At doses of 150 mg/kg/day ( > 30 times the dose of propranolol contained in the maximum recommended human daily dose of Inderide), but not at doses of 80 mg/kg/day, treatment was associated with embryotoxicity (reduced litter size and increased resorption sites) as well as neonatal toxicity (deaths).
seizures and coma.Q4. She was transferred to ICU on high-dose insulin (2 units/kg/hr) and adrenaline infusions, which were subsequently weaned off over the following 24-48 hours. 20-40 mg PO q6-8hr. A dose greater than 1g is considered potentially lethal. pulseless VT) or progressive cardiogenic shock culminating in bradycardic PEA.To illustrate this last point, we had a 55-year old lady come through our department recently with a 4 gram (i.e. In the table below, the first figure is the number of pills, and the second figure is the dosage of each pill. Post-arrest echocardiogram was entirely normal (no evidence of LV dysfunction) and serial bloods showed only trivial elevations in troponin and transaminases with preserved renal function (i.e. The usual maintenance dosage is 120 to 160 mg once daily. 1 mg, to be given over 1 minute, dose may be repeated if necessary at intervals of 2 minutes, maximum total dose is 5 mg in anaesthesia; maximum 10 mg per course. She is believed to have taken an overdose, but of unknown substance. If a satisfactory response is not obtained within four to six weeks after reaching the maximum dose, propranolol therapy should be discontinued. Hypertrophic Subaortic Stenosis. Co-administration of such drugs with Propranolol may lead to clinically relevant drug interactions and changes on its efficacy and/or toxicity (see Propafenone has negative inotropic and beta-blocking properties that can be additive to those of Propranolol.Quinidine increases the concentration of Propranolol and produces greater degrees of clinical beta-blockade and may cause postural hypotension.Amiodarone is an antiarrhythmic agent with negative chronotropic properties that may be additive to those seen with β-blockers such as Propranolol.The clearance of lidocaine is reduced with administration of Propranolol. The net physiologic effect of beta-adrenergic blockade is usually advantageous and is manifested during exercise by delayed onset of pain and increased work capacity.Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action.
Although individual patients may respond at any dosage level, the average optimal dosage appears to be 160 mg once daily. On arrival to ED, she was treated aggressively with bicarbonate, adrenaline and high-dose insulin and achieved return of spontaneous circulation after a further 15 minutes of CPR. Why is this? The significance of the membrane action in the treatment of arrhythmias is uncertain.The mechanism of the anti-migraine effect of Propranolol has not been established.
1-2mmol/kg every 2 minutes until QRS normalises.There are a range of treatments and a progression through them, to deal with the beta effects, especially unstable haemodynamics. Become a Resus Member for FREE! Its molecular and structural formula are:Propranolol Hydrochloride, USP is a stable, white, crystalline solid which is readily soluble in water and ethanol.
In propranolol overdoses we have to deal with the beta blocker effects and the Na channel blocking effects. In these patients, it may be more difficult to adjust the dosage of insulin.Beta-adrenergic blockade may mask certain clinical signs of hyperthyroidism. Over a twenty-four (24) hour period, blood levels are fairly constant for about twelve (12) hours, then decline exponentially.