INDICARDIN 10MG 50TAB

Indications

Approved Uses

Hypertension; angina pectoris; cardiac arrhythmias (e.g., rate control in atrial fibrillation/supraventricular tachyarrhythmias); secondary prevention after myocardial infarction; migraine prophylaxis; essential tremor; hypertrophic obstructive cardiomyopathy (hypertrophic subaortic stenosis); pheochromocytoma (adjunct to alpha-blockade).

Off-Label Uses

Common off-label uses include performance anxiety (situational), portal hypertension/variceal bleed prophylaxis, thyrotoxicosis symptom control (adjunct), antipsychotic-induced akathisia, and PTSD-related hyperarousal/nightmares (evidence variable).

Dosage & Administration

Dosing by Condition

Immediate-release oral propranolol typical adult dosing: Hypertension: 40 mg twice daily initially; usual 80-160 mg/day (divided), may increase up to 320 mg/day. Angina: 40 mg 2-3 times daily initially; usual 120-240 mg/day (divided), max ~320 mg/day. Arrhythmias (rate control/SVT): 10-40 mg 3-4 times daily. Migraine prophylaxis: 40 mg twice daily initially; usual 80-160 mg/day (divided). Essential tremor: 40 mg twice daily initially; usual 80-160 mg/day (divided; some patients require higher). Post-MI: commonly 40 mg four times daily for 2-3 days then 80 mg twice daily (or equivalent total daily dose per local protocol).

Initial Dose

40 mg twice daily for hypertension and most indications; 10 mg three times daily for anxiety or elderly patients

Maintenance Dose

80-160 mg/day in divided doses for hypertension; dose varies by indication

Maximum Dose

Hypertension: 320mg/day. Angina: 320mg/day. Essential Tremor: 320mg/day. Migraine Prophylaxis: 240mg/day.

Children's Dosage

Arrhythmias: 0.25-0.5 mg/kg three to four times daily (oral); Hypertension: 0.5-1 mg/kg/day in divided doses, max 4 mg/kg/day. Use under specialist supervision only.

Dose Adjustment Notes

Titrate gradually to effect and tolerability (often every 3-7 days or weekly); use caution and consider lower doses in hepatic impairment; no routine renal dose adjustment, but use caution in severe renal impairment and in the elderly.

How to Take

Swallow tablet with water; may be taken with or without food, but take consistently with respect to meals (food can increase propranolol bioavailability).

Side Effects

Common Side Effects

Fatigue/tiredness, dizziness, bradycardia, hypotension, cold extremities, gastrointestinal upset (nausea/diarrhea), and sleep disturbance/vivid dreams (sometimes nightmares).

Side Effect Frequency

Common (1-10%): fatigue, dizziness, bradycardia, cold extremities, sleep disturbances/nightmares, gastrointestinal upset (nausea, diarrhea/constipation). Uncommon (<1%): hypotension, bronchospasm (especially in asthma/COPD), rash/psoriasiform reactions, depression/sexual dysfunction, AV block/heart failure exacerbation, thrombocytopenia, alopecia.

Safety & Warnings

Contraindications

Contraindicated in bronchial asthma/bronchospasm; cardiogenic shock; overt/uncontrolled heart failure; severe bradycardia; sick sinus syndrome (unless paced); second- or third-degree AV block (unless paced); hypersensitivity to propranolol (and generally avoid in severe peripheral arterial circulatory disorders).

Warnings & Precautions

Key warnings/precautions: avoid abrupt discontinuation (taper); caution/avoid in asthma or significant bronchospastic disease; may mask hypoglycemia and hyperthyroidism signs; caution in diabetes, peripheral vascular disease/Raynaud’s, conduction disease (1st-degree AV block), and heart failure (monitor); perioperative management should be coordinated with anesthesia; hepatic impairment may increase exposure.

Age Restriction

No fixed minimum age in labeling; pediatric use is indication-specific and should be specialist/physician-directed (notably, use for anxiety/performance anxiety is generally not established/approved in children).

Driving Warning

May Cause Drowsiness

Drug Interactions

Drug Interactions

Clinically important interactions include: verapamil/diltiazem (additive bradycardia/AV block/hypotension); digoxin (bradycardia/AV block); clonidine (severe rebound hypertension if clonidine stopped first); insulin/oral hypoglycemics (masks hypoglycemia); other antihypertensives (additive hypotension); NSAIDs (may blunt antihypertensive effect); CYP inhibitors like cimetidine (↑ propranolol) and inducers like rifampin (↓ propranolol); antiarrhythmics (additive negative inotropy/conduction effects); caution with fingolimod (marked bradycardia).

Food Interaction

Food can increase propranolol bioavailability; take consistently with respect to meals (with food may reduce GI upset for some patients).

Special Populations

Pregnancy

Consult Doctor

Children

Arrhythmias: 0.25-0.5 mg/kg three to four times daily (oral); Hypertension: 0.5-1 mg/kg/day in divided doses, max 4 mg/kg/day. Use under specialist supervision only.

Elderly

Start at lower doses (e.g., 10 mg twice daily), titrate slowly, monitor heart rate and blood pressure closely due to increased sensitivity and risk of bradycardia and hypotension

Kidney Impairment

No routine renal dose adjustment is typically required; use caution and monitor in severe renal impairment.

Storage & Patient Advice

Stopping the Medicine

Do not stop abruptly; taper gradually over at least 1-2 weeks (often longer, e.g., up to a few weeks) under medical supervision, especially in ischemic heart disease.

Overdose

Overdose may cause severe bradycardia, hypotension, AV block, cardiogenic shock, bronchospasm, hypoglycemia, seizures, and cardiac arrest; management is emergency supportive care with early decontamination when appropriate, IV fluids/vasopressors, atropine, and IV glucagon as a key antidotal therapy (plus pacing/high-dose insulin therapy per toxicology protocols when refractory).

Patient Counseling

Take exactly as prescribed and at consistent times (and consistently with meals); do not stop abruptly-taper to avoid rebound angina/arrhythmia/MI risk; may cause dizziness/fatigue-use caution driving; check pulse/BP as advised and seek care for very slow pulse, fainting, wheeze/shortness of breath, or swelling; in diabetes, it can mask hypoglycemia warning signs-monitor glucose; inform clinicians before surgery/anesthesia; limit alcohol if it worsens dizziness/hypotension.

Monitoring Requirements

Monitor blood pressure and heart rate (and symptoms of bradycardia/hypotension); consider ECG when used for arrhythmias or in conduction disease; monitor blood glucose more closely in diabetes; monitor for bronchospasm in asthma/COPD risk; assess hepatic function if clinically indicated in hepatic impairment.

Pharmacology

Mechanism of Action

Non-selective beta-adrenergic receptor antagonist (β1 and β2) that decreases heart rate and contractility, reduces cardiac output and blood pressure, and suppresses renin release.

Onset of Action

Onset for immediate-release oral propranolol is typically within 30-60 minutes (peak effect ~1-2 hours); full antihypertensive benefit may take about 1-2 weeks.

Half-Life

Approximately 3-6 hours (commonly cited ~4 hours; may be prolonged up to ~8 hours depending on formulation and patient factors).

Excretion

Primarily renal excretion of metabolites: >90% recovered in urine mainly as metabolites; <1% excreted unchanged (with a smaller fraction via feces/bile).

Product Information

Available Dosage Forms

Tablet, modified-release capsule, oral solution, intravenous injection

Composition per Dose

Each tablet: 10 mg propranolol hydrochloride

Generic Availability

Yes

OTC Alternatives

No OTC alternative

Cv Drug Class

Beta-Blocker

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