Propranolol (Cardiovascular)

Propranolol is used to treat high blood pressure, irregular heart rhythms, pheochromocytoma (tumor on a small gland near the kidneys), certain types of tremor, and hypertrophic subaortic stenosis (a heart muscle disease). It 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.

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 products. Ask your pharmacist or check the Medication Guide 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. Be sure to mention any of the following: ACE inhibitors; antacids containing aluminum (Maalox, Mylanta, others); anticoagulants (''blood thinners'') such as warfarin (Coumadin, Jantoven); calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac, others), nicardipine (Cardene), nifedipine (Adalat, Procardia XL), and nisoldipine (Sular); cholestyramine (Prevalite); cimetidine; ciprofloxacin (Cipro); chlorpromazine; colestipol (Colestid); diazepam (Diastat, Valium); digoxin (Lanoxin); fluvoxamine (Luvox); haloperidol (Haldol); HMG-CoA reductase inhibitors (cholesterol-lowering agents) such as lovastatin (Altoprev, Mevacor, in Advicor) and pravastatin (Pravachol); isoniazid (in Rifamate, in Rifater); medications for depression such as bupropion (Aplenzin, Forfivo XL, Wellbutrin, Zyban), fluoxetine (Prozac, Sarafem, Selfemra), imipramine (Tofranil), and paroxetine (Brisdelle, Paxil, Pexeva); fluconazole (Diflucan); medications for migraine headaches such as rizatriptan (Maxalt) and zolmitriptan (Zomig); medications for high blood pressure such as clonidine (Catapres, Kapvay, in Clorpres), doxazosin (Cardura), prazosin (Minipress), and terazosin; medications for seizures such as phenytoin (Dilantin, Phenytek) and phenobarbital; certain medications for irregular heartbeats such as amiodarone (Cordarone, Nexterone, Pacerone), propafenone (Rythmol), and quinidine (in Nuedexta); monoamine oxidase (MAO) inhibitors such as phenelzine (Nardil); montelukast (Singulair); nonsteroidal anti-inflammatory drugs (NSAIDs) such as indomethacin (Indocin, Tivorbex); theophylline (Theo-24, Theochron, Uniphyl); reserpine; rifampin (Rifadin, Rimactane, in Rifater, in Rifamate); ritonavir (Norvir, in Kaletra, in Viekira Pak); teniposide (Vumon); thioridazine; ticlopidine; tolbutamide; tricyclic antidepressants; and zileuton (Zyflo). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• tell your doctor if you have or have ever had asthma or other lung disease; heart, liver, or kidney disease; diabetes; severe allergies; or thyroid problems.

• 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.

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

  • weight gain

  • 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 (http://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 (http://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. http://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

Keep all appointments with your doctor and the laboratory.

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.

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