Propranolol ER S.R.

• Do not stop using this drug without first consulting your medical provider. Your condition may become worse when the drug is suddenly stopped, especially if you have chest pain (angina) or heart conditions, such as coronary artery disease, ischemic heart disease or high blood pressure.
• If your medical provider decides you should no longer use this drug, you must gradually decrease your dose according to their instructions.

• When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease strain on the heart. Seek immediate medical attention if you develop:

  • Chest pain
  • Tightness or pressure in the chest
  • Chest pain spreading to the jaw, neck or arm
  • Unusual sweating
  • Trouble breathing
  • Fast or irregular heartbeat

• This medication is a beta blocker used to treat high blood pressure, irregular heartbeats, shaking (tremors) and other conditions as determined by your medical provider. It is used after a heart attack to improve survival. It is also used to prevent migraine headaches and chest pain (angina).
• Lowering high blood pressure helps prevent strokes, heart attacks and kidney problems. Preventing chest pain can help improve your ability to exercise.
• This drug works by blocking the action of certain natural chemicals (such as epinephrine) in your body that affect the heart and blood vessels. This reduces heart rate, blood pressure and strain on the heart.

• Take this medication by mouth as directed by your medical provider, usually once daily. Swallow the capsules whole. Do not crush or chew the capsules.
• The dosage is based on your medical condition and response to treatment.
• Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day. Keep taking this medication even if you feel well.
• This medication is used to help prevent chest pain or migraines. It should not be used to treat chest pain or migraines when they occur. Use other medications (such as Nitroglycerin tablets placed under the tongue for chest pain or Sumatriptan for migraines) to relieve sudden attacks as directed by your medical provider. Consult your medical provider or pharmacist for details.
• It may take 1 to 2 weeks before you get the full benefit of this drug.
• If you also take certain drugs to lower your cholesterol—including bile acid-binding resins, such as Cholestyramine or Colestipol—take Propranolol at least 1 hour before or at least 4 hours after these medications.
• Tell your medical provider if your condition worsens—for example, your routine blood pressure readings increase or your chest pain or migraines occur more often.

• Dizziness, lightheadedness or tiredness may occur as your body adjusts to the medication. Nausea or vomiting, stomach pain, vision changes, trouble sleeping and unusual dreams may also occur. If any of these effects last or get worse, tell your medical provider or pharmacist right away.
• To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.
• This drug may reduce blood flow to your hands and feet, causing them to feel cold. Smoking may worsen this effect. Dress warmly and avoid tobacco use.

• Remember that this medication has been prescribed because your medical provider has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not experience serious side effects. Tell your medical provider right away if you experience any serious side effects, including:

  • Blue fingers or toes
  • Mental or mood changes, such as depression
  • Numbness or tingling in the arms or legs
  • New or worsening symptoms of heart failure, such as shortness of breath, swelling ankles or feet, unusual tiredness or unusual/sudden weight gain
  • Very slow heartbeat
  • Fainting
  • Decreased sexual ability
  • Increased thirst or urination
  • Easy bruising or bleeding
  • Signs of infection, such as sore throat that doesn't go away or fever
  • Aching or swollen joints

• A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

  • Rash
  • Itching or swelling, especially of the face/tongue/throat
  • Severe dizziness
  • Trouble breathing

• This is not a complete list of possible side effects. If you notice other effects not listed above, request a callback for medical advice. You may also report side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

• Before taking Propranolol, tell your medical provider or pharmacist if you are allergic to it, have had a serious reaction to other beta blockers, such as Metoprolol, or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Go to your patient dashboard and request a callback for more details.

