Ciplar Tablets (Generic Propranolol Hydrochloride Tablets) – Product Information
Ciplar (Generic Propranolol Hydrochloride Tablets) is a nonselective beta-adrenergic receptor blocking agent used in the treatment of Hypertension, Angina Pectoris Due to Coronary Atherosclerosis, Atrial Fibrillation, Myocardial Infarction, Migraine, Essential Tremor, Hypertrophic Subaortic Stenosis and Pheochromocytoma.
We also stock Pradaxa (Dabigatran Etexilate Capsules)
which are used to reduce the risk of stroke and blood clots in patients that have a medical condition called atrial fibrillation.
Name of Drug
Manufacturer of Ciplar Tablets (Propranolol Hydrochloride Tablets)
Cipla Limited, India
Active Pharmaceutical Ingredient
The active pharmaceutical ingredient contained in Ciplar tablets is Propranolol Hydrochloride. Each tablet contains 40 mg of Propranolol hydrochloride IP.
Mechanism of Action
The mechanism of the antihypertensive effect of Propranolol (Ciplar Tablets)has not been established. Factors that may contribute to the antihypertensive action include: (1) decreased cardiac output, (2) inhibition of renin release by the kidneys, and (3) diminution of tonic sympathetic nerve outflow from vasomotor centers in the brain.
In angina pectoris, propranolol generally reduces the oxygen requirement of the heart at any given level of effort by blocking the catecholamine-induced increases in the heart rate, systolic blood pressure, and the velocity and extent of myocardial contraction.
Propranolol exerts its antiarrhythmic effects in concentrations associated with beta-adrenergic blockade, and this appears to be its principal antiarrhythmic mechanism of action.
The specific mechanism of propranolol's antitremor effects has not been established, but beta-2 (noncardiac) receptors may be involved. A central effect is also possible.
Uses of Ciplar (Generic Propranolol Hydrochloride Tablets)
The uses of Ciplar Tablets (Generic Propranolol Hydrochloride) are given below: Hypertension: Ciplar is used in the management of hypertension. It may be used alone or used in combination with other antihypertensive agents, particularly a thiazide diuretic. Ciplar is not indicatedin the management of hypertensive emergencies.
Angina Pectoris Due to Coronary Atherosclerosis: Ciplar is used to decrease angina frequency and increase exercise tolerance in patients with angina pectoris.
Atrial Fibrillation: Ciplar is used to control ventricular rate in patients with atrial fibrillation and a rapid ventricular response.
Myocardial Infarction: Ciplar is used to reduce cardiovascular mortality in patients who have survived the acute phase of myocardial infarction and are clinically stable.
Migraine: Ciplar is used for the prophylaxis of common migraine headache. The efficacy of propranolol in the treatment of a migraine attack that has started has not been established, and propranolol is not indicated for such use.
Essential Tremor: Ciplar is used in the management of familial or hereditary essential tremor. Familial or essential tremor consists of involuntary, rhythmic, oscillatory movements, usually limited to the upper limbs. It is absent at rest, but occurs when the limb is held in a fixed posture or position against gravity and during active movement. Ciplar causes a reduction in the tremor amplitude, but not in the tremor frequency. Inderal is not indicated for the treatment of tremor associated with Parkinsonism.
Hypertrophic Subaortic Stenosis: Ciplar improves NYHA functional class in symptomatic patients with hypertrophic subaortic stenosis.
Pheochromocytoma: Ciplar is used as an adjunct to alpha-adrenergic blockade to control blood pressure and reduce symptoms of catecholamine-secreting tumors.
Ciplar (Generic Propranolol Hydrochloride Tablets) – Dosage
Due to the variable bioavailability of Propranolol, the dose of Ciplar (Generic Propranolol Hydrochloride Tablets) must be individualized based on response.
Hypertension: The usual starting dosage is 40 mg Propranolol Hydrochloride twice daily, whether used alone or added to a diuretic. Dosage may be increased gradually until adequate blood pressure control is achieved. The usual maintenance dosage is 120 mg to 240 mg per day. In some instances a dosage of 640 mg a day may be required.
