PropranololPropranolol Hydrochloride

About Propranolol

Propranolol blocks beta-1 and beta-2 receptors, slowing the heart and lowering blood pressure. The tablets and oral solution are labeled for high blood pressure; angina; atrial fibrillation, to slow the heart rate; lowering the risk of cardiovascular death after the acute phase of a heart attack; migraine prevention; essential tremor; hypertrophic subaortic stenosis; and, with an alpha blocker, pheochromocytoma. Their safety and effectiveness in children have not been established. For blood pressure, tablets usually start at 40 mg twice a day, with 120 to 240 mg a day for maintenance; migraine prevention starts at 80 mg a day in divided doses. Inderal LA and its generics, taken once a day, cover high blood pressure, angina, migraine prevention and hypertrophic subaortic stenosis, usually starting at 80 mg. InnoPran XL and Inderal XL, sold under one FDA application, are taken at bedtime for high blood pressure only.

There is no boxed warning, but the labels warn that angina has worsened, and some people have had a heart attack, after propranolol was stopped abruptly, so it is reduced gradually (over at least a few weeks, or one to two weeks for InnoPran XL) and never interrupted without the prescriber’s advice. It must not be taken in cardiogenic shock, with sinus bradycardia or heart block greater than first degree, with bronchial asthma, or with an allergy to propranolol. It can worsen heart failure, provoke bronchospasm, and hide the signs of low blood sugar or cause it, particularly in infants and children and during fasting. Severe skin reactions, including Stevens-Johnson syndrome, have been reported. With immediate-release forms, fatigue, lethargy and vivid dreams appear dose-related.

The forms are not interchangeable: Inderal LA is not a milligram-for-milligram substitute for immediate-release propranolol. Hemangeol is labeled only for proliferating infantile hemangioma needing systemic treatment, started at 5 weeks to 5 months of age and raised to 1.7 mg per kg twice a day for six months; doses are given during or right after a feeding, at least 9 hours apart, and skipped if the baby is not eating or is vomiting, because of the risk of low blood sugar. It is not used in premature babies under 5 weeks corrected age, babies under 2 kg, or with asthma, a slow heart rate or low blood pressure. Newborns exposed near delivery may have a slow heartbeat, low blood sugar or slowed breathing, and propranolol passes into breast milk.

Taking Propranolol

How to take it

Tablets and oral solution two to four times a day; measure the solution with an oral syringe or dosing cup. Swallow extended-release capsules whole, and take InnoPran XL or Inderal XL at bedtime, consistently with or without food. Give Hemangeol during or right after a feeding.

If you miss a dose

Tablets, solution and capsules: take it as soon as you remember, unless it is almost time for the next dose; then skip the missed dose, and never take a double dose. Hemangeol: if a baby spits up a dose or may not have taken all of it, do not give another; wait for the next scheduled dose.

Storage

At room temperature, away from light, heat and moisture, out of reach of children. Do not freeze or shake Hemangeol, and throw away an opened bottle after two months.

Interactions to know about

Fluoxetine, paroxetine, cimetidine, ciprofloxacin and fluvoxamine can raise propranolol levels; rifampin, phenytoin and smoking lower them, and alcohol may raise them. It raises rizatriptan and warfarin levels.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Propranolol differs from pharmacy to pharmacy

Generic tablets have several makers, but each pharmacy sets its own cash price, including its dispensing fee, so quotes for the same tablet can differ, and doses two to four times a day add up to many tablets. Generic capsules rated equivalent to Inderal LA also have several makers.

InnoPran XL, Inderal XL and Hemangeol have no generic, so they are priced as brands, and the oral solution comes from only a few makers.

Ways to pay less for Propranolol without insurance

• Ask for generic tablets, solution or capsules, and make sure the prescription does not block substitution.
• Ask whether propranolol is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• Once your dose is stable, ask for a ninety-day supply, and refill early so you never run out.
• If InnoPran XL or Inderal XL is prescribed, ask the prescriber whether generic extended-release capsules would suit you; for Hemangeol, ask the maker about savings or assistance for someone paying cash.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Propranolol

1. 1.Is my prescription for tablets, liquid or an extended-release capsule, and can it be swapped?
2. 2.Is it safe with my asthma, COPD or diabetes?
3. 3.Do my medicines, such as fluvoxamine, cimetidine, rizatriptan or warfarin, interact with it?
4. 4.For my baby on Hemangeol, which signs of low blood sugar mean I should stop it and call?

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