-              The name of your medicine is Inderal. The active ingredient is propranolol. Propranolol is one of a group of drugs called beta-blockers. It has effects on the heart and circulation and also on other parts of the body.

-              Inderal can be used for many conditions including hypertension (high blood pressure), angina (chest pain), some arrythmias (disorders of heart rhythm), protection of the heart after a myocardial infarction (heart attack), prevention of migraine, essential tremor, anxiety, certain thyroid conditions (such as thyrotoxicosis, which is caused by an overactive thyroid gland), hypertrophic cardiomyopathy (thickened heart muscle), phaeochromocytoma (high blood pressure due to a tumour usually near the kidney) and bleeding in the oesophagus caused by high blood pressure in the liver.

a. Do not take Inderal:

-  If you are allergic to propranolol, or to any of the other ingredients listed below.

-  If you have ever had asthma or wheezing. Go back to your doctor or pharmacist.

-  If you have heart failure not under control with certain other conditions such as heart block, very slow or very irregular heartbeats, very low blood pressure or very poor circulation.

-  If you are fasting or have been fasting recently.

-  If you have phaeochromocytoma (high blood pressure due to a tumour usually near the kidney) which is not being treated or you have metabolic acidosis or a particular type of chest pain called Prinzmetal’ s angina.

Your doctor will know about these conditions. If you have one of these conditions, make sure your doctor knows about it before you take Inderal.

b. Take special care with Inderal

-  If you get allergic reactions to such things as insect stings, tell your doctor.

-  If you are diabetic, Inderal may change your normal response to low blood sugar, which usually involves an increase in heart rate. Inderal may cause low blood sugar levels even in patients who are not diabetic.

-  If you suffer from unstable angina (non exercise-induced sharp chest pain)

-  If you have thyrotoxicosis, Inderal may hide the symptoms of thyrotoxicosis.

-  If you have kidney or liver problems (including cirrhosis of the liver), talk to your doctor because you may need to have some check-ups during your treatment.

-  If you have any other health problems such as circulation disorders, heart problems, breathlessness or swollen ankles. tell your doctor.

c. Using other medicines, herbal or dietary supplements

Inderal can interfere with the action of some other drugs and some drugs can have an effect on Inderal. Please tell your doctor or pharmacist if you are using or have recently used any other medicines, including medicines obtained without a prescription. The drugs which can cause some problems when taken together with Inderal are: verapamil, diltiazem, nifedipine, nisoldipine, nicardipine, isradipine, lacidipine, (which are used to treat hypertension or angina), disopyramide, lidocaine, quinidine, amiodarone or propafenone (for irregular heartbeats), digoxin (for heart failure), adrenaline (a heart stimulant), ibuprofen and indometacin (for pain and inflammation), ergotamine, dihydroergotamine or rizatriptan (for migraine), chlorpromazine and thioridazine (for certain psychiatric disorders), cimetidine (for stomach problems), rifampicin (for the treatment of tuberculosis), theophylline (for asthma), warfarin (to thin the blood) and hydralazine (for hypertension).

If you frequently drink a lot of alcohol, this may affect how your tablets work.

Are you taking a drug called clonidine (for hypertension or migraine)? If you are taking clonidine and Inderal together, you must not stop taking clonidine unless your doctor tells you to do so. If it becomes necessary for you to stop taking clonidine, your doctor will give you careful instructions on how to do it.

If you go into hospital to have an operation, tell the anaesthetist or the medical staff that you are taking Inderal.

d. Taking Inderal with food or drink
Inderal tablets should be swallowed with a drink of water.
e. Pregnancy and breast-feeding
Tell your doctor if you are pregnant or breast-feeding before taking Inderal

f. Driving and using machines
Inderal is unlikely to affect your ability to drive or to operate machinery. However, some people may occasionally feel dizzy or tired when taking Inderal. If this happens to you, ask your doctor for advice.
g. Important information about some of the ingredients of Inderal

Inderal tablets contain a small amount of glycerol. When glycerol is given in high doses it can cause headache, stomach upset and diarrhoea

Always use Inderal exactly as your doctor or health care provider told you. You should check with your doctor or pharmacist if you are not sure.

