you have these symptoms.
• you should know that if you have allergic reactions to different substances, your reactions may be worse while you are taking propranolol and your allergic reactions may not respond to the usual doses of injectable epinephrine.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Propranolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness or lightheadedness
• tiredness
• diarrhea
• constipation

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or get emergency medical treatment:

• difficulty breathing or swallowing
• rash
• blistering or peeling skin
• hives
• itching
• swelling of the face, throat, tongue, or lips
• feeling faint
• unusual weight gain
• shortness of breath
• irregular heartbeat

Propranolol may cause other side effects. Call your doctor if you have any unusual problems while you are using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat, and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• slow heartbeat
• dizziness
• fatigue or weakness
• fainting
• difficulty breathing
• cough or wheezing

Keep all appointments with your doctor and the laboratory. Your doctor will need to determine your response to propranolol. Your doctor may ask you to check your pulse (heart rate). Ask your pharmacist or doctor to teach you how to take your pulse. If your pulse is faster or slower than it should be, call your doctor.

Before you are tested for glaucoma (increased pressure in your eyes that may lead to vision loss), tell your doctor and the technician that you are taking propranolol.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Inderal^®¶
• Inderal^® LA
• Inderal^® XL
• InnoPran^®¶
• InnoPran^® XL
• Pronol^®¶

• Inderide^® (containing Hydrochlorothiazide, Propranolol)^¶
• Inderide^® LA (containing Hydrochlorothiazide, Propranolol)^¶