Inderal 10mg tabs 56 pcs renewal

Description

Composition
Active substance:
1 tablet contains: propranolol (propranolol hydrochloride) 0.01 g 0.04 g
Excipients:
Sugar (sucrose), calcium stearate, potato starch, talc.
Description:
white pills Valium chamfered.
Product form:
Tablets 10 and 40 mg.
10, 50 tablets in blisters. 50 100 tablets in glass jars. Each bank or 5, 10 contour cell packs of 10 tablets together with instructions for use placed into the package. Or 1, 2 blisters with 50 tablets together with instructions for use placed into the package.
Contraindications
Increased sensitivity to the drug, atrioventricular block II-III degree sinoauricular block, sinus bradycardia, hypotension, uncontrolled congestive heart failure IIB-III degree, acute heart failure, acute myocardial infarction (systolic blood pressure – 100 mm Hg.). , cardiogenic shock, pulmonary edema, sick sinus syndrome, Prinzmetal angina, cardiomegaly (without heart failure), vasomotor rhinitis, occlusive diseases n rifericheskih vessels, diabetes, metabolic acidosis (in t. h. DKA), bronchial asthma, susceptibility to bronchospastic reactions, chronic obstructive pulmonary disease (including history), pheochromocytoma (without the simultaneous use of alpha blockers), spastic colitis, simultaneous with antipsychotics and anxiolytics (chlorpromazine, trioxazine et al.), MAO inhibitors, lactation, age 18 years (effectiveness and safety are installed).
Precautions -pechenochnaya and / or kidney failure, hyperthyroidism, myasthenia gravis, heart failure, pheochromocytoma, psoriasis, pregnancy, a history of allergic reactions, Raynaud’s syndrome, old age.
Dosage
10 mg
Indications
Arterial hypertension, angina, unstable angina, sinus tachycardia (including hyperthyroidism), supraventricular tachycardia, atrial tachyarrhythmia, supraventricular and ventricular extrasystoles, prophylaxis of myocardial infarction (systolic blood pressure over 100 mm-Hg. V.), Pheochromocytoma, essential tremor, migraine (prevention of attacks), as an adjunct in the treatment of hyperthyroidism and thyrotoxic crisis (intolerance thyreostatics medicaments), sympathoadrenal garments on the background of diencephalic syndrome.
Interaction with other drugs
The hypotensive effect of propranolol is enhanced when combined with diuretics, reserpine, hydralazine, and other antihypertensive agents, as well as ethanol.
The hypotensive effect of weakening the non-steroidal anti-inflammatory drugs (sodium retention and blockage of prostaglandin synthesis by the kidneys), estrogens (sodium retention) and MAO inhibitors.
Cimetidine increases bioavailability.
Increasing the concentration of lidocaine in the blood plasma, reduces the clearance of theophylline.
Simultaneous with the appointment phenothiazine derivatives increases the concentrations of both drugs in plasma.
And enhances the action thyreostatics uterotoniziruyuschih preparations; reduces the effect of antihistamines.
It increases the likelihood of severe systemic reactions (anaphylaxis) due to the introduction of allergens used for immunotherapy or skin tests.
Amiodarone, verapamil and diltiazem – increased severity of negative chrono, foreign-and dromotropic actions of propranolol.
Iodine-containing radiopaque drugs for intravenous administration to increase the risk of anaphylactic reactions.
Phenytoin intravenous administration, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity cardiodepressive action and likely to reduce blood pressure.
Changes effectiveness of insulin and of oral hypoglycemic drugs, masking the symptoms of developing hypoglycemia (tachycardia, increased blood pressure).
Reduces the clearance of xanthine (except dyphylline).
Antihypertensive effect of weakening glucocorticosteroids.
Cardiac glycosides, methyldopa, reserpine and guanfacine, antiarrhythmic drugs increase the risk of developing or worsening bradycardia, atrioventricular block, cardiac arrest and heart failure.
Nifedipine can lead to a significant reduction in blood pressure.
Prolongs the action of non-depolarizing muscle relaxants and anticoagulant effect of coumarin.
Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and hypnotics drugs increase CNS depression.
Not recommended simultaneous application with MAO inhibitors due to a significant increase in hypotensive action, a break in treatment between the reception of MAO inhibitors and propranolol should be at least 14 days.
Non-hydrogenated ergot alkaloids increase the risk of peripheral circulatory disorders.
Sulfasalazine propranolol increases the concentration in plasma (inhibits metabolism), rifampicin shortened half-life.
Overdose
Symptoms: bradycardia, dizziness or fainting, decreased blood pressure, arrhythmia, shortness of breath, cyanosis of nails of fingers or hands or cramps.
Treatment: gastric lavage, appointment of activated carbon, in violation of the atrio-ventricular conduction – in / administered 1-2 mg atropine, epinephrine, low efficiency carried setting temporary pacemaker; with ventricular arrhythmia – lidocaine (IA class of drugs does not apply); arterial hypotension the patient should be in the Trendelenburg position. If there are no signs of pulmonary edema, / in plazmozameschayuschie administered solutions, the ineffectiveness -epinefrin, dopamine, dobutamine; at cramps – in / diazepam; inhalation with bronchospasm or parenterally – beta adrenostimulyatorov.
pharmachologic effect
Pharmacological group:
Beta-blocker.
