Propranolol dosing

Propranolol doses required to relieve adrenergic symptoms vary, but an initial dose of 20 to 40 mg four times daily is effective for most patients (heart rate less than 90 beats/min). Younger or more severely toxic patients may require as much as 240 to 480 mg/day. 

CHLORPROMAZINE, HALOPERIDOL PR0PAN0L0L, TIMOLOL t plasma concentrations and efficacy of both chlorpromazine and propranolol during co-administration Propanolol and chlorpromazine mutually inhibit each other s hepatic metabolism. Haloperidol inhibits CYP2D6-mediated metabolism of propanolol and timolol Watch for toxic effects of chlorpromazine and propranolol doses accordingly... 

No evidence of carcinogenicity has been documented in rats at doses of atenolol up to 300 mg kg day Doses of up to 200 mg kg day have not shown decreased fertility in rats. However, dose related fetal resorptions were noted at doses of greater than 50 mg kg day Chronic propranolol dosing at 100 mg kg to newborn rats resulted in decreased... 

Fill up a glass syringe with the appropriate amount of DESI solvent. For propranolol-dosed tissues 80/20 (v/v) methanol/water solution was delivered to the emitter by a syringe pump at a flow rate of 5 xl/min (see Note 8). Make sure that the syringe contains enough DESI solvent to... 

Cromakalim (137) is a potassium channel activator commonly used as an antihypertensive agent (107). The rationale for the design of cromakalim is based on P-blockers such as propranolol (115) and atenolol (123). Conformational restriction of the propanolamine side chain as observed in the cromakalim chroman nucleus provides compounds with desired antihypertensive activity free of the side effects commonly associated with P-blockers. Enantiomerically pure cromakalim is produced by resolution of the diastereomeric (T)-a-meth5lben2ylcarbamate derivatives. X-ray crystallographic analysis of this diastereomer provides the absolute stereochemistry of cromakalim. Biological activity resides primarily in the (—)-(33, 4R)-enantiomer [94535-50-9] (137) (108). In spontaneously hypertensive rats, the (—)-(33, 4R)-enantiomer, at dosages of 0.3 mg/kg, lowers the systoHc pressure 47%, whereas the (+)-(3R,43)-enantiomer only decreases the systoHc pressure by 14% at a dose of 3.0 mg/kg. 

After po doses, atenolol is rapidly but incompletely absorbed ( 50%) from the GI tract, and 50% is excreted unchanged in the feces. Six to 16% of the plasma concentration is bound to protein. Atenolol undergoes Httie first-pass metaboHsm. Peak plasma concentrations occur in 2—4 h after po doses. The elimination half-hfe of atenolol is 6—7 h. Excretion of absorbed dmg is mainly by the kidneys and elimination can be impaired in patients having renal failure. The adverse effects of atenolol are similar to those seen for propranolol therapy (98,99,108). 

Propranolol (at high doses) has been noted to have quinidine-like activity. 

Dose propranolol carefully in patients with a TIPS procedure because of increased enteral bioavailability... 

P-Blockersa Inhibit AV nodal conduction by slowing AV nodal conduction and prolonging AV nodal refractoriness Esmolol 500 mcg/kg IV over 1 minute Propranolol 0.15 mg/kg IV Metoprolol 2.5-5 mg IV x 2-3 doses Esmolol 50-200 mcg/kg/minute continuous infusion Propranolol 80-240 mg/day Metoprolol 50-200 mg/day ... 

Use of zileuton is uncommon due to the need for dosing four times a day, potential drug interactions, and the potential for hepatotoxicity with the resulting need for frequent monitoring of liver enzymes. In patients started on zileuton, serum alanine aminotransferase concentrations should be monitored before treatment begins, monthly for the first 3 months, every 2 to 3 months for the remainder of the first year, and then periodically thereafter for as long as the patient continues to receive the medication. Zileuton also inhibits the cytochrome P-450 (CYP) mixed function enzyme system and has been shown to decrease the clearance of theophylline, R-warfarin and propranolol.34... 

Because p-blockers decrease blood pressure and heart rate, they should be started at low doses to increase tolerability. Propranolol is hepatically metabolized, and its half-life and pharmacologic effects are prolonged in portal hypertension. A reasonable starting dose of propranolol is 10 mg two to three times daily. 

Adverse Effects The most common adverse effects are gastrointestinal upset, tremor, and polyuria,30 which are dose-related. Nausea, dyspepsia, and diarrhea can be minimized by coadministration with food, use of sustained-release formulations, and giving smaller doses more frequently to reduce the amount of drug in the gastrointestinal tract at a given time. Tremor is present in up to 50% of patients. In addition to the approaches above, low-dose P-blocker therapy such as propranolol 20 to 60 mg/day often reduces the tremor. 

Treat severe or troublesome autonomic signs and symptoms with a non-selective (3-blocker such as propranolol 20 to 40 mg four times daily. Titrate the 3-blocker dose based on signs and symptoms. 

Rizatriptan 5 or 10 mg at onset as regular or orally disintegrating tablet can repeat after 2 hours if needed Optimal dose is 10 mg maximum daily dose is 30 mg onset of effect is similar with standard and orally disintegrating tablets use 5-mg dose (15 ms day max) in patients receiving propranolol... 

Blockers blunt the peripheral autonomic symptoms of arousal (e.g., rapid heart rate, sweating, blushing, and tremor) and are often used to decrease anxiety in performance-related situations. For specific SAD, 10 to 80 mg of propranolol or 25 to 100 mg of atenolol can be taken 1 hour before the performance. A test dose should be taken at home on a day before the performance to be sure adverse effects will not be problematic. 

Propranolol, pindolol, and nadolol have been used for antiaggressive effects, especially in organic aggressive syndrome. If propranolol is used, a 20-mg test dose should be given to assess tolerability. If well tolerated, it can be initiated at 20 mg three times daily. Increments can then be 60 mg/ day every 3 days. Six to 8 weeks may be needed to evaluate response. 

Specific Sociai Anxiety Disorder, Acute Phase Treatment. Different strategies have evolved for treating specific social anxiety disorder versus generalized social anxiety disorder. Less complicated is the management of the specific subtype. Exposure-based psychotherapy is a mainstay of treatment, and as-needed medication doses prior to scheduled performances are also widely used. Preferred agents for performance anxiety are alprazolam or propranolol. 

The beta blocker propranolol (Inderal) has been studied in the treatment of impulsivity and appears to provide a slight benefit to some patients. It can be started at a dose of 10 mg taken three times per day and increased gradually to a maximum of 200mg/day. Side effects of propranolol include depression, fatigue, lowered blood pressure, impotence, and a worsening of symptoms in patients with asthma. 

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