Cardinol

Indications

Propranolol is used to treat high blood pressure, angina (chest pain caused by poor blood flow to the heart) and some types of irregular heartbeat. It is also used to prevent migraine, to reduce shaking of the hands (essential tremor) and to ease the physical signs of anxiety such as a pounding heart and trembling. Doctors may also use it after a heart attack, to control symptoms of an overactive thyroid, and to lower the risk of bleeding from swollen veins in the food pipe in people with liver disease.

How It Works

Propranolol is a beta-blocker. It blocks the effect of adrenaline on the heart and blood vessels, so the heart beats more slowly and with less force. This lowers blood pressure, reduces the heart's need for oxygen and calms physical symptoms of stress.

Dosage and Administration

• Anxiety symptoms: usually 40 mg once a day, which the doctor may increase to 40 mg two or three times a day.
• Migraine prevention and tremor: usually 40 mg two or three times a day to start, adjusted by the doctor.
• High blood pressure: usually started at 40 mg twice a day and increased gradually by the doctor if needed.
• Angina, irregular heartbeat, after a heart attack, thyroid problems and liver disease: as prescribed.
• Children: as prescribed by the doctor.

Take by mouth at the same times each day. Modified-release capsules are taken once a day and swallowed whole. Do not stop suddenly; your doctor will reduce the dose slowly over 1 to 2 weeks.

Interactions

Tell your doctor about all your medicines. Verapamil and Diltiazem taken with propranolol can slow the heart too much. Other blood pressure medicines, Amiodarone and Digoxin can add to its effects. If you also take Clonidine, do not stop Clonidine on your own because blood pressure can rise sharply. Propranolol can hide the warning signs of low blood sugar in people taking Insulin or diabetes tablets. Painkillers such as Ibuprofen can weaken its effect, and Cimetidine and Fluvoxamine can raise its level. It can block the effect of Salbutamol inhalers. Alcohol can increase dizziness.

Contraindications

• Asthma or a past history of wheezing or bronchospasm.
• Very slow heart rate, heart block or sick sinus syndrome.
• Heart failure that is not controlled, or shock caused by heart failure.
• Very low blood pressure or severe circulation problems in the legs.
• Untreated phaeochromocytoma (an adrenal tumour) or metabolic acidosis.
• Allergy to propranolol.

Side Effects

Common: tiredness, cold hands and feet, slow pulse, trouble sleeping, vivid dreams, nausea and diarrhoea. Less common: dizziness, low mood, numbness of the fingers and hair thinning.

Get urgent medical help if you have wheezing or difficulty breathing, fainting, a very slow pulse, chest pain that gets worse, swelling of the ankles with breathlessness, or signs of allergy such as rash or swelling of the face, lips or throat.

Pregnancy and Lactation

Use in pregnancy only if the doctor decides it is needed. It may slow the baby's growth and can cause a slow heartbeat or low blood sugar in the newborn, so the baby should be checked after birth. Small amounts pass into breast milk; it is usually acceptable while breastfeeding, but ask your doctor and watch the baby for drowsiness or poor feeding.

Precautions and Warnings

Never stop taking it suddenly, as this can bring on chest pain or a heart attack. Use with care in diabetes, thyroid disease, liver or kidney disease, psoriasis, myasthenia gravis and circulation problems. Tell the doctor or dentist that you take it before any operation. It can cause dizziness or tiredness, so take care when driving.

Overdose

An overdose can cause a very slow heartbeat, very low blood pressure, dizziness, fainting, breathing difficulty, low blood sugar and fits. Go to a hospital emergency department straight away.

Therapeutic Class

Non-selective beta-adrenergic blocker (beta-blocker).

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.