Indications: Hypertension, Arrhythmias, Angina, Migraine prophylaxis, Thyrotoxicosis.

Cautions: avoid abrupt withdrawal especially in ischaemic heart disease; first-degree AV block; portal hypertension (risk of deterioration in liver function); diabetes; history of obstructive airways disease (introduce cautiously and monitor lung function—and thyrotoxicosis may be masked; psoriasis; history of hypersensitivity— may increase sensitivity to allergens and result in more serious hypersensitivity response, also may reduce response to adrenaline (epinephrine).

Contra-indications: asthma, uncontrolled heart failure, Prinzmetal's angina, marked bradycardia, hypotension, sick sinus syndrome, second- or third- degree AV block, cardiogenic shock, metabolic acidosis, severe peripheral arterial disease; phaeochromocytoma (apart from specific use with alpha-blockers.

Hepatic impairment: reduce oral dose.

Renal impairment: manufacturer advises caution—dose reduction may be required.

Side Effects: also gastro-intestinal disturbances; bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction (including exacerbation of intermittent claudication and Raynaud's phenomenon); bronchospasm (see above), dyspnea; headache, fatigue, sleep disturbances, paraesthesia, dizziness, vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes and dry eyes (reversible on withdrawal) see under Propranolol Hydrochloride.

Dose: Hypertension, initially 80 mg once daily, increased in increments of up to 80 mg at weekly.

intervals if required; max. 240 mg daily (higher doses rarely necessary) Angina, initially 40 mg once daily, increased at weekly intervals if required; usual max. 160 mg daily (rarely up to 240 mg may be required) Arrhythmias, initially 40 mg once daily, increased at weekly intervals up to 160 mg if required; reduce to 40 mg if bradycardia occurs Migraine prophylaxis, initially 40 mg once daily, increased in 40 mg increments at weekly intervals according to response; usual maintenance dose 80–160 mg once daily Thyrotoxicosis (adjunct), 80–160 mg once daily.