Propranolol + Hydralazine Pharmacology

Propranolol + Hydralazine

About Propranolol + Hydralazine
Mechanism of Action of Propranolol + Hydralazine
Pharmacokinets of Propranolol + Hydralazine
Onset of Action for Propranolol + Hydralazine
Duration of Action for Propranolol + Hydralazine
Half Life of Propranolol + Hydralazine
Side Effects of Propranolol + Hydralazine
Contra-indications of Propranolol + Hydralazine
Special Precautions while taking Propranolol + Hydralazine
Pregnancy Related Information
Old Age Related Information
Breast Feeding Related Information
Children Related Information
Indications for Propranolol + Hydralazine
Interactions for Propranolol + Hydralazine
Typical Dosage for Propranolol + Hydralazine
Schedule of Propranolol + Hydralazine
Storage Requirements for Propranolol + Hydralazine
Effects of Missed Dosage of Propranolol + Hydralazine
Effects of Overdose of Propranolol + Hydralazine


About Propranolol
A synthetic non-selective beta blocker , Antiarrhythmic,antihypertensive,antianxiety,migraine prophylatic.
Mechanism of Action of Propranolol
Propranolol is a non selective beta receptor antagonist. It have negative chronotropic and negative inotropic effects on heart. It decreases oxygen consumption; cardiac work and aortic pressure It decreases nor adrenaline and renin releases. It decreases central sympathetic out flow.
In sympathetic over activity, it prolongs systole by retarding conduction. It increases oxygen supply and exercise tolerance in angina patients. It decrease automaticity and abbreviates refractory period of myocardial fibers and decreases rate of depolarization in SA node, Purkinje fibers, and other ectoptic foci. Prolong effective refractory period of AV node and AV conduction is delayed. At higher doses direct depressant membrane stabilizing action is exerted. The drug decreases BP in hypertensive individuals. Initially total peripheral resistance increases due to blockade of beta mediated vasodilatation and decrease in cardiac output; so little change in BP. But when treatment is continued due to adaptation of resistance vessels to decreased cardiac output total peripheral resistance decreases and systolic and diastolic BP falls.
Antimigraine action: Propranolol is useful in migraine due to its beta blockade action. Through beta blockade action it inhibits vasodilation and relieves migraine.
Pharmacokinets of Propranolol
Absorption: well absorbed orally, bioavailabity is increased by administering along with food.
Distribution: Widely distributed in a plasma protein bound form.
Metabolism: Metabolized in liver.
Excretion: Excreted through urine.

Onset of Action for Propranolol
Duration of Action for Propranolol
Up to 12 hours
Half Life of Propranolol
4 hours
Side Effects of Propranolol
1.Congestive heart failure is precipitated or aggravated
2.Decreases coronary blood flow
5.Decreases exercise capacity
6.Decreases carbohydrate tolerance
7.Decrease insulin release
8.Increases free fatty acid levels and increase LDL to HDL ratio
9.Worsens chronic obstructive lung diseases
10.Gastrointestinal problems
12.Sexual dysfunction
13.Cold extremities
15.Exacerbates prinzmetal`s angina

Contra-indications of Propranolol
1.Hypersensitivity to the drug
2.Second or third degree heart block
3.Congestive heart failure
4.Cardiogenic shock
6.Chronic obstructive pulmonary diseases

Special Precautions while taking Propranolol
1.Peripheral arterial diseases
2.Ischaemic heart disease
3.Congestive heart failure
4.Renal impairment
5.Hepatic impairment
6. Diabetes mellitus
7. The drug should be gradually withdraw with caution
8. Non allergic bronchospastic diseases
9. Thyrotoxicosis
10. Along with other antihypertensive drugs

Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
Use with caution
Indications for Propranolol
1. Hypertension
2. Arrhythmias
3. Anxiety
4. Angina
5. Migraine
6. Prophylaxis of myocardial infarction
7. Tremors
8. Phaeochromocytoma
9. Hypertrophic sub aortic stenosis

