Indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.

INDERAL XL is not indicated for the treatment of hypertensive emergencies.

Following abrupt discontinuation of therapy with beta-blockers, exacerbations of angina pectoris and myocardial infarction have occurred. When discontinuing chronically administered INDERAL XL, particularly in patients with ischemic heart disease, gradually reduce the dose over a period of 1-2 weeks. If angina markedly worsens or acute coronary insufficiency develops, promptly resume therapy, at least temporarily and take other measures appropriate for the management of unstable angina. 

Bradycardia, including sinus pause, heart block, and cardiac arrest have occurred with the use of INDERAL XL. Patients with first-degree atrioventricular block, sinus node dysfunction, or conduction disorders (including Wolff-Parkinson-White) may be at increased risk.

Beta-blockers, like INDERAL XL, can cause depression of myocardial contractility and may precipitate heart failure and cardiogenic shock.

The exposure to propranolol is increased in patients with renal or hepatic impairment. Initiate INDERAL XL therapy in patients with impaired renal or hepatic function at the lowest dose (80 mg) once daily and monitor patients for marked bradycardia and hypotension.

INDERAL XL may mask clinical signs of hyperthyroidism, such as tachycardia.

INDERAL XL is contraindicated in patients with:

• Cardiogenic shock and decompensated heart failure
• Sinus bradycardia, sick sinus syndrome, and greater than first-degree block unless a permanent pacemaker is in place
• Bronchial asthma

Beta adrenergic blocker-treated patients treated with epinephrine for a severe anaphylactic reaction may be less responsive to the typical doses of epinephrine. In these patients, consider other medications (e.g., intravenous fluids, glucagon).

Warfarin concentrations are increased when administered with propranolol.

Co-administration of propranolol increases the plasma concentrations of propafenone.

CYP2D6, CYP1A2 and CYP2C19 Inhibitors: CYP2D6 inhibitors (e.g. bupropion, fluoxetine, paroxetine, quinidine), CYP1A2 inhibitors (e.g., ciprofloxacin, enoxamine, fluvoxamine) and CYP2C19 inhibitors (e.g., fluconazole, fluvoxamine, ticlopidine) increase exposure to propranolol when co-administered with INDERAL XL.

CYP1A2 and CYP2C19 Inducers: CYP1A2 inducers (e.g., phenytoin, montelukast, smoking) and CYP2C19 inducers (e.g. rifampin) decrease the plasma levels of propranolol resulting in a loss of efficacy.

Co-administered cholestyramine or colestipol significantly reduces the plasma concentrations of co administered propranolol which may result in loss of efficacy.

Beta-blockers may antagonize the antihypertensive effects of clonidine, and rebound hypertension may result if clonidine is withdrawn abruptly. If clonidine and a beta-blocker are co-administered, withdraw the beta-blocker several days before the withdrawal of clonidine.

Co-administration of beta-blockers with alpha-blocker (e.g., prazosin) has been associated with prolongation of first dose hypotension and syncope.

Propranolol may reduce sensitivity to dobutamine stress echocardiography in patients undergoing evaluation for myocardial ischemia.

The hypotensive effect of MAO inhibitors or tricyclic antidepressants may be exacerbated when administered with beta-blockers.

Nonsteroidal anti-inflammatory drugs (NSAIDS) may attenuate the antihypertensive effect of beta adrenoreceptor blocking agents.

Intrauterine growth retardation, small placentas, and congenital anomalies have been reported for neonates whose mothers received propranolol HCl during pregnancy.

Propranolol is excreted in human milk.

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• Use in patients under the age of 18. GoToSource

• Psychogenic polydipsia and water intoxication. GoToSource

• Neuroleptic-induced akathisia. GoToSource

• Aggression in patients with brain injuries. GoToSource

• Post-traumatic stress disorder. GoToSource

• Glaucoma. GoToSource

• Tension headache. GoToSource

• Alcohol withdrawal symptoms. GoToSource

• Hyperthyroidism. GoToSource

• Slow progression of aortic dilation in marfan syndrome. GoToSource

• Fibromyalgia syndrome and temporomandibular disorder. GoToSource

• Chronic broca’s aphasia with anomia. GoToSource

• Central serous chorioretinopathy. GoToSource

• Cholinergic urticaria. GoToSource

• Infancy hemangiomas. GoToSource

• Cocaine withdrawal symptoms. GoToSource

• Retinopathy of prematurity. GoToSource

• Postural tachycardia syndrome. GoToSource

• Performance anxiety. GoToSource

• Severely burned pediatric patients. GoToSource

Stevens-johnson syndrome (severe skin reaction). GoToSource

Cardiorespiratory arrest in patients with thyroid storm. GoToSource

Bronchospasm (muscles lining the airways of lungs constrict or tighten). GoToSource

Sclerosing peritonitis (inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs). GoToSource

Bradycardia (slow heart rate) and hypotension (low blood pressure). GoToSource

Fetal death. GoToSource

Depression, impairment of memory function and impotence. GoToSource

Psoriasis. GoToSource

Psychosis. GoToSource

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