Indirin Special Precautions

Propranolol Hydrochloride (Indirin) as with other beta-blockers: Although contraindicated in uncontrolled heart failure, it may be used in patients whose signs of heart failure have been controlled. Caution must be exercised in patients whose cardiac reserve is poor.
Should not be used in combination with calcium channel blockers with negative inotropic effects (e.g. verapamil, diltiazem), as it can lead to an exaggeration of these effects particularly in patients with impaired ventricular function and/or SA or AV conduction abnormalities. This may result in severe hypotension, bradycardia and cardiac failure. Neither the beta-blocker nor the calcium channel blocker should be administered intravenously within 48 hours of discontinuing the other.
Although contraindicated in severe peripheral arterial circulatory disturbances, it may also aggravate less severe peripheral arterial circulatory disturbances.
Due to its negative effect on conduction time, caution must be exercised if it is given to patients with first degree heart block.
May block/modify the signs and symptoms of the hypoglycemia (especially tachycardia). Propranolol occasionally causes hypoglycemia, even in non-diabetic patients, e.g. neonates, infants, children, elderly patients, patients on hemodialysis or patients suffering from chronic liver disease and patients suffering from overdose. Severe hypoglycemia associated with propranolol has rarely presented with seizures and/or coma in isolated patients. Caution must be exercised in the concurrent use of propranolol and hypoglycemic therapy in diabetic patients. Propranolol may prolong hypoglycemic response to insulin.
May mask the signs of thyrotoxicosis.
Should not be used in untreated phaeochromocytoma. However, in patients with phaeochromocytoma, an alpha-blocker may be given concomitantly.
Will reduce heart rate as a result of its pharmacological action. In the rare instances when a treated patient develops symptoms which may be attributable to a slow heart rate, the dose may be reduced.
May cause a more severe reaction to a variety of allergens, when given to patients with a history of anaphylactic reaction to such allergens. Such patients may be unresponsive to the usual doses of adrenaline used to treat the allergic reactions.
Avoid abrupt withdrawal of beta-blockers. The dosage should be withdrawn gradually over a period of 7-14 days. Patients should be followed during withdrawal especially those with ischaemic heart disease.
When a patient is scheduled for surgery and a decision is made to discontinue beta-blocker therapy, this should be done at least 48 hours prior to the procedure. The risk/benefit of stopping beta blockade should be made for each patient.
Since the half-life may be increased in patients with significant hepatic or renal impairment, caution must be exercised when starting treatment and selecting the initial dose.
Propranolol must be used with caution in patients with decompensated cirrhosis. In patients with portal hypertension, liver function may deteriorate and hepatic encephalopathy may develop. There have been reports suggesting that treatment with propranolol may increase the risk of developing hepatic encephalopathy.
In patients with chronic obstructive pulmonary disease, non-selective beta-blockers such as propranolol may aggravate the obstructive condition. Therefore propranolol should not be used in this condition.
Bronchospasms can usually be reversed by beta2 agonist bronchodilators such as salbutamol. Large doses of beta bronchodilators may be required to overcome the beta blockade produced by propranolol and the dose should be titrated according to the clinical response; both intravenous and inhalational administration should be considered. The use of intravenous aminophylline and/or the use of ipratropium (given by nebuliser) may also be considered. Glucagon (1 to 2 mg given intravenously) has also been reported to produce a bronchodilator effect in asthmatic patients. Oxygen or artificial ventilation may be required in severe cases.
Isolated reports of myasthenia gravis like syndrome or exacerbation of myasthenia gravis have been reported in patients administered with propranolol.
Interfere with laboratory tests: Propranolol has been reported to interfere with the estimation of serum bilirubin by the diazo method and with the determination of catecholamines by methods using fluorescence.
Lactose: This medicine contains lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
Effect on Ability to Drive and Use Machines: Propranolol has no or negligible influence on the ability to drive and use machines. It should be taken into account that occasionally, dizziness or fatigue may occur.