Angina Pectoris: Total daily doses of 80 mg to 320 mg Propranolol Hydrochloride, when administered orally, twice a day, three times a day, or four times a day, have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG. If treatment is to be discontinued, reduce dosage gradually over a period of several weeks.
Atrial Fibrillation: The recommended dose is 10 mg to 30 mg Propranolol Hydrochloride three or four times daily before meals and at bedtime.
Myocardial Infarction: In the Beta-Blocker Heart Attack Trial (BHAT), the initial dose was 40 mg three times a day, with titration after 1 month to 60 mg to 80 mg three times a day as tolerated. The recommended daily dosage is 180 mg to 240 mg Propranolol Hydrochloride per day in divided doses.
Migraine: The initial dose is 80 mg Propranolol Hydrochloride daily in divided doses. The usual effective dose range is 160 mg to 240 mg per day. The dosage may be increased gradually to achieve optimum migraine prophylaxis. If a satisfactory response is not obtained within four to six weeks after reaching the maximum dose, propranolol therapy should be discontinued.
Essential Tremor: The initial dosage is 40 mg propranolol hydrochloride twice daily. Optimum reduction of essential tremor is usually achieved with a dose of 120 mg per day. Occasionally, it may be necessary to administer 240 mg to 320 mg per day.
Hypertrophic Subaortic Stenosis: The usual dosage is 20 mg to 40 mg propranolol hydrochloride three or four times daily before meals and at bedtime.
Pheochromocytoma: The usual dosage is 60 mg propranolol hydrochloride daily in divided doses for three days prior to surgery as adjunctive therapy to alpha-adrenergic blockade. For the management of inoperable tumors, the usual dosage is 30 mg daily in divided doses as adjunctive therapy to alpha-adrenergic blockade.
Ciplar Tablets - Contraindications
Ciplar tablets are contraindicated in persons with a hypersensitivity (allergy) to Propranolol Hydrochloride or any of the other ingredients of this medicine.
Ciplar (Generic Propranolol Hydrochloride Tablets) is also contraindicated in patients with 1) cardiogenic shock; 2) sinus bradycardia and greater than first degree block; 3) bronchial asthma
Storage Instructions for Ciplar (Generic Propranolol Hydrochloride Tablets)
Store at 20°C to 25°C (68°F to 77°F). Excursions permitted to 15°C to 30°C (59°F to 86°F). Store in a tight, light-resistant container, with a child-resistant closure (as required). Protect from light.Keep this and all medications out of the reach of children.
Warnings and Precautions to be taken when using Tablets ( Tablets)
Before using tablets please inform your doctor about all the medicines that you take including no prescription medications, over the counter medicines and herbal remedies.
Angina Pectoris:There have been reports of exacerbation of angina and, in some cases, myocardial infarction, following abrupt discontinuance of propranolol therapy. Therefore, when discontinuance of propranolol is planned, the dosage should be gradually reduced over at least a few weeks and the patient should be cautioned against interruption or cessation of therapy without the physician's advice.
Hypersensitivity and Skin Reactions: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, have been associated with the administration of propranolol. Cutaneous reactions, including Stevens-Johnson Syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported with use of Propranolol Hydrochloride Tablets(Ciplar).
Cardiac Failure: Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failure, and its inhibition by beta blockade may precipitate more severe failure.
In Patients without a History of Heart Failure, continued use of beta blockers can, in some cases, lead to cardiac failure.
Nonallergic Bronchospasm (e.g., Chronic Bronchitis, Emphysema):In general, patients with bronchospastic lung disease should not receive beta blockers. Propranolol should be administered with caution in this setting since it may provoke a bronchial asthmatic attack by blocking bronchodilation produced by endogenous and exogenous catecholamine stimulation of beta-receptors.
