Beta-Prograne - (Propranolol)
Beta-prograne and Half Beta-prograne prolonged-release capsules contain the active ingredient propranolol hydrochloride, which is a type of medicine called a beta-blocker. Propranolol is also available without a brand name, ie as the generic medicine.
Pharmacist - M.B.A. (Public Health) D.I.C.
Beta-Prograne - (Propranolol)
What is it used for? High blood pressure (…
What is it used for?
- High blood pressure (hypertension).
- Angina pectoris (as a regular long-term treatment to help prevent attacks).
- Tremor without underlying cause (essential tremor).
- To help relieve symptoms of an overactive thyroid gland (thyrotoxicosis), such as a rapid heartbeat, palpitations and tremor.
- Anxiety (short-term use to relieve symptoms such as racing pulse, sweating and tremor).
- Preventing bleeding from varicose veins in the foodpipe (oesophageal varices) that occur due to high blood pressure in the vein taking blood from the gut to the liver (portal hypertension) - usually a result of liver cirrhosis.
- Preventing migraines (this medicine is taken as a regular treatment to prevent migraines; it will not relieve an attack once it has started).
How does it work?
- Beta-prograne and Half Beta-prograne prolonged-release capsules contain the active ingredient propranolol hydrochloride, which is a type of medicine called a beta-blocker. Propranolol is also available without a brand name, ie as the generic medicine.
- Beta-blockers work by blocking beta receptors that are found in various parts of the body. Blocking beta receptors prevents the action of two chemicals, called noradrenaline and adrenaline, which are produced naturally by the body. These are often referred to as the 'fight or flight' chemicals, because they are responsible for the body's reaction to stressful situations.
- Beta receptors are found in the heart. When they are blocked by propranolol the heart is made to beat more slowly and with less force. This reduces the pressure at which the blood is pumped out of the heart and around the body. This in turn reduces blood pressure, which means that propranolol can be used to treat high blood pressure. It also reduces the energy used by the heart to pump blood around the body, and so reduces the heart's need for oxygen, which means it can also be used in the management of angina.
- Angina is chest pain that occurs because the heart does not get enough oxygen to meet demand, such as when doing exercise. Propranolol reduces the workload of the heart and so decreases its demand for oxygen. This helps to prevent attacks of angina.
- In addition to these heart related uses, propranolol can also be used to control symptoms that are associated with anxiety or an overactive thyroid gland (thyrotoxicosis), such as a racing pulse, sweating and tremor. This is because it blocks the effects of adrenaline.
- Propranolol is also used to prevent migraine, although it is not fully understood how propranolol works in this area.
How do I take it?
- Beta-prograne and Half Beta-prograne are long-acting forms of propranolol. This means they only need to be taken once a day. The dose prescribed depends on the condition being treated. It is important to follow the instructions given by your doctor. These will be printed on the dispensing label your pharmacist has put on the packet of medicine.
- The capsules should be swallowed whole with a drink of water. They should not be opened, chewed or crushed, as this would damage the prolonged-release action.
- The capsules can be taken either with or without food.
- It is important that you don't suddenly stop taking this medicine unless your doctor tells you to.
This medicine may cause fatigue and dizziness. You should take care when performing potentially hazardous activities, such as driving or operating machinery, until you know how this medicine affects you and are sure you can perform such activities safely.
You should not stop taking this medicine suddenly, particularly if you have ischaemic heart disease (inadequate flow of blood to the heart, eg angina). When treatment with this medicine is stopped it should be done gradually, usually over one to two weeks, following the instructions given by your doctor.
If you go into hospital or to the dentist to have an operation you should tell the person treating you that you are taking this medicine. This is because your blood pressure may fall too low if you are given certain types of anaesthetics while taking this medicine.
Use with caution in
- Elderly people.
- Decreased kidney function.
- Decreased liver function.
- Heart failure.
- People with slowed conduction of electrical messages between the chambers of the heart (1st degree heart block).
- People with poor blood circulation in the arteries of the extremities, eg hands and feet (avoid if problems are severe -– see below)
- People with high pressure in the vein taking blood from the gut to the liver (portal hypertension).
- People with advanced (decompensated) liver cirrhosis.
- Diabetes (this medicine may mask the symptoms of low blood sugar, such as increased heart rate and tremor, and the dose of your diabetes medicine may need adjusting).
- People with a history of sudden drops in blood sugar levels (hypoglycaemia).
- Abnormal muscle weakness (myasthenia gravis).
- People with a history of allergies (beta-blockers may increase sensitivity to allergens and result in more serious allergic reactions; they may also reduce the response to adrenaline used to treat anaphylactic shock).
Not to be used in
- History of asthma, wheezing or any other breathing difficulties.
- Uncontrolled heart failure.
- Failure of the heart to maintain adequate circulation of blood (cardiogenic shock).
- A problem common in the elderly, related to poor control of the working of the heart (sick sinus syndrome).
- People with a serious defect in the heart's electrical message pathways (2nd or 3rd degree heart block), unless an artificial pacemaker is fitted.
- People with a very slow heart rate.
- A severe form of angina pectoris, not caused by exertion (Prinzmetal's angina).
- People with low blood pressure (hypotension).
