Indications: Hypertension, angina, arrhythmias, thyrotoxicosis, secondary prevention after acute myocardial infarction, migraine, and in phaeochromocytoma along with an alpha blocker. Cautions: first degree AV block; portal hypertension and chronic obstructive pulmonary disease; late pregnancy; breast feeding; avoid abrupt withdrawal in angina; reduce oral dose of propranolol in liver disease; reduce initial dose in renal impairment; a small dose should be used initially in elderly patients; can mask signs and symptoms of hypoglycemia in patients receiving insulin therapy.

Contra-indications: Asthma; uncontrolled heart failure; Prinzmetals’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).

Side Effects: Gastro intestinal disturbances; bradycardia, heart failure, hypotension, conduction disorders, bronchospasm, peripheral vasoconstriction (exacerbation of intermittent claudification or Raynaud’s phenomenon); dyspnea; headache, fatigue, sleep disturbances, paraesthesia, dizziness, vertigo, psychoses; sexual dysfunctions; purpura; thrombocytopenia, disturbed vision, exacerbation of psoriasis. alopecia, rarely rashes, dry eyes (reversible on withdrawal).

Dose: by mouth, hypertension, initially 80 mg twice daily.

Maintenance, 160-320 mg daily. Angina, initially 40 mg 2-3 times daily. Maintenance, 120-240 mg daily.

Arrhythmias and thyrotoxicosis, 10-40 mg 3-4 times daily.

Prophylaxis after infarction, 40 mg 4 times daily for 2-3 days, then 80 mg twice daily, beginning 5-21 days after infarction.

Migraine prophylaxis and essential tremor, initially 40 mg 2-3 times daily.

Maintenance, 80-160 mg daily.

By IV injection, arrhythmias and thyrotoxic crisis, 1 mg over 1minute, preceded by atropine sulphate 1-2 mg in divided doses. If necessary, repeat at 2 minute intervals; max. dose 10 mg (5 mg in anaesthesia).