Interactions for Propranolol
Quinidine: Orthostatic hypotension.
Rifampicin, Phenobarbital, NSAIDs, Thyroid hormones, Smoking: Decrease antihypertensive action of propranolol.
Corticosteroids: Antagonism of hypotensive effect.
Sympathomimetics: Marked hypertension and bradycardia.
Insulin: Hypoglycemic effects prolonged by propranalol and masking of symptoms of hypoglycemia in diabetes.
Lidocaine: Increased levels of lidocaine may occur resulting in toxicity.
Calcium channel blockers: Severe bradycardia especially in those with impaired LV function.
Phenothiazines: Chlorpromazine increases plasma levels of propranolol.
Reserpine: Additive effect resulting in vertigo, syncope or postural hypotension.
Clonidine: May increase the postural hypotension. Severity of rebound hypertension caused by abrupt withdrawal of clonidine enhanced.
Haloperidol: Severe hypotension.
Prazosin: May increase first dose response (acute postural hypotension) of prazosin.
Theophylline: Propranolol antagonises effect of theophylline.
Alcohol: Enhanced hypotensive effect.
ACE inhibitors: Enhanced hypotensive effect.
Lab tests: May interfere with Glaucoma screening test due to reduction in intraocular pressure.
Typical Dosage for Propranolol
40 to 240mg/day
Hypertension: Starts with 80mg once daily or in 2 divided doses and gradually increases up to 320mg/day based on patient`s response in divided doses 12th hourly or 8th hourly.
Maximum daily dose: 640mg.
Sustained release formulations: 120 to 160mg/day. Once daily.
Children: 1mg/kg/day gradually increases to 4mg/kg/day based on patient`s response in 4 divided doses
Maximum dose: 5mg/kg/day.
Arrhythmias & Anxiety: 30mg to 150mg/day in 3 to 5 divided doses.
Children: 0.5 to 4mg/kg/day in 3 to 4 divided doses.
Angina: 40 to 80mg two times daily to 4 times daily.
Migraine: 80 to 120mg/day in divided doses in 12th hourly to 8th hourly. And gradually increases at 1 week intervals to 160mg/day.
Children: 1mg/kg/day four times daily and gradually increases up to 5mg/kg/day based on patient`s response.
Prophylaxis of myocardial infarction: Initiate the therapy with 20mg dose 5days after myocardial infarction. Then give doses of 40mg thrice daily and gradually increases at weekly intervals up to 80mg based on patients response.

Schedule of Propranolol
Storage Requirements for Propranolol
Store at controlled room temperature between 20 to 25 degree celcious in a well closed container.
Effects of Missed Dosage of Propranolol
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Propranolol
Treatment is supportive and symptomatic. After ingestion empty the stomach by induced emesis or gastric lavage. Administer activated charcoal. Treat Bradycardia with atropine 0.5 to 1mg.If required administer isoproterinol with caution. Treat hypotension with glucagons and vasopressors like epinephrine. Treat cardiac failure with diuretics and cardiac glycosides. Treat bronchospasm with isoproterinol and aminophylline.


About Hydralazine
A direct-acting smooth muscle relaxant, Pyridazine derivative, Antihypertensive(Vasodilator).
Mechanism of Action of Hydralazine
Hydralazine exerts its pharmacological actions by direct vasodilator action on arteriolar smooth muscles with little actions on venous capacitance vessels. It produces after load reduction by dilating resistance vessels which leads to decreasing aortic impedence.So that more blood is pumped even in weaker ventricular contractions. It decreases total peripheral resistance and there is greater decrease in diastolic pressure than systolic pressure. There is a decrease in intracellular Ca2+concentration but there is no reduction in renal blood flow.
Pharmacokinets of Hydralazine
Absorption: It is well absorbed orally, but bioavailability is low in fast acetylators.Distribution: Widely distributed in a highly plasma protein bound form.Metabolism: It is metabolized in liver,plasma and gastrointestinal mucosa. Excretion: Excreted mainly through urine and the rest of dose is excreted through bile and faeces.
Onset of Action for Hydralazine
10 to 30 minutes
Duration of Action for Hydralazine
Up to 6 hours
Half Life of Hydralazine
1 hour
Side Effects of Hydralazine
1. Tachycardia
2. Tachyphylaxis
3. Edema
4. Palpitation
5. Dizziness
6. Dryness of mouth
7. Nasal congestion
8. Headache
9. Palpitation
10. Weakness
11. Orthostatic hypotension
12. Angina
13. Anxiety
14. Sleep disturbances
15. Reversible lupus erythmatosis
16. Paraeshesia
17. Tremor
18. Muscle cramps

