inderal
| Product dosage: 10mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 90 | $0.51 | $46.09 (0%) | 🛒 Add to cart |
| 180 | $0.34 | $92.17 $61.12 (34%) | 🛒 Add to cart |
| 270 | $0.28 | $138.26 $75.14 (46%) | 🛒 Add to cart |
| 360 | $0.26
Best per pill | $184.35 $93.18 (49%) | 🛒 Add to cart |
| Product dosage: 40mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 90 | $0.56 | $50.09 (0%) | 🛒 Add to cart |
| 180 | $0.38 | $100.19 $68.13 (32%) | 🛒 Add to cart |
| 270 | $0.32 | $150.28 $86.16 (43%) | 🛒 Add to cart |
| 360 | $0.29
Best per pill | $200.38 $104.20 (48%) | 🛒 Add to cart |
| Product dosage: 80mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 60 | $0.73 | $44.08 (0%) | 🛒 Add to cart |
| 90 | $0.59 | $66.12 $53.10 (20%) | 🛒 Add to cart |
| 120 | $0.51 | $88.17 $61.12 (31%) | 🛒 Add to cart |
| 180 | $0.44 | $132.25 $79.15 (40%) | 🛒 Add to cart |
| 270 | $0.39 | $198.37 $105.20 (47%) | 🛒 Add to cart |
| 360 | $0.37
Best per pill | $264.50 $132.25 (50%) | 🛒 Add to cart |
Synonyms | |||
Similar products
Before we get to the formal monograph, let me give you the real picture on this one. I’ve been prescribing Inderal for nearly twenty years now, and it’s one of those drugs that separates the experienced clinicians from the textbook prescribers. The official documentation tells you it’s a beta-blocker for hypertension and angina, but the real clinical utility is so much broader - and sometimes trickier - than the package insert suggests.
I remember when our hospital’s formulary committee debated whether to restrict it to cardiology only. Dr. Chen from neurology practically stormed the meeting with migraine charts showing 70% reduction in frequency. Meanwhile, psychiatry was quietly using it for performance anxiety with remarkable success. The struggle was real - cardiology wanted to gatekeep what they saw as “their” drug, while other specialties had mountains of off-label evidence.
Inderal: Comprehensive Beta-Blockade Therapy for Cardiovascular and Neurological Conditions - Evidence-Based Review
1. Introduction: What is Inderal? Its Role in Modern Medicine
Inderal, known generically as propranolol hydrochloride, represents the prototype non-selective beta-adrenergic blocking agent that fundamentally changed cardiovascular therapeutics. Approved by the FDA in 1967, it was the first beta-blocker available in the United States and remains clinically relevant over five decades later due to its unique pharmacological profile.
The significance of Inderal extends beyond its initial antihypertensive and antianginal indications. Its lipophilic nature allows penetration of the blood-brain barrier, creating neurological and psychiatric applications that weren’t anticipated during initial development. What makes Inderal particularly valuable in modern practice is its non-selectivity - blocking both β1 and β2 receptors - which creates both therapeutic advantages and specific considerations in clinical use.
2. Key Components and Pharmaceutical Properties of Inderal
The active pharmaceutical ingredient in Inderal is propranolol hydrochloride, chemically described as 1-(isopropylamino)-3-(1-naphthyloxy) propan-2-ol hydrochloride. The molecular structure features a naphthalene ring system connected to an isopropylaminoethanol side chain, creating the optimal configuration for beta-adrenergic receptor antagonism.
Available formulations include immediate-release tablets (10, 20, 40, 60, 80 mg), extended-release capsules (60, 80, 120, 160 mg), and injectable solutions (1 mg/mL). The bioavailability of oral propranolol demonstrates significant interindividual variation (approximately 25%) due to extensive first-pass metabolism in the liver, primarily via cytochrome P450 enzymes CYP2D6 and CYP1A2.
The extended-release formulation was a game-changer in my tremor patients. I had one gentleman, Robert, 68 with essential tremor so severe he couldn’t sign checks. The immediate-release gave him breakthrough symptoms every 6 hours - the long-acting formulation finally gave him consistent control throughout the day.
3. Mechanism of Action: Scientific Substantiation of Inderal’s Effects
Inderal exerts its therapeutic effects through competitive antagonism of catecholamines at β-adrenergic receptors. The drug binds reversibly to both β1-receptors (predominantly in cardiac tissue) and β2-receptors (located in bronchial, vascular, and uterine smooth muscle), preventing the activation of adenylate cyclase and subsequent cyclic AMP production.
