propranolol hydrochloride

Adult Dosing .

Dosage forms:  ER CAP: 60 mg, 80 mg, 120 mg, 160 mg; TAB: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg; SOL: 20 mg per 5 mL, 40 mg per 5 mL; INJ: various

HTN

[80-240 mg/day PO divided bid-tid]

Start: 40 mg PO bid, may incr. dose q3-7 days; Max: 640 mg/day; Alt: start 80 mg ER PO qd, may incr. dose q3-7 days to 120-160 mg ER PO qd; Info: taper dose gradually to D/C

angina

[80-320 mg/day PO divided bid-qid]

Start: 80 mg/day PO divided bid-qid, may incr. dose q3-7 days; Max: 320 mg/day; Alt: start 80 mg ER PO qd, may incr. dose q3-7 days; Info: taper dose gradually to D/C

cardiovascular event risk reduction, post-MI

[180-240 mg/day PO divided tid-qid]

Start: 40 mg PO tid x1mo ASAP after pt stable; Max: 240 mg/day; Info: taper dose gradually to D/C

atrial fibrillation/flutter

[immediate rate control]

Dose: 1 mg IV q2min prn up to 3 doses; Max: 3 mg/total dose

[maintenance rate control]

Dose: 10-40 mg PO tid-qid; Info: taper dose gradually to D/C

supraventricular arrhythmia

[1-3 mg IV x1]

Info: for life-threatening arrhythmias or those occurring under anesthesia; may give 2nd dose after 2min and subsequent doses q4h prn

migraine prophylaxis

[160-240 mg/day PO divided bid-qid]

Start: 80 mg/day PO divided bid-qid; Alt: start 80 mg ER PO qd, incr. dose to 160-240 mg ER PO qd; Info: D/C if no response w/in 4-6wk; taper dose gradually to D/C

essential tremor

[immediate-release form]

Dose: 120 mg/day PO divided bid-tid; Start: 40 mg PO bid; Max: 320 mg/day; Info: taper dose gradually to D/C

[extended-release form (off-label)]

Dose: 120 mg ER PO qd; Start: 60 mg ER PO qd; Max: 320 mg/day ER; Info: taper dose gradually to D/C

IHSS

[20-40 mg PO tid-qid]

Alt: 80-160 mg ER PO qd; Info: taper dose gradually to D/C

pheochromocytoma, adjunct tx

[60 mg/day PO divided bid-qid]

Info: adjunct to alpha blockers; give x3 days prior to surgery; give 30 mg/day if inoperable tumor; taper dose gradually to D/C

performance anxiety (off-label)

[10-40 mg PO x1]

Start: 1h before event

portal HTN (off-label)

[10-60 mg PO tid-qid]

Start: 10 mg PO tid; Info: for prevention of variceal bleeding; titrate dose to reduce resting heart rate by 25%; taper dose gradually to D/C

thyroid storm (off-label)

[60-80 mg PO q4h]

Alt: 40 mg PO q6h; Info: taper dose gradually to D/C

thyrotoxicosis (off-label)

[10-40 mg PO q6-8h]

Info: taper dose gradually to D/C

renal dosing

[see below]

renal impairment: not defined, caution advised

HD/PD: not defined, caution advised

hepatic dosing

[PO route]

hepatic impairment: not defined, caution advised

[IV route]

hepatic impairment: consider decr. usual dose

Peds Dosing .

Dosage forms:  TAB: 10 mg, 20 mg, 40 mg, 60 mg, 80 mg; SOL: 20 mg per 5 mL, 40 mg per 5 mL; INJ: various

HTN (off-label)

[1-5 mg/kg/day PO divided q6-12h]

Start: 0.5-1 mg/kg/day PO divided q6-12h, may incr. dose q3-5 days; Max: 8 mg/kg/day; Info: taper dose gradually to D/C

infantile hemangioma (off-label)

[2-3 mg/kg/day PO divided bid-tid for at least 6mo]

Info: periodically readjust dose based on wt; give during or immed. after feeding; skip dose if vomiting or not feeding; taper dose gradually to D/C

migraine prophylaxis (off-label)

[<35 kg]

Dose: 10-20 mg PO tid; Start: 10 mg PO qd, may incr. by 10 mg/day qwk; Info: taper dose gradually to D/C

[>35 kg]

Dose: 20-40 mg PO tid; Info: taper dose gradually to D/C

supraventricular arrhythmia (off-label)

[2-4 mg/kg/day PO divided q6-8h]

Start: 0.5-1 mg/kg/day PO divided q6-12h, incr. dose q3-5 days; Max: 16 mg/kg/day PO; 1 mg/dose IV in infants, 3 mg/dose IV in children; Alt: 0.01-0.1 mg/kg/dose IV q6-8h prn

thyroid storm (off-label)

[<13 yo]

Dose: 2 mg/kg/day PO divided q6-12h; Max: 40 mg/dose; Info: taper dose gradually to D/C

[13 yo and older]

Dose: 10-40 mg PO q6-8h; Info: taper dose gradually to D/C

thyrotoxicosis (off-label)

[<13 yo]

Dose: 2 mg/kg/day PO divided q6-12h; Max: 40 mg/dose; Info: taper dose gradually to D/C

[13 yo and older]

Dose: 10-40 mg PO q6-8h; Info: taper dose gradually to D/C

tetralogy spells (off-label)

[4-8 mg/kg/day PO divided q6h]

Start: 2-4 mg/kg/day PO divided q6h; Max: 15 mg/kg/day; Alt: 0.15-0.25 mg/kg/dose IV q15min prn x2 doses

cyclic vomiting syndrome prophylaxis (off-label)

[2 yo and older]

Dose: 0.25-1 mg/kg/day PO divided bid-tid; Alt: 10 mg PO bid-tid; Info: taper dose over 1-2wk to D/C

renal dosing

[see below]

renal impairment: not defined, caution advised

HD/PD: not defined, caution advised

hepatic dosing

[PO route]

hepatic impairment: not defined, caution advised

[IV route]

hepatic impairment: consider decr. usual dose