Pharmacodynamics:
Non-selective beta-blocker. It possesses antianginal, hypotensive and antiarrhythmic effect. Non-selective beta-adrenoceptor blocking (75% and 25% beta1- beta2- adrenergic receptor), reduces the formation of catecholamines stimulated cAMP from ATP, thereby reduces intracellular calcium intake has a negative chronotropic, dromo-, BATM and inotropic effect (frequency urezhaet heart rate, conduction and excitability inhibits, reduces myocardial contractility).
The early use of beta-blockers total peripheral vascular resistance in the first 24 hours is increased (as a result of reciprocal increase in the activity of alpha-adrenoceptor stimulation and removal of beta2-adrenoceptor vessels skeletal muscle), but after 1-3 days returns to the original, and prolonged decreases appointing .
The hypotensive effect was associated with reduced cardiac output, sympathetic stimulation of peripheral vessels, decreased activity renin-angiotensin system (has a value in patients with initial hypersecretion renin) sensitivity arch baroreceptors aorta (not going to increase their activity in response to lower BP) and the influence on the central nervous system. The hypotensive effect is stabilized by the end of 2 weeks course destination.
Antianginal effect is due to a decrease in myocardial oxygen demand (due to the negative chronotropic and inotropic effect). The decrease in heart rate leads to a lengthening of diastole and improve myocardial perfusion. By increasing the end-diastolic pressure in the left ventricle and increased tensile ventricular muscle fibers may increase the oxygen demand, especially in patients with chronic heart failure.
Antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased sympathetic nervous system activity, increased cAMP levels, hypertension), decrease the rate of spontaneous excitation of the sinus and ectopic pacemakers and slowing of atrioventricular conduction. Inhibition of pulses observed mainly in the antegrade and to a lesser extent in the retrograde direction through the atrioventricular node and additional routes. According to the classification of antiarrhythmic drugs includes preparations of group II. Reducing the severity of myocardial ischemia – by reducing myocardial oxygen demand, post-infarction mortality rate can also be reduced due to antiarrhythmic action.
The ability to prevent the development of headaches of vascular origin due to a decrease in severity expansion cerebral arteries due to beta adrenoblockade vascular receptors, inhibition caused by catecholamines platelet aggregation and lipolysis, decrease in platelet adhesiveness, preventing activation of coagulation factors during the release of adrenaline, stimulation of oxygen to the tissues and secretions decrease renin.
Reduction of tremor during treatment with propranolol may be due to blockade of beta2-adrenergic receptors. Increases the atherogenic properties of blood. Enhances the uterine contractions (spontaneous vyznat and drugs that stimulate the myometrium). Increases the tone of the bronchi.
Pharmacokinetics:
Quickly and adequately (90%) is absorbed by ingestion and relatively rapidly excreted from the body. Bioavailability after oral administration, 30-40% (the “first pass” through the liver microsomal oxidation) Propafenone-increasing (formed metabolites which inhibit liver enzymes), its value depends on the nature of the food and the intensity of hepatic blood flow. Glyukuronirovaniya metabolized by the liver. The maximum plasma concentration is reached after 1-1.5 hours. It has high lipophilicity, accumulates in the tissues of the lungs, brain, kidney, heart. Penetrates the blood-brain and placental barriers into breast milk. Communication with blood plasma protein-90-95%. The volume of distribution – 3-5 l / kg.
Enters the bile into the intestine and is reabsorbed deglyukuroniziruetsya. The half-life of 3-5 hours, a course on the background of administration can be prolonged to 12 h excreted by the kidneys -. 90%, in an unmodified form, less than 1%. It is not removed by hemodialysis.
Conditions of supply of pharmacies
On prescription.
side effects
With the cardiovascular system: sinus bradycardia, atrioventricular block, heart failure, heart rate, conduction disturbances infarction, arrhythmia, reduced blood pressure, orthostatic hypotension, chest pain, peripheral artery spasm, cold extremities.
On the part of the digestive tract: dry mouth, nausea, vomiting, diarrhea, constipation, epigastric pain, abnormal liver function, change in taste.
From the nervous system: rarely – headache, insomnia, “nightmarish” dream, asthenic syndrome, reduced ability to rapid mental and motor reactions, agitation, depression, paresthesia, fatigue, weakness, dizziness, drowsiness, confusion, or short-term memory loss , hallucinations, tremors.
The respiratory system: rhinitis, nasal congestion, dyspnea, bronchospasm, laryngospasm.
Metabolism: hypoglycemia (in patients with type I diabetes), hyperglycemia (in patients with diabetes mellitus type II).
From the senses: the dryness of the eyes (reduced secretion of tear fluid), impaired visual acuity, keratoconjunctivitis.
Reproductive system: decreased libido, reduced potency.
For the skin: alopecia, exacerbation of psoriasis flow, increased sweating, flushing of the skin, rash, psoriasiform skin reactions.
