BEDRANOL 40MG

Indications

• Hypertension
• Angina pectoris
• Migraine prophylaxis
• Essential tremors
• Arrhythmias
• Anxiety
• Post-myocardial infarction management

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines in paediatric patients.

Adults: Refer to the BNF for specific dosing information based on the indication.

Mechanism of action

Propranolol blocks beta-adrenergic receptors, leading to vasoconstriction and inhibition of angiogenic factors such as vascular endothelial growth factor (VEGF) and basic growth factor of fibroblasts (bFGF). This blockade induces apoptosis of endothelial cells and downregulates the renin-angiotensin-aldosterone system, contributing to its antihypertensive effects.

Pharmacodynamics

Propranolol exhibits a long duration of action, allowing for once or twice daily administration depending on the clinical indication. It is important to note that abrupt discontinuation of propranolol can lead to exacerbations of angina and increase the risk of myocardial infarctions, indicating a potential rebound effect.

Pharmacokinetics

Propranolol is well absorbed following oral administration, with a bioavailability of approximately 25% due to first-pass metabolism in the liver. It is highly protein-bound, primarily to albumin, and has a large volume of distribution. The drug is metabolized in the liver by cytochrome P450 enzymes, particularly CYP2D6, and is excreted in urine predominantly as metabolites. The half-life of propranolol ranges from 3 to 6 hours, but this can be prolonged in patients with hepatic impairment.

Contra-indications

• Asthma or history of bronchospasm
• Severe bradycardia
• Heart block greater than first degree
• Cardiogenic shock
• Uncompensated heart failure
• Hypersensitivity to propranolol or any excipients

Adverse effects

• Fatigue
• Dizziness
• Cold extremities
• Bradycardia
• Hypotension
• Nausea
• Diarrhea
• Sleep disturbances
• Depression
• Worsening of asthma symptoms

Interactions

• Calcium channel blockers may enhance the hypotensive effect
• Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the antihypertensive effect
• CYP2D6 inhibitors may increase propranolol levels
• Other antihypertensives may have additive effects leading to hypotension

Precautions

• Use with caution in patients with a history of depression
• Monitor for signs of heart failure in patients with cardiac disease
• Gradual withdrawal is advised to avoid exacerbation of angina
• Caution in patients with diabetes as it may mask hypoglycemic symptoms

Pregnancy

Propranolol should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. It is classified as Category C.

Breast-feeding

Propranolol is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

Store in a cool, dry place, away from light. Keep out of reach of children.

Formulations

• Tablets (various strengths)
• Oral solution
• Extended-release capsules
• Injectable solution

Mechanism of action

Propranolol is a nonselective β-adrenergic receptor antagonist. Blocking of these receptors leads to vasoconstriction, inhibition of angiogenic factors like vascular endothelial growth factor (VEGF) and basic growth factor of fibroblasts (bFGF), induction of apoptosis of endothelial cells, as well as down regulation of the renin-angiotensin-aldosterone system.

Pharmacodynamics

Propranolol is a beta-adrenergic receptor antagonist used to treat hypertension. Propranolol has a long duration of action as it is given once or twice daily depending on the indication. When patients abruptly stop taking propranolol, they may experience exacerbations of angina and myocardial infarctions.