Your doctor will have decided how many Inderal tablets you need to take each day depending on your condition. Follow your doctor’ s instructions about when and how to take your tablets. Please read the label on the container.

This will also tell you how many tablets to take and when you should take them. Ask your doctor or pharmacist if you are not sure. The following table shows the usual total daily dosages for an adult:

Certain thyroid conditions (such as thyrotoxicosis)* 30 mg to 160 mg

Hypertrophic cardiomyopathy (thickened heart muscle) 30 mg to 160 mg

Phaeochromocytoma*                                                    30 mg to 60 mg

Bleeding in the oesophagus caused by high blood pressure

in the liver                                                                    80 mg to 160 mg

*Under some circumstances, Inderal can be used to treat children with these conditions. The dosage will be adjusted by the doctor according to the child’ s age or weight.

Elderly patients may be started on a lower dose.

a. If you take more Inderal than you should

Propranolol is severely toxic if used in overdose. If you have accidently taken more than the prescribed dose or are experiencing symptoms of overdose, you should urgently seek medical If you accidentally take an overdose of your medicine, either call your doctor straight away, or go to your nearest hospital casualty department. Always take any remaining tablets, the container and the label with you, so that the medicine can be identified.

b. If you forget to take Inderal
If you forget to take your medicine, take your dose when you remember and then take your next dose at the usual time. Don’ t take two doses at the same time. If you are worried, ask your doctor or pharmacist for advice.

c. If you stop taking Inderal

Do not stop taking your medicine without talking to your doctor first. In some cases, it may be necessary to stop taking the medicine gradually.

If you have any further questions on the use of this product, ask your doctor or pharmacist.

Like all medicines, Inderal can cause side effects, although not everybody gets them.

Common side effects that may occur (in 1% or more patients but less than 10%; between 1 in 10 and 1 in 100 patients)
- Cold fingers and toes
- The heart beating more slowly
- Numbness and spasm in the fingers which is followed by warmth and pain (Raynaud’s phenomenon)
- Disturbed sleep/nightmares
- Fatigue
Uncommon side effects that may occur (in 0.1% or more patients but less than 1%; between 1 in 100 and 1 in 1000 patients)
- Diarrhoea
- Nausea
- Vomiting
Rare side effects that may occur (in 0.01% or more patients and less than 0.1%; between 1 in 1000 and 1 in 10000 patients)

-       Worsening of breathing difficulties, if you have or have had asthma

-       Breathlessness and/or swollen ankles, if you also have heart failure

-       Heart block which may cause an abnormal heart beat, dizziness, tiredness or fainting

-       Dizziness, particularly on standing up

-       Worsening of your blood circulation, if you already suffer from poor circulation

-       Hair loss

-       Mood changes

-       Confusion

-       Memory loss

-       Psychosis or hallucinations (disturbances of the mind)

-       Tingling of the hands

-       Disturbances of vision

-       Dry eyes

-       Skin rash, including worsening of psoriasis

-       Bruising more easily (thrombocytopaenia)

-       Purple spots on the skin (purpura)

Very rare side effects that may occur (in less than 0.01% patients; less than 1 in 10000 patients)
- Severe muscle weakness (myasthenia gravis)
- There may be changes to some of the cells or other parts of your blood. It is possible that your doctor may occasionally take blood samples to check whether Inderal has had any effect on your blood.
Side effects that may occur with an unknown frequency
Low levels of blood sugar may occur in diabetic and non diabetic patients including the newborn, toddlers and children, elderly patients, patients on artificial kidneys (haemodialysis) or patients on medication for diabetes. It may also occur in patients who are fasting or have been fasting recently or who have a long-term liver disease.
Seizure linked to low levels of sugar in the blood.
Do not be alarmed by this list of possible events. You may not have any of them.
If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

- Keep out of the reach and sight children.
- Keep your medicine below 30^oC and away from strong light and dampness.

- Check the expiry date on the carton and don’t use the medicine after that date.
- Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.