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PROPRANOLOL IN THYROTOXICOSIS


(PROPRANOLOL IN PHAEOCHROMOCYTOMA)

How does it work?
How do I take it?
What side effects can be expected?
Other medicines or substances which might interfere with your treatment
Storing your medicine

Available as tablets containing Propranolol 10 mg, 40 mg and 80 mg. A syrup form can also be obtained. May be supplied under the trade name Inderal .

How does it work?

Propranolol is a beta-adrenoceptor blocking drug (beta-blocker) which is so-called because it blocks the activity of the nerves which form the sympathetic nervous system. Overactivity of the sympathetic nervous system is responsible for many of the symptoms of thyrotoxicosis which are "dampened down" by treatment with Propranolol. These include rapidly beating heart (palpitations), shakiness (tremor), intolerance to heat and sweating, diarrhoea, muscle aches and mental symptoms. Propranolol is thus used for the symptomatic relief of thyrotoxicosis (hyperthyroidism). It has no direct effect on the cause, namely overproduction of thyroid hormones, which requires to be treated concurrently.

How do I take it?

Propranolol treatment must be established by careful manipulation of the dose in order to achieve satisfactory control of the symptoms of thyrotoxicosis. It is usual to start low (e.g. 10 mg twice or three times daily) and add dosage increments, as necessary, at intervals of several days until a suitable maintenance dose is found. An average maintenance dose may be in the range 10-40 mg taken three or four times daily. Propranolol is best taken with a meal or snack - the presence of food in the stomach will actually increase the amount that is absorbed. Finally, it is important that you do not stop your treatment without consulting your Doctor (especially if you suffer from a heart condition) since to do so might result in a "flare up" of the symptoms of thyrotoxicosis.

What side effects can be expected?

Other medicines or substances which might interfere with your treatment

Beta-blockers are also used to lower blood pressure and to treat certain heart conditions. Accordingly they may interfere with other medicines which you take for these reasons. Your Doctor will, however, take such treatments into account when considering your suitability for beta-blocker therapy.

Beta-blockers (especially Propranolol) may interfere with diabetes control. This does not mean that they are unsuitable in such cases but re-adjustment of insulin or other anti-diabetic medication might be necessary.

As described above, these medicines can cause wheezing (see "Side effects") and they will therefore antagonise or reverse the effects of medicines such as Ventolin and Bricanyl which are used to assist breathing.

The circulation problems (cold hands, feet,etc) described under "Side effects" above is likely to be much more marked if beta-blockers are taken concurrently with certain migraine treatments (Cafergot , Migril , Lingraine , Deseril ) which also reduce blood flow through the tissues.

If you are one of the very few people who require to inject adrenaline (EpiPen ) in the event of a severe allergic reaction, you should not be taking Propranolol. Such a combination can result in a dangerously high blood pressure and marked slowing of the heart beat. For the same reason, you should ideally avoid certain of the cough and cold remedies that can be bought at the Chemist but such problems are far less severe than with adrenaline. Your Pharmacist can advise you.

Storing your medicine

No special requirements. This medicine can be stored at room temperature.

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Tayside University Hospitals NHS Trust; 2000; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.

PROPRANOLOL IN PHAEOCHROMOCYTOMA

How does it work?
How do I take it?
What side effects can be expected?
Other medicines or substances which might interfere with your treatment
Storing your medicine

Available as tablets containing Propranolol 10 mg, 40 mg and 80 mg and Controlled Release capsules 80 mg and 160 mg. A syrup form can also be obtained. May be supplied under the trade name Inderal .

How does it work?

Propranolol is a beta-adrenoceptor blocking drug (beta-blocker) which blocks the action of adrenaline on the heart. Adrenaline is a natural hormone which is produced in excessive amounts by a phaeochromocytoma (an adrenaline-producing tumour) causing a rapid and unpredictable rise in blood pressure (BP), rapid heart beat (palpitations) and skin flushing. Propranolol protects the heart by blocking the effect of adrenaline so maintaining a normal heart beat and reducing flushes. It also contributes a useful blood pressure lowering effect when used together with a second blood pressure lowering medicine called an alpha-blocker (e.g. phenoxybenzamine). The mechanism by which Propranolol lowers raised BP is not clearly understood. Propranolol is therefore used to control the symptoms of a phaeochromocytoma. It has no direct effect on the tumour itself. This requires to be treated surgically.

How do I take it?

In phaeochromocytoma, Propranolol is usually given in a relatively low dose (e.g. 10 mg three times a day) and together with a second drug which also lowers blood pressure (an alpha-blocker). Double this dose may be required and should be given for 3 days before surgical removal of the tumour(s). It is best taken with a meal or snack - the presence of food in the stomach will actually increase the amount that is absorbed. Finally, it is important that you do not stop your treatment without consulting your Doctor since to do so might result in a "flare up" of the symptoms of phaeochromocytoma.

What side effects can be expected?

Other medicines or substances which might interfere with your treatment

Beta-blockers are also used to lower blood pressure and to treat certain heart conditions. Accordingly they may interfere with other medicines which you take for these reasons. Your Doctor will, however, take such treatments into account when considering your suitability for beta-blocker therapy.

Beta-blockers (especially Propranolol) may interfere with diabetes control. This does not mean that they are unsuitable in such cases but re-adjustment of insulin or other anti-diabetic medication might be necessary.

As described above, these medicines can cause wheezing (see "Side effects") and they will therefore antagonise or reverse the effects of medicines such as Ventolin and Bricanyl which are used to assist breathing.

The circulation problems (cold hands, feet,etc) described under "Side effects" above is likely to be much more marked if beta-blockers are taken concurrently with certain migraine treatments (Cafergot , Migril , Lingraine , Deseril ) which also reduce blood flow through the tissues.

Storing your medicine

No special requirements. This medicine can be stored at room temperature.

Top

NHS Tayside; 2006; version 1.0

Disclaimer; no liability whatsoever is accepted for information given and all such information, especially with regard to drug usage (UK version provided), must be checked with a person’s health provider.