From endocrine system: decreased thyroid function.
Allergic reactions: skin rash, itching.
Laboratory findings: agranulocytosis, increased activity of “liver” transaminases and bilirubin.
Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia.
Other: muscle weakness, back pain or joint pain, chest pain, leukopenia, thrombocytopenia, and the syndrome of “cancellation”.
special instructions
Monitoring patients receiving Inderal should include monitoring of heart rate and blood pressure (at the beginning of treatment – daily, then 1 every 3-4 months), the ECG.
In elderly patients it is recommended to monitor renal function (1 every 4-5 months.).
In the case of elderly patients increasing bradycardia (less than 50 u. / Minute), hypotension (systolic blood pressure less than 100 mm Hg. V.) Atriventrikulyarnoy blockade bronchospasm, ventricular arrhythmias, severe liver dysfunction and / or kidney, it is necessary reduce dose or discontinue treatment.
It should teach the patient’s heart rate counting procedure and to instruct the need of medical advice in heart rate less than 50 bpm. / Min.
It is recommended to discontinue therapy in the development of depression caused by the intake of beta-blockers.
Patients who use contact lenses should bear in mind that during treatment may decrease the production of tear fluid.
Before assigning Inderal patients with heart failure (early phase) should be used digitalis and / or diuretics.
Treatment of coronary heart disease and resistant hypertension should be long – receiving Inderal is possible within a few years.
Discontinuation of treatment carried out gradually, under supervision of a physician: abrupt withdrawal can dramatically enhance myocardial ischemia, anginal syndrome, degrade exercise tolerance.
Cancellation are gradually reducing the dose for 2 weeks or more (dose reduced by 25% every 3-4 days).
Diabetic patients use the drug performed under the control of blood glucose (1 every 4-5 months.).
Thyrotoxicosis Anaprilin may mask certain clinical signs of hyperthyroidism (e.g., tachycardia). Abrupt withdrawal contraindicated in patients with hyperthyroidism, because the symptoms can increase. In the appointment of beta-blockers in patients receiving hypoglycemic agents, caution should be exercised, as during long breaks in food intake may develop hypoglycemia. And its such symptoms as tachycardia and tremor, are masked by the action of the drug. Patients should be instructed regarding what is the main symptom of hypoglycemia during treatment with beta-blockers is sweating.
With caution in conjunction with hypoglycemic agents (risk of hypoglycemia during therapy with insulin and hyperglycemia – while taking oral hypoglycemic agents).
At the same time taking clonidine his appointment may be terminated only a few days after discontinuation of propranolol.
When pheochromocytoma administered only in association with alpha-blockers.
If necessary, take during pregnancy, which is possible only if the benefit to the mother outweighs the risk of side effects in the fetus and child. If necessary, take during pregnancy – a careful monitoring of the fetus, for 48-72 hours before delivery – should be abolished.
Can not be used simultaneously with antipsychotic drugs (neuroleptics) and anxiolytics.
Drugs that reduce stocks catecholamines (e.g., reserpine) can enhance the action of beta-blockers, however patients receiving combination formulations should be under constant medical supervision for detecting arterial hypotension and bradycardia.
The treatment of propranolol should be avoided intravenous verapamil, diltiazem.
Carefully apply together with psychotropic drugs, e.g., MAO inhibitors, in their exchange application over 2 weeks.
A few days before the general anesthesia with chloroform or ether, is necessary to stop taking the drug (increased risk of depression of myocardial function and the development of arterial hypotension).
In the period of treatment should refrain from driving motor vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions.
In “smokers” the effectiveness of beta-blockers lower.
During treatment is not recommended to take ethanol (perhaps a sharp decrease in blood pressure).
It should be lifted before the study drug in blood and urine catecholamines, normetanephrine and vanilinmindalnoy acid; titers of antinuclear antibodies.
During treatment, avoid the use of natural licorice: foods rich in protein, can increase bioavailability.
Storage conditions
Store in a dry place, protected from light and out of reach of children.
Dosing and Administration
When hypertension – inwards to 40 mg 2 times a day. With insufficient expression of the hypotensive effect dose increased to 40 mg three times or 80 mg 2 times a day. The maximum daily dose – 320 mg.
Angina, cardiac arrhythmias – at an initial dose of 20 mg three times a day and then to increase the dose of 80-120 mg over 2-3 hours. The maximum daily dose – 240 mg.
For the prevention of migraine, as well as essential tremor – at an initial dose of 40 mg 2-3 times a day, if necessary, the dose is gradually increased up to 160 mg / day.
In human liver necessary reduction in dose.
When impaired renal function it is necessary to reduce the initial dose or increase the interval between doses of the drug.
Prophylaxis of recurrent myocardial infarction – therapy begin between 5th and 21st day after myocardial infarction in a dose of 40 mg four times a day, for 2-3 days. Then, at a dose of 80 mg 2 times a day.
In pheochromocytoma – used only with alpha-adrenergic blockers. Preoperatively administered 60 mg daily for 3 days.
Information
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist