Inderal 40mg tab 100 pieces ozone


Inderal 40mg tab 100 pieces ozone



Active substance:
1 tablet contains: propranolol hydrochloride (Inderal) – 10 mg or 40 mg.
Sucrose (sugar), calcium stearate monohydrate, potato starch.
Product form:
Tablets of 10 mg or 40 mg.
The package 50 or 100 pieces.
Increased sensitivity to the drug, atrioventricular block II-III degree sinoauricular block, sinus bradycardia (less than 50 beats per minute), hypotension, uncontrolled congestive heart failure II-III level, acute heart failure, acute myocardial infarction (systolic blood pressure – at least 100 mm Hg. v.), cardiogenic shock, pulmonary edema, sick sinus syndrome, Prinzmetal angina, cardiomegaly (without heart failure), vasomotor rhinitis, occlusion yuzionnye peripheral vascular disease, diabetes, deficiency sucrase / isomaltase, fructose intolerance, glucose-galactose malabsorption, metabolic acidosis (including diabetic ketoacidosis), bronchial asthma, susceptibility to bronchospastic reactions, chronic obstructive pulmonary disease (including a history ), pheochromocytoma (without the simultaneous use of alpha blockers), spastic colitis, simultaneous with antipsychotics and anxiolytics (chlorpromazine and trioxazine et al.), monoamine oxidase inhibitors, lactation, age under 18 years (effectiveness and safety have been established).
Liver and / or kidney failure, hyperthyroidism, myasthenia gravis, chronic heart failure FC I-II, pheochromocytoma, psoriasis, pregnancy, a history of allergic reactions, Raynaud’s syndrome, old age.
40 mg
Arterial hypertension, angina, unstable angina, sinus tachycardia (including hyperthyroidism), supraventricular tachycardia, atrial tachyarrhythmia, supraventricular and ventricular extrasystoles, myocardial infarction (systolic blood pressure – 100 mm Hg.), Pheochromocytoma, essential tremor, migraine (prevention of attacks), as an adjunct in the treatment of hyperthyroidism and thyrotoxic crisis (intolerance thyreostatics medicaments), simpatoad renalovye crises against the backdrop of diencephalic syndrome.
Interaction with other drugs
Propranolol antihypertensive effect is enhanced when combined with diuretics, reserpine, hydralazine, and other antihypertensive agents, as well as ethanol.
The antihypertensive effect of weakening the non-steroidal anti-inflammatory drugs (sodium retention and blockage of prostaglandin synthesis by the kidneys), estrogens (sodium retention) and monoamine oxidase 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 steps and probability of lowering blood pressure.
Changes effectiveness of insulin and of oral hypoglycemic drugs, masking the symptoms of developing hypoglycemia (tachycardia, hypertension).
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 atrioventri-acous- blockade, cardiac arrest and heart failure.
The simultaneous use of propranolol and nifedipine may lead to a significant reduction in blood pressure.
Prolongs the action of non-depolarizing muscle relaxants and anticoagulant effect of warfarin.
Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedatives and hypnotics drugs enhance central nervous system depression.
Not recommended simultaneous application with inhibitors of monoamine oxidase because of the considerable amplification of antihypertensive action, break in treatment between taking monoamine oxidase 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.
Symptoms: bradycardia, dizziness or fainting, marked reduction in 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 – intravenously administered 1 – 2 mg atropine, epinephrine, low efficiency carried setting temporary pacemaker; with ventricular arrhythmia – lidocaine (IA class of drugs does not apply); with hypotension – the patient must be in the Trendelenburg position. If there are no signs of pulmonary edema, plasma-substituting solutions are administered intravenously, after failure – epinephrine, dopamine, dobutamine; in convulsions – intravenous diazepam; inhalation with bronchospasm or parenterally – beta-agonists.
pharmachologic effect
Pharmacological group:
Cardiovascular agents.
Non-selective beta-blocker. It possesses antianginal, hypotensive and antiarrhythmic effect. Non-selective beta-adrenoceptor blocking (75% and 25% beta1- beta2-adrenoceptor), catecholamines reduces stimulated formation of cyclic AMP from ATP, thereby reduces intracellular calcium intake has a negative chronotropic, dromo-, BATM and inotropic effects (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 blood vessels, reduction in activity of the renin-angiotensin system (has a value in patients with initial hypersecretion renin) baroreceptor sensitivity of the aortic arch (not going to increase their activity in response to a decrease in blood pressure) and the influence the central nervous system. The antihypertensive effect is stabilized by the end of 2 weeks of a course assignment.
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, increasing the content of cyclic AMP, 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.
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 epinephrine, 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.
Quickly and adequately (90%) is absorbed by ingestion and relatively rapidly excreted from the body. Bioavailability after after ingestion – 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. Metabolized 3 ways – aromatic hydroxylation, N-dealkylation and glyukuronirovaniya through the liver, including involving cytochrome isoenzymes CYP2D6, CYP1A2, CYP2C19.
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 plasma proteins – 90-95%. The volume of distribution – 3-5 l / kg.