Contra-indications of Hydralazine
1. Hypersensitivity to the drug,
2. Ischaemic heart disease
3. Coronary artery diseases
4. Valvular stenosis
5. Pericarditis
6. Aortic aneurism

Special Precautions while taking Hydralazine
1. Renal impairment
2. Hepatic impairment
3. Cardiovascular disorders
4. Cerebro vascular disorders
5. Use with caution along with other antihypertensive drugs
6. Slowly withdraw the drug with caution

Pregnancy Related Information
Use with caution
Old Age Related Information
Breast Feeding Related Information
Children Related Information
Use with caution
Indications for Hydralazine
1. Hypertension
2. Congestive heart failure
3. Pregnancy associated hypertensive crisis
4. Hypertension associated with renal involvement

Interactions for Hydralazine
MAOIs, Thiazide diuretics & TCAs: Antihypertensive effect of hydralazine enhanced.
Sympathomimetics: Use these agents with great caution since hydralazine alone may cause tachycardia and angina.
Propranolol, Metoprolol: Oral bioavailability of these agents may be increased. Also they counteract reflex tachycardia.
Parenteral antihypertensive drugs: (e.g. Diazoxide): Profound hypotensive episodes may occur.
Alcohol: Hydralazine potentiates effect of alcohol.
Typical Dosage for Hydralazine
Oral: Starts with 10mg 6th hourly. Increase the dosage up to 25mg 12th hourly to 6th hourly or 50mg 12th hourly to 6th hourly depending up on the patient`s response.
Maximum daily dose: 200mg
Maximum dose in fast acetylators: 300 to 400mg/day
I.V.: 10 to 20mg. Repeat if required by the patient
Children: Starts with 0.75mg/day. Increased up to 7.5mg/kg/day based on patient`s response.
Heart failure: Starts with 50 to 75mg. Increase the dosage up to 200 to 600mg/day in 2 to 4 divided doses based on patient`s response.
Maximum dose: 3gm/day
Pregnancy associated hypertensive crisis: Starts with 5mg I.V. Increases to 10mg at every half an hour until desired response is obtained.

Schedule of Hydralazine
Storage Requirements for Hydralazine
Store at controlled room temperature at a temperature range of 15 to 30 degree C in a light resistant tightly closed container.
Effects of Missed Dosage of Hydralazine
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Hydralazine
Treatment is supportive and symptomatic. After ingestion empty the stomach by induced emesis and gastric lavage. Administer activated charcoal to reduce absorption.

Home Delivery for Propranolol + Hydralazine in Your City

Medicine India is just a publishing medium for medicine related information and does not provide services or sales of medicines including propranolol + hydralazine.

However, we do publish a comprehensive directory of Pharmacies, Chemists and Druggists in cities all over India. You can use this directory to find the medicine stores in your city (or area) that provide home delivery services for propranolol + hydralazine and other medicines and health products. Home delivery services for propranolol + hydralazine may be free or they may cost you depending on the pharmacy and the minimum order requirements. It would be best to get this clarified while placing the order.

Please be aware that you should take propranolol + hydralazine only if a doctor has recommended or prescribed it. Some or all pharmacies who provide a home delivery service for medicines might insist on a prescription for propranolol + hydralazine before they complete the sale. You can get this information while placing the order for propranolol + hydralazine with the pharmacy.

Propranolol + Hydralazine is a generic medicine name and there are several brands available for it. Some of the brands for propranolol + hydralazine might be better known than propranolol + hydralazine itself. If the pharmacy that's willing to deliver medicines to your home doesn't have propranolol + hydralazine in stock, you can ask for one of the branded alternatives for propranolol + hydralazine.