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INNOPRAN-XL (PROPRANOLOL HYDROCHLORIDE): DRUG-DRUG INTERACTIONS

Caution should be exercised when InnoPran-XL (Propranolol HCl) is administered with drugs that have an effect on CYP2D6, 1A2, or 2C19 metabolic pathways. Co-administration of such drugs with propranolol may lead to clinically relevant drug interactions and changes on its efficacy and/or toxicity.

Plasma propranolol levels may increase with acute alcohol consumption and decrease upon chronic use.

Cardiovascular Drugs

ACE Inhibitors

When combined with beta-blockers, ACE inhibitors can cause hypotension, particularly in the setting of acute myocardial infraction.

The antihypertensive effects of clonidine may be antagonized by beta-blockers. InnoPran-XL (Propranolol HCl) capsules should be administered cautiously to patients withdrawing from clonidine.

Alpha Blockers

Prazosin has been associated with prolongation of first dose hypotension in the presence of beta-blockers.

Postural hypotension has been reported in patients taking both beta-blockers and terazosin or doxazosin.

Antiarrhythmics

Propafenone has negative inotropic and beta-blocking properties that can be additive to those of InnoPran-XL (Propranolol Hydrochloride).

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 beta blockers such as InnoPran-XL (Propranolol Hydrochloride) capsules.

The clearance of lidocaine and bupivacaine are significantly reduced with administration of propranolol. Lidocaine and bupivacaine toxicity has been reported following coadministration with this drug.

Caution should be exercised when administering Propranolol (InnoPran-XL) with drugs that slow A-V nodal conduction, e.g., digitalis, lidocaine, and calcium channel blockers.

Calcium Channel Blockers

Caution should be exercised when patients receiving a beta-blocker are administered a calcium-channel-blocking drug with negative inotropic and/or chronotropic effects. Both agents may depress myocardial contractility or atrioventricular conduction.

There have been reports of significant bradycardia, heart failure, and cardiovascular collapse with concurrent use of verapamil and beta-blockers.

Co-administration of Propranolol (InnoPran-XL) capsules and diltiazem in patients with cardiac disease has been associated with bradycardia, hypotension, high degree heart block, and heart failure.

Digitalis Glycosides

Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia.

Inotropic Agents

Patients on long-term therapy with Propranolol HCl (InnoPran-XL) may experience uncontrolled hypertension if administered epinephrine as a consequence of unopposed alpha-receptor stimulation. Epinephrine is therefore not indicated in the treatment of propranolol overdose.

Isoproterenol and Dobutamine

Propranolol HCl (InnoPran-XL) capsules is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, e.g., dobutamine or isoproterenol. Also, propranolol may reduce sensitivity to dobutamine stress echocardiography in patients undergoing evaluation for myocardial ischemia.

Reserpine

Patients receiving catecholamine-depleting drugs, such as reserpine and Propranolol Hydrochloride (InnoPran-XL), should be closely observed for excessive reduction of resting sympathetic nervous activity, which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic hypotension.

Non-Cardiovascular Drugs

Anesthetic Agents

Methoxyflurane and trichloroethylene may depress myocardial contractility when administered with Propranolol Hydrochloride (InnoPran-XL) capsules.

The clearance of local amide anesthetics (e.g., lidocaine, bupivacaine, mepivacaine) is reduced with administration of propranolol. Lidocaine and bupivacaine toxicity has been reported following coadministration with propranolol. Caution should be exercised when amide anesthetic agents are administered concomitantly with propanolol.

Antidepressants

The hypotensive effects of MAO inhibitors or tricyclic antidepressants may be exacerbated when administered with beta-blockers by interfering with the beta-blocking activity of InnoPran-XL (Propranolol).

Neuroleptic Drugs

Hypotension and cardiac arrest have been reported with the concomitant use of propranolol and haloperidol.

Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDS) have been reported to blunt the antihypertensive effect of beta-adrenoreceptor blocking agents.

Administration of indomethacin with propranolol may reduce the efficacy of InnoPran-XL (Propranolol) capsules in reducing blood pressure and heart rate.

Thyroxine

Thyroxine may result in a lower than expected T3 concentration when used concomitantly with propranolol.

Warfarin

InnoPran-XL (Propranolol HCl) when administered with warfarin increases the concentration of warfarin. Prothrombin time, therefore, should be monitored.

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