Propranolol Hydrochloride

Patients on long-term propranolol therapy may experience uncontrolled hypertension if administered epinephrine due to unopposed alpha-receptor stimulation. Not indicated for propranolol overdose.

Reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers like propranolol.

Beta-blockers may antagonize clonidine's antihypertensive effects and rebound hypertension may result if clonidine is withdrawn abruptly. Withdraw beta-blocker several days before clonidine withdrawal.

Both digitalis glycosides and propranolol slow atrioventricular conduction and decrease heart rate, increasing risk of bradycardia.

Coadministration in cardiac disease patients associated with bradycardia, hypotension, high degree heart block, and heart failure.

Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects and has been associated with severe bradycardia, asystole and heart failure when administered with propranolol.

Propranolol reduces lidocaine clearance and lidocaine toxicity has been reported following coadministration.

Co-administration of propranolol with alpha-blocker prazosin has been associated with prolongation of first dose hypotension and syncope.

AUC of propafenone is increased by more than 200% by coadministration of propranolol.

CYP2D6 inhibitor that reduces metabolism of propranolol, leading to 2-3 fold increased blood concentration and greater beta-blockade.

Catecholamine-depleting effect may cause excessive reduction of sympathetic activity resulting in hypotension, bradycardia, vertigo, syncope, or orthostatic hypotension.

Hepatic enzyme inducer that decreases blood levels of propranolol by increasing hepatic metabolism.

CYP2D6 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP2D6 inhibitor that increases propranolol exposure. Monitor for bradycardia and hypotension.

Co-administered cholestyramine significantly reduces propranolol plasma concentrations, resulting in loss of efficacy.

CYP2D6, CYP1A2, and CYP2C19 inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP1A2 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

Co-administered colestipol significantly reduces propranolol plasma concentrations, resulting in loss of efficacy.

Patients on corticosteroids may be at increased risk of hypoglycemia due to loss of counter-regulatory cortisol response; monitor for signs of hypoglycemia.

CYP2D6 inhibitor that may increase blood levels of propranolol.

CYP2D6 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

Propranolol may reduce sensitivity to dobutamine stress echocardiography in patients undergoing myocardial ischemia evaluation.

Postural hypotension reported in patients taking both beta-blockers and doxazosin.

CYP1A2 inhibitor that increases propranolol exposure. Monitor for bradycardia and hypotension.

CYP2C19 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP2D6 and CYP2C19 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP1A2 and CYP2C19 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP1A2 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP1A2 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

ACE inhibitors combined with beta-blockers can cause hypotension, particularly during acute myocardial infarction.

The hypotensive effect of MAO inhibitors may be exacerbated when administered with propranolol. Monitor for postural hypotension.

CYP1A2 inducer that decreases propranolol plasma levels, resulting in loss of efficacy.

Calcium channel blocker that increases propranolol Cmax by 80% and AUC by 47%.

Propranolol increases nifedipine Cmax by 64% and AUC by 79%.

Calcium channel blocker that increases propranolol Cmax by 50% and AUC by 30%.

NSAIDs may attenuate the antihypertensive effect of propranolol. Monitor blood pressure.

CYP2D6 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

Hepatic enzyme inducer that decreases blood levels of propranolol by increasing hepatic metabolism.

Hepatic enzyme inducer that decreases blood levels of propranolol by increasing hepatic metabolism.

Drug Interactions Caution should be exercised when propranolol is administered with drugs that have an effect on CYP2D6, 1A2, or 2C19 metabolic pathways. Coadministration of such drugs with propranolol may lead to clinically relevant drug interactions and changes on its efficacy and/or toxicity (see CLINICAL PHARMACOLOGY: Drug Interactions ). Cardiovascular Drugs Antiarrhythmics Propafenone has negative inotropic and beta-blocking properties that can be additive to those of propranolol.

Hepatic enzyme inducer that decreases blood levels of propranolol by increasing hepatic metabolism.

CYP2D6 and CYP1A2 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP1A2 substrate/inhibitor that may increase propranolol levels; also propranolol increases rizatriptan AUC by 67% and Cmax by 75%.

CYP2C19 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

Postural hypotension reported in patients taking both beta-blockers and terazosin.

CYP1A2 substrate/inhibitor that may increase propranolol levels; also coadministration decreases theophylline oral clearance by 30-52%.

CYP2C19 inhibitor that increases propranolol exposure. Monitor for bradycardia and hypotension.

CYP2C19 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

Warfarin concentrations are increased when administered with propranolol. Monitor prothrombin time accordingly.

CYP1A2 substrate/inhibitor that may increase blood levels and/or toxicity of propranolol.

CYP1A2 substrate/inhibitor that may increase propranolol levels; also propranolol increases zolmitriptan AUC by 56% and Cmax by 37%.

The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.

Benzodiazepines Propranolol can inhibit the metabolism of diazepam, resulting in increased concentrations of diazepam and its metabolites. Diazepam does not alter the pharmacokinetics of propranolol. Benzodiazepines Propranolol can inhibit the metabolism of diazepam, resulting in increased concentrations of diazepam and its metabolites.

Propranolol did not have an effect on the pharmacokinetics of fluvastatin. Propranolol did not have an effect on the pharmacokinetics of fluvastatin. Propranolol did not have an effect on the pharmacokinetics of fluvastatin.

No interactions were observed with either ranitidine or lansoprazole. No interactions were observed with either ranitidine or lansoprazole.

The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.

Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics. Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics. Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics.

Co-administration of metoclopramide with the long-acting propranolol did not have a significant effect on propranolol's pharmacokinetics. Co-administration of metoclopramide with the long-acting propranolol did not have a significant effect on propranolol's pharmacokinetics. Co-administration of metoclopramide with the long-acting propranolol did not have a significant effect on propranolol's pharmacokinetics.

No interaction was observed with omeprazole. No interaction was observed with omeprazole.

The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.

Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics. Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics. Co-administration of propranolol with lovastatin or pravastatin, decreased 18% to 23% the AUC of both, but did not alter their pharmacodynamics.

The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol. The pharmacokinetics of oxazepam, triazolam, lorazepam, and alprazolam are not affected by co-administration of propranolol.