propranolol (Inderal®)
Beta adrenergic blocker, Antidysrhythmic (Class II)
Propranolol is a nonselective beta adrenergic blocker that inhibits chronotropic, inotropic and vasodilatory response to beta adrenergic stimulation. It slows the sinus rate, depresses AV conduction, decreases cardiac output, and reduces blood pressure.
In addition, propranolol decreases myocardial oxygen demand, and reduces the risk of sudden death in patients with AMI
15-60 minutes
6-12 hours
Angina pectoris
Decrease myocardial workload during MI
Hypertension
Sinus bradycardias
Second or third degree AV block
Asthma
CHF
COPD
Bradycardias
Heart blocks
Bronchospasm
Dyspnea
Anxiety
Hallucinations
Dizziness
Angina pectoris
Palpitations
Syncope
Nausea and vomiting
Visual disturbances
Catecholamine-depleting drugs may potentiate hypotension
Sympathomimetic effects may be antagonized
Calcium channel blockers may worsen AV conduction abnormalities
Succinylcholine effects may be enhanced
Isoproterenol, norepinephrine, dopamine, and dobutamine may reverse effects of propranolol.
Epinephrine may cause a rise in blood pressure, a decrease in heart rate, and severe vasoconstriction
Hypoglycemic effects of insulin may be prolonged
1 mg/ml vials
IV: 1-3 mg over 2-5 minutes (not to exceed 1 mg/min); can be repeated in 2-5 minutes (to a total dose of 0.1 mg/kg)
IV: 0.01 – 0.05 mg/kg/dose (diluted) slow push over 10 minutes every 5 minutes as needed (max 3 mg)
Pregnancy Safety: Category C
May mask the signs & symptoms of hypovolemia
Propranolol may produce life-threatening side effects; closely monitor patient during administration.
Use with caution in elderly patients
Use with caution in patients with impaired hepatic or renal function
Atropine should be readily available.
Beta 1 selective drugs now available are more commonly used for cardiac emergencies.