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Active Ingredient: Propranolol.

Other names for this medication:
N-propranolol.

Pharmacological action of the drug
Hypotensive, antianginal, antiarrhythmic, uterotonizing.
Blocks beta1 and beta2-adrenergic receptors, has a membrane-stabilizing effect. It reduces the heart rate, reduces the force of the heart and the need for myocardium in oxygen. Reduces cardiac output, renin secretion, arterial pressure, renal blood flow and glomerular filtration rate. After taking a single dose, the hypotensive effect lasts for 20-24 hours. With prolonged use reduces venous return, has a cardioprotective effect.
In patients with moderate form of hypertension – reduces the likelihood of developing IHD and cerebral strokes. With IHD reduces the frequency of seizures, increases the tolerance of physical exertion, reduces the need for nitroglycerin. It is most effective in patients of young age (under 40 years) with hyperdynamic type of circulation and with increased content of renin.
Increases the tone of the bronchi and contractility of the uterus (reduces bleeding during labor and in the postoperative period), increases secretory and motor activity of the gastrointestinal tract. It inhibits platelet aggregation and activates fibrinolysis. Inhibits lipolysis in adipose tissue, preventing the increase in the level of free fatty acids (the concentration of triglycerides in the plasma and the coefficient of atherogenity increase.)
Suppresses glycogenolysis, secretion of glucagon and insulin, the conversion of thyroxine to triiodothyronine .It reduces intraocular pressure, reduces the secretion of watery moisture. and almost completely absorbed from the digestive tract.It is almost completely associated with plasma proteins.Conducts in lung tissue, brain, kidneys, heart, passes through the parade succinic barrier, enters the breast milk. Excreted kidneys as metabolites.

Indications for prescription
Arterial hypertension, angina pectoris, sinus tachycardia (including hyperthyroidism), supraventricular tachycardia, tachysystolic atrial fibrillation, supraventricular and ventricular extrasystole, hypertrophic cardiomyopathy, myocardial infarction, mitral valve prolapse, subaortic stenosis, sympathoadrenal crisis in patients with diencephalic syndrome, neurocirculatory dystonia, portal hypertension, essential tremor, panic attacks, aggressive behavior, migraine (prophylaxis), ancillary treatment and pheochromocytoma (only in association with alpha-blockers), thyrotoxicosis (including preoperative) thyrotoxic crisis, primary uterine inertia, menopausal vasomotor symptoms of withdrawal syndrome; treatment of akathisia caused by neuroleptics.

Contraindications
Hypersensitivity, AV blockade of II-III degree, sinoatrial block, bradycardia (less than 55 bpm), sinus node weakness syndrome, arterial hypotension, acute and severe chronic heart failure, Prinzmetal angina, cardiogenic shock, obliterating vascular diseases, bronchial asthma.
For the duration of treatment, breastfeeding should be discontinued.

➡Restrictions on the use:
☞Chronic bronchitis,
☞emphysema,
☞diabetes mellitus,
☞hypoglycemia,
☞acidosis,
☞impaired liver and kidney function,
☞psoriasis,
☞spastic colitis,
☞myasthenia gravis,
☞elderly age.

Side effects of the drug
➡From the cardiovascular system and blood (hematopoiesis, hemostasis):
☛bradycardia,
☛heart failure,
☛AV blockade,
☛hypotension,
☛violation of peripheral circulation,
☛thrombocytopenic purpura,
☛leukopenia,
☛agranulocytosis.

Interactions
Strengthens (mutually) the negative influence of verapamil and diltiazem on the myocardium, prolongs the action of nondepolarizing muscle relaxants, inhibits the excretion of lidocaine. Weaken the hypotensive effect of NSAIDs, glucocorticoids, estrogens, cocaine; strengthen – nitrates and other antihypertensive drugs. Heparin, antacids lower the level in the plasma; cimetidine and phenothiazines – increase. It is not recommended simultaneous administration with MAO inhibitors. Slows the metabolism of theophylline and increases its concentration in the blood plasma.

Method of application
Inside, squeezed with liquid or semi-liquid food (water, juice, apple puree, pudding), adults: with arterial hypertension – the initial dose – 80 mg twice a day, maintaining a dose of 160-320 mg. Prolonged forms: 80 mg once a day, if necessary up to 120-160 mg once, under the control of blood pressure. At arrhythmias – 10-30 mg 3-4 times a day, with subaortal stenosis – 20-40 mg 3-4 times a day.
With portal hypertension, angina, migraine, excitation, tremor, the initial dose of 40 mg 2-3 times a day, supporting – 160, 120-240, 80-160, 80-120, 80-160 mg / day, respectively. When pheochromocytoma – 30-60 mg / day for 3 days (before surgery). With myocardial infarction – from 5 to 21 days after a heart attack 40 mg 4 times a day for 2-3 days, then – 80 mg 2 times a day.
For the stimulation of labor – 20 mg every 30 minutes 4-6 times (80-120 mg / day), for the prevention of postpartum bleeding – 20 mg 3 times a day for 3-5 days. Children: Inside, the initial dose: 0.5-1 mg / kg / day, supporting – 2-4 mg / kg / day in 2 divided doses.

An overdose of a medicine
➡Symptoms:
➲dizziness,
➲bradycardia,
➲arrhythmia,
➲heart failure,
➲hypotension,
➲collapse,
➲difficulty breathing,
➲acrocyanosis,
➲convulsions.

➡Treatment: gastric lavage and the appointment of adsorptive agents, symptomatic therapy: atropine, beta-adrenomimetiki (isoprenaline, isadrin), sedatives (diazepam, lorazepam), cardiotonic (dobutamine, dopamine, epinephrine) drugs, vasopressor drugs, glucagon, etc .; it is possible to carry out transvenous stimulation.
Hemodialysis is ineffective.

Other recommendations
Treatment should be carried out under the supervision of a doctor. Reduces compensatory cardiovascular reactions in response to the use of general anesthetics. Intravenous introduction to children is not recommended. In elderly patients, the risk of CNS side effects is increased. When a violation of the liver is recommended to reduce doses. Can mask symptoms of hypoglycemia (tachycardia) in diabetic patients taking insulin and other hypoglycemic drugs. For the duration of treatment, it is recommended to exclude the use of alcoholic beverages. With caution apply during work drivers of vehicles and people whose profession is associated with increased concentration of attention. Stop the treatment gradually, for about 2 weeks. During the treatment, it is possible to change the test results when carrying out laboratory tests (increased levels of urea, transaminases, phosphatases, LDH).

Storage method
List B. In a dry, the dark place at a temperature of no higher than 25 ° C.

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