Propranolol


Indications.



  • Arterial hypertension.

  • Prophylaxis of exertional angina attacks.

  • Long-term treatment after myocardial infarction.

  • Treatment of certain rhythm disorders: supraventricular (atrial tachycardias, flutters and fibrillations, junctional tachycardias) or ventricular (ventricular extrasystoles, ventricular tachycardias).

  • Cardiovascular manifestations of hyperthyroidism and intolerance to replacement therapy for hypothyroidism.

  • Functional signs of obstructive cardiomyopathy.

  • Basic treatment of migraine and facial pain.

  • Tremors, especially essential.

  • Cardiac functional manifestations of tachycardia and palpitations during transient emotional situations.

  • Prevention of gastrointestinal bleeding from ruptured esophageal varices (primary prevention) and their recurrence (secondary prevention) in patients with cirrhosis: Prevention of a first ruptured oesophageal varice is limited to patients with portal hypertension, in whom l Endoscopic examination reveals oesophageal varices of intermediate or large sizes (stage II or III).


Dosage in migraine.


In the treatment of migraine a dose of 40 mg 3 times a day is indicated.
If tolerated, a 160 mg prolonged-release tablet may be offered.
The treatment should be reassessed 3 months after its start, the time necessary for the treatment to work on the migraine.
The aim is to reduce the number of seizures and to reduce the intensity and duration of a seizure.

Contraindications:



  • Chronic obstructive pulmonary disease and asthma: nonselective beta blockers are strictly contraindicated in asthmatics (even if the asthma is old and not currently symptomatic, whatever the dosage).

  • Heart failure not controlled by treatment.

  • Cardiogenic shock.

  • 2nd and 3rd degree atrioventricular blocks not paired.

  • Prinzmetal's angina pectoris.

  • Sinus disease (including sinoatrial block).

  • Bradycardia (<45-50 beats per minute).

  • Raynaud's phenomenon and peripheral arterial disorders.

  • Untreated pheochromocytoma.

  • Arterial hypotension.

  • Hypersensitivity to propranolol.

  • History of anaphylactic reaction.

  • As part of the primary and secondary prevention of digestive hemorrhages in cirrhotic patients: advanced hepatic failure with hyperbilirubinemia, massive ascites, hepatic encephalopathy.
    Predisposition to hypoglycemia (such as after fasting or in the event of abnormal response to hypoglycaemia).


Since propranolol is excreted in milk, it is not recommended for breastfeeding women.

Particular attention should be paid to newborns whose mother takes beta-blockers, as there is a risk of bradycardia, respiratory distress and hypoglycemia after birth.

Side effects.


Common (1 to 9.9%):



  • General: asthenia.

  • Cardiovascular disorders: bradycardia, cooling of the extremities, Raynaud's syndrome.

  • Central nervous system disorders: insomnia, nightmares.


Uncommon (0.1 to 0.9%):


Digestive disorders: gastralgia, nausea, vomiting, diarrhea.

Rare (0.01 to 0.09%):



  • General: dizziness.

  • hematologic: thrombocytopenia.

  • Cardiovascular disorders: heart failure, slowing of atrioventricular conduction or intensification of existing atrioventricular block, orthostatic hypotension which may be associated with syncope, worsening of existing intermittent claudication.

  • Central nervous system disorders: hallucinations, psychosis, mood changes, confusion.
    Incapacity.

  • Skin system: purpura, alopecia, psoriasiform rashes, exacerbation of psoriasis, skin rash.

  • Neurological disorders: paresthesias.

  • Vision: dry eye, visual disturbance.

  • Respiratory system: Bronchospasm can occur in patients with asthma or a history of asthma, sometimes with fatal outcome.


Very rare (<0.01%):



  • Endocrine system: hypoglycemia in at-risk subjects.

  • At the biological level: in rare cases, the appearance of antinuclear antibodies has been observed, accompanied only exceptionally by clinical manifestations such as lupus syndrome and resulting in discontinuation of treatment.

  • Nervous system: Isolated cases of myasthenia gravis or exacerbation have been reported.


Unknown frequency, especially in children and adolescents:


Hypoglycemia and seizures associated with hypoglycemia.

Overdose.


Bradycardia, arterial hypotension.
Treatment is based on glucagon (10 mg as a slow bolus then 1 to 10 mg / h), especially in newborns with hypoglycaemia (0.3 mg / kg as a slow injection).
If this treatment is insufficient, isoprenin or dobutamine will be used.