Enters the bile into the intestine and is reabsorbed deglyukuroniziruetsya. The half-life – 3-5 h, against a course of administration may be extended to 12 hours excreted by the kidneys -. 90%, in an unmodified form – less than 1%. It is not removed by hemodialysis.
Pharmacokinetics in elderly patients, patients with impaired renal and hepatic function: due to hypoalbuminemia (or age-induced liver disease or kidney disease) significantly increases the concentration of drug in blood plasma, which could cause amplification of the pharmacological effects of the drug. Changes in the metabolic activity of the drug in elderly and old age are also caused by the state of the liver microsomal system and reduced activity of cytochrome P450 – dependent monooxygenase oxidation in hepatocytes, which contributes to a longer maintenance of high concentrations of propranolol in the tissues. Purpose of such patients the drug carried with the selection of a smaller individual dose.
Pregnancy and breast-feeding
Use during pregnancy is possible only if the potential benefit to the mother outweighs the potential risk to the fetus. If necessary, take during pregnancy – a careful monitoring of the fetus, for 48-72 hours before delivery – should be abolished.
Propranolol is secreted in breast milk, so if you need to use the drug Inderal should stop breastfeeding.
Conditions of supply of pharmacies
On prescription.
side effects
With the cardiovascular system: sinus bradycardia, atrioventricular block, heart failure, palpitations, conduction disturbances infarction, arrhythmias, blood pressure, orthostatic hypotension, chest pain, peripheral artery spasm, cold extremities.
On the part of the digestive tract: dryness of the oral mucosa, nausea, vomiting, diarrhea, constipation, epigastric pain, impaired liver function, change in taste, mesenteric thrombosis, ischemic colitis.
From the nervous system: headache, insomnia, “nightmarish” dream, asthenic syndrome, emotional lability, decreased ability to rapid mental and motor reactions, agitation, depression, paresthesia, fatigue, weakness, dizziness, drowsiness, confusion, or momentary loss of memory, hallucinations, tremors, catatonia.
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, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme.
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 electrocardiogram.
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 beats per minute), hypotension (systolic blood pressure less than 100 mm Hg. V.) Atriventrikulyarnoy blockade bronchospasm, ventricular arrhythmias, severe liver dysfunction and / or kidney disease, reduce dose or stop treatment.
It should teach the patient the method of calculation of heart rate and the need to instruct the medical consultation at a heart rate less than 50 beats per minute.
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) must apply cardiac glycosides and / or diuretics.
Treatment of coronary heart disease and resistant hypertension should be long – receiving Inderal is possible within a few years.
Discontinue therapy drug Inderal should be gradually, under the supervision of a physician: abrupt withdrawal can dramatically enhance myocardial ischemia, angina potentiate worsen exercise capacity.
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.
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.
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 bradycardia and hypotension.
The treatment of propranolol should be avoided intravenous verapamil, diltiazem.
Carefully apply together with psychotropic drugs, e.g., inhibitors of monoamine oxidase, with 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 myocardial function depression and hypotension).
The “smoking” 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 catechu-lamins, normetanephrine and vanilinmindalnoy acid; titers of antinuclear antibodies.
During treatment, avoid the use of natural licorice; food rich in protein, can increase bioavailability.
Effects on ability to drive vehicles and management mechanisms.
During the period of treatment must be careful when driving vehicles and activities potentially hazardous activities that require high concentration and psychomotor speed reactions.
Storage conditions
In a dry, dark place at a temperature not higher than 25 ° C.
Dosing and Administration
Inderal is taken orally before meals with a little liquid.
When hypertension: 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.
При стенокардии, нарушениях сердечного ритма: в начальной дозе 20 мг 3 раза в сутки, затем дозу увеличивают до 80 – 120 мг за 2 – 3 приема. Максимальная суточная доза – 240 мг.
Для профилактики мигрени, а также при эссенциальном треморе: в начальной дозе 40 мг 2 – 3 раза в сутки, при необходимости дозу постепенно увеличивают до 160 мг/сут.
При нарушении функции печени необходимо снижение дозы препарата.
При нарушенной функции почек необходимо снизить первоначальную дозу или увеличить интервал между приемами препарата.
Профилактика повторного инфаркта миокарда: терапию начинать между 5-ым и 21-ым днем после перенесенного инфаркта миокарда в дозе 40 мг 4 раза в сутки, в течение 2 – 3 дней. Затем в дозе 80 мг 2 раза в сутки.
При феохромоцитоме: применять только с блокаторами альфа-адренорецепторов.
Перед операцией назначают 60 мг в сутки, в течение 3 дней.
Appearance may differ from that depicted in the picture. There are contraindications. You need to read the manual or consult with a specialist

Additional information

Weight0.100 kg

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