Propranolol is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled.
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This medicine is a beta-blocker. Propranolol, the main ingredient of Inderal, blocks chemicals, such as adrenaline, and prevents them from increasing heart rate, blood pressure, and oxygen use. It effectively reduces autonomic nervous system arousal (e.g. performance anxiety symptoms, palpitations, hyperventilation, sweating, pounding heartbeat, nausea, disabling tremor). Full benefits in a few hours to weeks, depending on severity of disorder.
It is usually used in combination with other drugs, particularly a thiazide diuretic. Propranolol can, however, in certain patients, be used alone or as an initial agent in patients in whom, in the judgment of the physician, treatment should be started with a beta-blocker rather than a diuretic. Propranolol by itself is not recommended for the emergency treatment of hypertensive crisis. It is, however, sometimes used as an adjunct to counteract the unwanted effect (tachycardia) of the primary agents used in these situations. Ventricular arrhythmias do not respond to propranolol as predictably as do the supraventricular arrhythmias with the exception of ventricular tachycardia induced by catecholamines or digitalis, propranolol is not the drug of first choice. Treatment must always be initiated and individual titration of dosage carried out using the conventional tablets. The long-acting formulation may be used for maintenance provided the dosage requirement is suitable.
The mechanism of the antihypertensive effects of propranolol has not been established. Among the factors that may be involved are decreased cardiac output, inhibition of renin release by the kidneys, and diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain. It has been suggested, but not established, that propranolol may achieve a better antihypertensive effect in patients with normal or elevated plasma renin activity (PRA) than those with low PRA. Propranolol may reduce the oxygen requirement of the heart at any level of effort by blocking catecholamine induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction. On the other hand, propranolol may increase oxygen requirements by increasing left ventricular fiber length, end diastolic pressure, and systolic ejection period. When the net effect is beneficial in anginal patients, it manifests itself during exercise or stress by delaying the onset of pain and reducing the incidence and severity of anginal attacks.
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