Indever 40 - Tablet Propranolol Hydrochloride - 40mg 10 Tablet(s) / Strip ACI Limited Introduction: Indever 40 belongs to a group of medicines called beta-blockers. It helps to decrease anxiety and relieve tremors. It is also used to help prevent migraine, heart-related chest pain (angina), and bleeding in the stomach caused by high blood pressure in the liver (portal hypertension). Indever 40 may also be used to treat high blood pressure and some types of abnormal heartbeat (arrhythmia). The dose will depend on what you are being treated for and how you respond to the medicine. You should always take it as prescribed by the doctor. It should be taken on an empty stomach and... Uses of Indever 40: Hypertension (high blood pressure)Angina (heart-related chest pain)Prevention of migraineAnxietyTremorsArrhythmia Side effects of Indever 40: Arrhythmia (irregular heartbeats)Raynaud phenomenonWeakness How to use Indever 40: Use it as advised by your doctor or check the label for directions before use. Indever 40 is to be taken empty stomach. Avoid Indever 40 with high-fat meals such as olive oil, nuts & seeds (Brazil nuts), dark chocolate, butter and meat. How Indever 40 works: Indever 40 is a beta blocker. It works by affecting the body’s response to nerve impulses, especially in the heart. It slows down your heart rate and makes it easier for the heart to pump blood around the body. It also widens the blood vessels in the body for better blood flow. What if you forget to take Indever 40?: If you miss a dose of Indever 40, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose. Indication: HTN, Cardiac arrhythmias, Myocardial infarction, Angina pectoris, Portal hypertension, Migraine prophylaxis, Phaeochromocytoma, Hyperthyroidism, Essential tremor Administration: Tab: Should be taken on an empty stomach. Take before meals. Cap: May be taken with or without food. Take consistently either always w/ or always w/o meals. Adult Dose: Oral Hypertension As conventional tab or oral soln: Initially, 40-80 mg bid. Usual range: 160-320 mg/day. Max: 640 mg/day. As extended release cap: Initially, 80 mg once daily. Usual range: 120-160 mg once daily. Max: 640 mg/day. Phaeochromocytoma As conventional tab or oral soln: 60 mg/day in divided doses given 3 days pre-op w/ alpha-blocker. If tumour is inoperable, 30 mg/day in divided doses may be given. Myocardial infarction As conventional tab or oral soln: 40 mg 4 times daily for 2-3 days followed by 80 mg bid. Alternatively, 180-240 mg/day in divided doses. Doses are given w/in 5-21 days... Child Dose: Oral Hypertension Child: As conventional tab: Initially, 1 mg/kg/day in 2 divided doses. Usual range: 2-4 mg/kg/day in 2 divided doses. Max: 4 mg/kg/day in 2 or 3 divided doses. Phaeochromocytoma Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily. Cardiac arrhythmias Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily. Prophylaxis of migraine Child: As conventional tab or oral soln: ?12 yr 10-20 mg bid or tid. >12 yr Initially, 40 mg bid or tid increased to wkly intervals up to 160 mg/day. Max: 240 mg/day. Hyperthyroidism Child: As conventional tab or oral... Contraindication: Sinus bradycardia, cardiogenic shock, sick sinus syndrome, Raynaud's syndrome, 2nd and 3rd degree heart block, overt CHF, bronchial asthma, COPD, untreated phaeochromocytoma, Prinzmetal's angina; severe peripheral arterial disease, metabolic acidosis. Concomitant use w/ thioridazine. Mode of Action: Propranolol is a non-cardioselective beta-blocker that competitively blocks beta1- and beta2-receptors resulting in decreased heart rate, myocardial contractility, BP and myocardial oxygen demand. It has membrane-stabilising properties. Precaution: Sinus node dysfunction, DM, history of nonallergic bronchospasm (e.g. chronic bronchitis, emphysema), myasthenia gravis, 1st degree heart block. May mask signs of hyperthyroidism and hypoglycaemia. Renal or hepatic impairment. Abrupt withdrawal may exacerbate angina symptoms or precipitate MI in patients w/ coronary artery disease. Elderly. Pregnancy and lactation. Patient Counselling Avoid cigarette smoking. Monitoring Parameters Monitor ECG, heart rate and BP. Side Effect: Most adverse effects have been mild and transient and have rarely required the withdrawal of therapy. Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type. Central Nervous System: Lightheadedness; mental depression manifested by insomnia, lassitude, weakness, fatigue; reversible mental depression progressing to catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics. For immediate formulations, fatigue, lethargy, and vivid dreams appear dose related. Gastrointestinal: Nausea, vomiting, epigastric... Pregnancy Category Note: Pregnancy category: C, D in 2nd & 3rd trimesters. Interaction: May cause additive negative chronotropic and/or inotropic effect w/ amiodarone, disopyramide, quinidine, flecainide and Ca channel blockers. May cause additive hypotensive effect w/ phenothiazines. β-adrenergic stimulating effects of sympathomimetic agents are antagonised. Concomitant admin w/ catecholamine-depleting drugs (e.g. reserpine) may cause additive effects and potentiate depression. Reduced antihypertensive effect w/ aluminium and NSAIDs. Coadministration w/ warfarin increases its bioavailability and prothrombin time. Altered antidiabetic response when used w/ antidiabetic agents and insulin. Increased risk of hypotension and attenuation of the reflex tachycardia w/ anaesth drugs. Potentially Fatal: Increased risk of QT interval prolongation and torsades de pointes w/ thioridazine.