Cardiovascular effects include reduced heart rate, decreased myocardial contractility, and suppressed renin release from the juxtaglomerular apparatus. The antianginal action derives from reduced myocardial oxygen demand through decreased heart rate and contractility. Neurologically, central nervous system penetration allows suppression of sympathetic outflow and modulation of essential tremor pathways.
The peripheral mechanism for anxiety symptoms is particularly elegant - by blocking the peripheral manifestations of anxiety (tachycardia, tremor, sweating), it interrupts the feedback loop to the brain that amplifies anxious feelings. This is why it works so well for performance anxiety even at single doses.
4. Indications for Use: What is Inderal Effective For?
Inderal for Hypertension
As monotherapy or in combination regimens, Inderal demonstrates efficacy in mild to moderate hypertension. The antihypertensive effect develops gradually, with maximal reduction typically occurring within 2-3 weeks of consistent dosing.
Inderal for Angina Pectoris
Through reduction of myocardial oxygen demand, Inderal provides prophylactic management of chronic stable angina. Dosage must be individualized, with abrupt discontinuation avoided due to rebound exacerbation risk.
Inderal for Cardiac Arrhythmias
The drug is particularly effective for supraventricular tachyarrhythmias, including sinus tachycardia, atrial fibrillation with rapid ventricular response, and AV nodal reentrant tachycardias.
Inderal for Migraine Prophylaxis
The mechanism in migraine prevention appears multifactorial, involving cerebral vasoconstriction, inhibition of platelet aggregation, and stabilization of serotoninergic neurotransmission.
Inderal for Essential Tremor
By blocking peripheral β2-receptors in skeletal muscle, Inderal reduces the amplitude of postural and action tremors without affecting rest tremors.
Inderal for Anxiety Disorders
Particularly effective for situational anxiety and performance anxiety, where peripheral somatic symptoms contribute significantly to the clinical presentation.
We had a fascinating case that taught me about the neurological applications - Sarah, a 42-year-old violinist with performance anxiety so severe she was considering leaving the symphony. Beta-blockers for musicians were controversial back then, but 20mg thirty minutes before performances gave her just enough dampening of the sympathetic surge without affecting her fine motor control. She’s still performing fifteen years later.
5. Instructions for Use: Dosage and Course of Administration
Dosing must be individualized based on indication, patient characteristics, and concomitant medications. The following table provides general guidance:
| Indication | Initial Dose | Maintenance Range | Administration Notes |
|---|---|---|---|
| Hypertension | 40mg twice daily | 120-240mg daily in divided doses | May increase to 640mg daily in resistant cases |
| Angina Pectoris | 10-20mg three or four times daily | 80-320mg daily in divided doses | Titrate gradually; avoid abrupt withdrawal |
| Arrhythmias | 10-30mg three or four times daily | 30-120mg daily in divided doses | Monitor ECG with dose adjustments |
| Migraine Prevention | 80mg daily in divided doses | 160-240mg daily | May require 4-6 weeks for full effect |
| Essential Tremor | 40mg twice daily | 120-320mg daily | Divided doses typically required |
| Performance Anxiety | 10-40mg single dose | As needed 30-60 minutes before event | Not for daily anxiety management |
The extended-release capsule formulation provides 24-hour coverage with once-daily dosing, typically administered in the morning. Food does not significantly affect absorption, though consistency in administration relative to meals is recommended.
6. Contraindications and Drug Interactions of Inderal
Absolute contraindications include bronchial asthma, severe chronic obstructive pulmonary disease, cardiogenic shock, decompensated heart failure, severe bradycardia, and second- or third-degree heart block without a functioning pacemaker.
Relative contraindications require careful risk-benefit assessment: diabetes mellitus (masks hypoglycemic symptoms), peripheral vascular disease, pheochromocytoma (must be alpha-blocked first), and hepatic impairment.
Significant drug interactions include:
- Verapamil/diltiazem: Additive bradycardia and myocardial depression
- Insulin/oral hypoglycemics: Altered glycemic response and masked hypoglycemia
- Epinephrine: Unopposed alpha-adrenergic effects causing hypertension
- Clonidine: Exaggerated rebound hypertension upon withdrawal
- CYP2D6 inhibitors (fluoxetine, quinidine): Increased propranolol concentrations
I learned the diabetes interaction the hard way early in my career. Mr. Henderson, a type 2 diabetic on glipizide, didn’t recognize his hypoglycemia because the tachycardia and tremor were blocked. His wife found him confused with a glucose of 45. We adjusted his regimen and educated them both about monitoring for other symptoms like sweating and neuroglycopenic signs.