- Severe conditions involving poor blood circulation in the arteries of the extremities, eg hands and feet (peripheral arterial disorders such as Raynaud's syndrome or intermittent claudication).
- People with an increase in the acidity of the blood (metabolic acidosis).
- Untreated tumour of the adrenal gland (phaeochromocytoma). If you are being treated for phaeochromocytoma you will be given another medicine called an alpha-blocker in combination with this one.
- This medicine is not recommended for children.
- This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
- Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- The manufacturer states that this medicine should not be used during pregnancy unless considered essential by your doctor. Beta-blockers reduce blood flow to the placenta, which could increase the chance of premature delivery or death of the foetus. They may also slow the baby's heartbeat, cause its blood sugar to drop, or restrict its growth in the womb. If you think you could be pregnant while taking this medicine, or want to try for a baby, it is important to seek medical advice from your doctor. It is important that you don't stop taking this medicine suddenly.
- This medicine may pass into breast milk. As this could potentially cause the baby's heart rate to slow down or its blood sugar to fall, it is recommended that this medicine is not used by breastfeeding mothers. Seek medical advice from your doctor.
- This medicine should be swallowed whole, not chewed.
- Do not stop taking this medication except on your doctor's advice.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
Common (affect between 1 in 10 and 1 in 100 people)
- Slower than normal heart beat (bradycardia).
- Cold extremities, eg hands and feet.
- Sleep disturbances.
- Narrowing of the blood vessels in the hands leading to periods of white, painful hands (Raynaud's phenomenon).
Uncommon (affect between 1 in 100 and 1 in 1000 people)
- Disturbances of the gut such as diarrhoea, nausea, vomiting.
Rare (affect between 1 in 1000 and 1 in 10,000 people)
- A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
- Deterioration of heart failure.
- Blockade of the electrical pathways that control the pumping action of the heart (heart block).
- Decrease in the number of platelets in the blood (thrombocytopenia).
- Changes in mood.
- Memory loss.
- Hair loss (alopecia).
- Dry eyes.
- Visual disturbances.
- Pins and needles sensations.
- Breathing difficulties due to a narrowing of the airways (bronchospasm).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
Propranolol is likely to have an additive effect with other medicines that decrease blood pressure, particularly medicines that are used to treat high blood pressure (antihypertensives). This may cause dizziness, which can usually be relieved by lying down until the symptoms pass. If you feel dizzy while taking this medicine in combination with other medicines that can lower blood pressure you should let your doctor know, as your doses may need adjusting. Other medicines that decrease blood pressure include the following:
- ACE inhibitors, eg enalapril
- alpha-blockers such as prazosin
- angiotensin II receptor antagonists such as losartan
- antipsychotics such as chlorpromazine
- benzodiazepines, eg temazepam, diazepam
- other beta-blockers such as atenolol
- calcium channel blockers such as verapamil, nifedipine. (If propranolol is taken with calcium channel blockers such as verapamil, nifedipine or diltiazem, there may also be an increased risk of slow heart rate and heart failure. Verapamil must not be given as an injection into a vein (intravenously) to people being treated with propranolol.)
- clonidine (If propranolol is taken in combination with clonidine there is also a risk of a rebound increase in blood pressure if the clonidine is suddenly stopped. If you are taking both these medicines it is important to keep taking both of them unless otherwise directed by your doctor. When stopping treatment, the propranolol should be stopped several days before slowly stopping the clonidine.)
- diuretics, eg furosemide, bendroflumethiazide
- dopamine agonists, eg bromocriptine, apomorphine
- MAOI antidepressants, eg phenelzine
- nitrates, eg glyceryl trinitrate
This medicine may reduce the blood sugar lowering effect of some medicines used to treat diabetes. People with diabetes should carefully monitor their blood sugar while taking this medicine, as propranolol can also mask some of the signs of low blood sugar, such as increased heart rate and tremor.
There may be an increased risk of slow heart rate and heart block if propranolol is used in combination with the following medicines:
- medicines for irregular heartbeats (anti-arrhythmics), eg amiodarone, flecainide, quinidine
- verapamil (also see above).
- There may be an increased risk of coldness, numbness or tingling of the hands and feet if ergot derivatives such as ergotamine or methysergide (used to treat migraines) are taken in combination with propranolol.
The following medicines may reduce the blood pressure lowering effect of this medicine:
- corticosteroids, such as dexamethasone or prednisolone
- oestrogens, such as those in the contraceptive pill
- regular use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac or indomethacin (occasional painkilling doses are unlikely to have a significant effect).
Propranolol can increase the blood levels of the following medicines and your doctor may need to prescribe a lower dose if you take either of these with propranolol:
- chlorpromazine (chlorpromazine may also increase the blood level and effect of propranolol)
The following medicines may increase the blood level of propranolol and could increase the chance of experiencing side effects:
- The antibiotic rifampicin may increase the breakdown of propranolol in the body and could make it less effective.
If you have any more questions please ask your Pharmacist.
Remember to keep all medicines out of reach of children
Please Note: We have made every effort to ensure that the content of this information sheet is correct at time of publish, but remember that information about drugs may change. This sheet does not list all the uses and side-effects associated with this drug. For full details please see the drug information leaflet which comes with your medicine. Your doctor will assess your medical circumstances and draw your attention to any information or side-effects which may be relevant in your particular case.