• Before using this medication, tell your medical provider or pharmacist your medical history, especially of:

  • Diabetes
  • Myasthenia gravis
  • Other breathing problems, such as asthma, bronchitis or emphysema
  • Heart failure
  • Certain types of heart rhythm problems, such as sinus bradycardia, Wolff-Parkinson-White syndrome or second- or third-degree atrioventricular block
  • Overactive thyroid (hyperthyroidism)
  • Kidney disease
  • Liver disease
  • Blood circulation problems, such as Raynaud's disease
  • A pheochromocytoma tumor
  • Mental or mood disorders, such as depression
  • Certain muscle or nerve diseases, including myasthenia gravis
  • Severe allergic reactions
• This drug may make you dizzy. Alcohol or marijuana (cannabis) can exacerbate the effect. Do not drive, use machinery or do anything that requires alertness until you can do it safely. Limit alcoholic beverages. Talk to your medical provider if you are using marijuana.
• Before having surgery, tell your doctor or dentist about all the products you use—including prescription drugs, nonprescription drugs and herbal products.
• If you have diabetes, this product may mask the fast/pounding heartbeat you would usually feel when your blood sugar falls too low (hypoglycemia). Other symptoms of low blood sugar, such as dizziness and sweating, are unaffected by this drug. This product may also make it harder to control your blood sugar. Check your blood sugar regularly as directed and share the results with your medical provider. Tell your medical provider right away if you have symptoms of high blood sugar, such as increased thirst or urination. They may need to adjust your diabetes medication, exercise program or diet.
• Children may be at greater risk for low blood sugar (hypoglycemia), especially if they are vomiting or not eating regularly. To help prevent low blood sugar, feed children on a regular schedule. If your child cannot eat regularly, is vomiting or has symptoms of low blood sugar (such as sweating or seizures), stop this medication and tell your medical provider right away.
• During pregnancy, this medication should be used only when there is a clear need. Infants exposed to this medication during pregnancy may have low birth weight, low blood sugar or slow breathing/heartbeat. Discuss the risks and benefits with your medical provider.
• This drug passes into breast milk. Consult your medical provider before breastfeeding.

• Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions.
• Keep a list of all the products you use—including prescription/nonprescription drugs and herbal products—and share it with your medical provider and pharmacist.
• Do not start, stop or change the dosage of any medicines without your medical provider's approval.

• Some products that may interact with this drug include:

  • Alpha blockers, such as Prazosin
  • Aluminum hydroxide
  • Anticholinergics, such as Atropine and Scopolamine
  • Chlorpromazine
  • Other drugs to treat high blood pressure, such as Clonidine, Hydralazine and Methyldopa
  • Epinephrine
  • Fingolimod
  • Haloperidol
  • Other heart medications, such as Digoxin, Disopyramide, Propafenone and Quinidine
  • Mefloquine
  • Rizatriptan
  • Theophylline
  • Thioridazine
  • Thyroid hormones, such as Levothyroxine
  • Warfarin
  • Drugs affecting liver enzymes that remove Propranolol from your body, such as Cimetidine, St. John's wort, certain SSRI antidepressants, including Fluoxetine/Paroxetine/Fluvoxamine, and rifamycins, including Rifabutin.
• Some products have ingredients that could raise your heart rate or blood pressure. Tell your pharmacist what products you are using, and ask how to use them safely—especially cough-and-cold products, diet aids or NSAIDs, such as Ibuprofen and Naproxen.
• This medication may interfere with certain laboratory tests—including glaucoma screenings and cardiovascular stress testing using Arbutamine—and cause false test results. Make sure laboratory personnel and all your medical providers know you use this drug.

• Do not share this medication with others.
• Lifestyle changes, such as stress reduction programs, exercise and dietary changes, may increase the effectiveness of this medicine. Talk to your medical provider or pharmacist about lifestyle changes that might benefit you.
• Have your blood pressure and pulse checked regularly while taking this medication. It may be best to learn how to monitor your own blood pressure and pulse. Discuss this with your medical provider.

If you miss a dose, take it as soon as you remember, but not if it is within 8 hours of the next dose. If it is within 8 hours of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

• Store at room temperature away from light and moisture. Do not store in the bathroom.
• Keep all medications away from children and pets.
• Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more information.