7. Clinical Studies and Evidence Base for Inderal
The evidence supporting Inderal’s efficacy spans decades of rigorous investigation. The Medical Research Council trial demonstrated 25-30% reduction in stroke incidence among hypertensive patients treated with propranolol compared to placebo. The Beta-Blocker Heart Attack Trial established mortality reduction when initiated post-myocardial infarction.
For migraine prophylaxis, a meta-analysis in Neurology (2012) found propranolol reduces migraine frequency by approximately 50% in 60-80% of patients, comparable to topiramate but with a different side effect profile. Essential tremor studies demonstrate 50-70% reduction in tremor amplitude in controlled trials.
The performance anxiety literature is particularly robust, with multiple studies showing significant reduction in somatic anxiety symptoms during public speaking, musical performance, and test-taking situations at single doses of 10-40mg.
What the studies don’t capture well is the individual variation in response. I’ve had patients with essential tremor who respond beautifully to 60mg daily, while others need 320mg. The genetic polymorphisms in CYP2D6 metabolism create about a four-fold difference in drug exposure between poor and extensive metabolizers.
8. Comparing Inderal with Similar Products and Choosing Appropriate Therapy
When selecting among beta-blockers, several considerations guide clinical decision-making:
Cardioselective agents (metoprolol, atenolol) may be preferable in patients with asthma, COPD, or diabetes due to reduced β2-mediated effects. However, for indications like essential tremor or performance anxiety, the non-selective profile of Inderal provides unique benefits.
Lipid solubility differentiates beta-blockers significantly. Inderal’s high lipophilicity facilitates CNS penetration, making it preferred for neurological indications but potentially increasing central side effects like fatigue and sleep disturbances.
The failed insight we had in our practice was assuming all beta-blockers were interchangeable for migraine. We tried switching several well-controlled patients to atenolol for theoretical pulmonary safety, and about a third had breakthrough migraines until we switched back to propranolol.
9. Frequently Asked Questions (FAQ) about Inderal
How long does Inderal take to work for different conditions?
The onset varies significantly by indication. For performance anxiety, effects begin within 30-60 minutes. Hypertension control develops over 1-3 weeks. Migraine prevention typically requires 4-6 weeks of consistent dosing.
Can Inderal be safely discontinued?
Abrupt discontinuation should be avoided, particularly in angina patients, due to rebound tachycardia and hypertension. Tapering over 1-2 weeks is generally recommended.
Is Inderal safe during pregnancy?
Category C - benefits may justify potential risks in some situations. Used for maternal hypertension, arrhythmias, or thyrotoxicosis with careful monitoring.
Does Inderal cause weight gain?
Modest weight gain (1-2 kg) occurs in some patients, possibly through reduced metabolic rate and blunted lipolysis.
Can Inderal be crushed or split?
Immediate-release tablets can be split, but extended-release capsules should be swallowed whole to maintain the controlled-release properties.
10. Conclusion: Validity of Inderal Use in Clinical Practice
After four decades of clinical use, Inderal maintains an important position in the therapeutic armamentarium. Its non-selective beta-blockade, combined with CNS penetration, creates a unique pharmacological profile that remains valuable for specific indications despite the development of newer agents.
The risk-benefit profile favors Inderal in patients without contraindications who require the specific benefits of non-selective blockade. For essential tremor, performance anxiety, and certain migraine cases, it often outperforms more selective alternatives.
Long-term follow-up of my patients has been revealing. Maria, now 72, has taken propranolol for migraine prevention for twenty-three years with excellent control and no significant adverse effects. James, the essential tremor patient, did eventually develop mild bradycardia at age 78 that required dose reduction, but his tremor control remained adequate at the lower dose.
The real testament came from Sarah, the violinist, who told me last year: “That little pill gave me back my career. I still get nervous before performances - that’s normal - but now it’s the good kind of nervous energy instead of the paralyzing fear.” That’s the clinical reality that never makes it into the controlled trials - the restoration of function and quality of life that comes from the right medication at the right time.