- Control of hypertension;
- Management of angina pectoris;
- Long-term management against re-infarction after recovery from acute myocardial infarction;
- Control of most forms of cardiac dysrhythmias;
- Prophylaxis of migraine;
- Management of essential tremor;
- Relief of situational anxiety and generalised anxiety symptoms, particularly those of somatic type;
- Prophylaxis of upper gastrointestinal bleeding in patients with portal hypertension and oesophageal varices.
- Adjunctive management of thyrotoxicosis and thyrotoxic crisis;
- Management of hypertrophic obstructive cardiomyopathy.
- Management of phaeochromocytoma peri-operatively (with an alphablocker).
POSOLOGY AND METHOD OF ADMINISTRATION
Posology
Adults:
Hypertension
A starting dose of 80 mg twice a day may be increased at weekly intervals according to response. The usual dose range is 160 to 320 mg per day. With concurrent diuretic or other antihypertensive drugs a further reduction of blood pressure is obtained.
Angina, migraine and essential tremor
A starting dose of 40 mg two or three times daily may be increased by the same amount at weekly intervals according to patient response. An adequate response in migraine and essential tremor is usually seen in the range 80 to 160 mg/day and in angina in the range 120 to 240 mg/day.
Situational and generalised anxiety
A dose of 40 mg daily may provide short term relief of acute situational anxiety. Generalised anxiety, requiring longer term therapy, usually responds adequately to 40 mg twice daily which, in individual cases, may be increased to 40 mg three times daily. Treatment should be continued according to response. Patients should be reviewed after 6 to 12 months treatment.
Arrhythmias, anxiety tachycardia, hypertrophic obstructive cardiomyopathy and thyrotoxicosis
A dosage range of 10 to 40 mg three or four times a day usually achieves the required response.
Post myocardial infarction
Treatment should start between days 5 and 21 after myocardial infarction, with an initial dose of 40mg four times a day for 2 or 3 days. In order to improve compliance, the total daily dosage may thereafter be given as 80mg twice a day.
Portal hypertension
Dosage should be titrated to achieve approximately 25% reduction in resting heart rate. Dosing should begin with 40 mg twice daily, increasing to 80 mg twice daily depending on heart rate response. If necessary, the dose may be increased incrementally to a maximum of 160 mg twice daily.
Phaeochromocytoma
(Used only with an alpha-receptor blocking drug).
Pre-operative: 60 mg daily for 3 days is recommended. Non-operable malignant cases: 30 mg daily.
Elderly people
Evidence concerning the relationship between blood level and age is conflicting. Propranolol should be used to treat elderly with caution. It is suggested that treatment should start with the lowest dose. The optimum dose should be individually determined according to clinical response.
Paediatric population
Dysrhythmias, phaeochromocytoma, thyrotoxicosis
Dosage should be individually determined and the following is only a guide:
Oral: 0.25 to 0.5 mg/kg three or four times daily as required.
Migraine
Oral: Under the age of 12: 20 mg two or three times daily.
Over the age of 12: The adult dose.