Major Surgery:Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery, however the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
Diabetes and Hypoglycemia: Beta-adrenergic blockade may prevent the appearance of certain premonitory signs and symptoms (pulse rate and pressure changes) of acute hypoglycemia, especially in labile insulin-dependent diabetics. In these patients, it may be more difficult to adjust the dosage of insulin.
Propranolol therapy, particularly when given to infants and children, diabetic or not, has been associated with hypoglycemia, especially during fasting as in preparation for surgery.
Thyrotoxicosis: Beta-adrenergic blockade may mask certain clinical signs of hyperthyroidism. Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation of symptoms of hyperthyroidism, including thyroid storm. Propranolol may change thyroid-function tests, increasing T4 and reverse T3 and decreasing T3.
Wolff-Parkinson-White Syndrome: Beta-adrenergic blockade in patients with Wolf-Parkinson-White Syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol.
Pheochromocytoma: Blocking only the peripheral dilator (beta) action of epinephrine with Propranolol leaves its constrictor (alpha) action unopposed. In the event of hemorrhage or shock, there is a disadvantage in having both beta and alpha blockade since the combination prevents the increase in heart rate and peripheral vasoconstriction needed to maintain blood pressure.
Side Effects of Ciplar (Generic Propranolol Hydrochloride Tablets)
The following side effects were observed and have been reported in patients using Propranolol Hydrochloride (Ciplar Tablets).
- Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type. Central Nervous System: Light-headedness, mental depression manifested by insomnia, lassitude, weakness, fatigue; catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics. For immediate-release formulations, fatigue, lethargy, and vivid dreams appear dose-related.
- Gastrointestinal: Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, ischemic colitis.
- Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, pharyngitis and agranulocytosis; erythematous rash, fever combined with aching and sore throat; laryngospasm, and respiratory distress.
- Respiratory: Bronchospasm.
- Hematologic: Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura.
- Autoimmune: Systemic lupus erythematosus (SLE).
- Skin and mucous membranes: Stevens-Johnson Syndrome, toxic epidermal necrolysis, dry eyes, exfoliative dermatitis, erythema multiforme, urticaria, alopecia, SLE-like reactions, and psoriasiform rashes. Oculomucocutaneous syndrome involving the skin, serous membranes and conjunctivae reported for a beta blocker (practolol) have not been associated with propranolol.
- Genitourinary: Male impotence; Peyronie's disease.
Ciplar (Generic Propranolol Hydrochloride Tablets) – Drug Interactions
Interactions with Substrates, Inhibitors or Inducers of Cytochrome P-450 Enzymes Because propranolol's metabolism involves multiple pathways in the cytochrome P-450 system(CYP2D6, 1A2, 2C19), co-administration with drugs that are metabolized by, or effect the activity (induction or inhibition) of one or more of these pathways may lead to clinically relevantdrug interactions.
Propranolol Hydrochloride (Ciplar Tablets) Overdosage
Propranolol is not significantly dialyzable. In the event of overdosage or exaggerated response, the following measures should be employed:
General: If ingestion is or may have been recent, evacuate gastric contents, taking care to prevent pulmonary aspiration.
Supportive Therapy: Hypotension and bradycardia have been reported following propranolol overdose and should be treated appropriately. Glucagon can exert potent inotropic and chronotropic effects and may be particularly useful for the treatment of hypotension or depressed myocardial function after a propranolol overdose. Glucagon should be administered as 50–150 mcg/kg intravenously followed by continuous drip of 1–5 mg/hour for positive chronotropic effect. Isoproterenol, dopamine or phosphodiesterase inhibitors may also be useful. Epinephrine, however, may provoke uncontrolled hypertension. Bradycardia can be treated with atropine or isoproterenol. Serious bradycardia may require temporary cardiac pacing.
The electrocardiogram, pulse, blood pressure, neurobehavioral status and intake and output balance must be monitored. Isoproterenol and aminophylline may be used for bronchospasm.
Propranolol Hydrochloride (Ciplar Tablets) During Pregnancy
Propranolol Hydrochloride (Ciplar Tablets) is classified by the US FDA as Pregnancy Category C.
In a series of reproductive and developmental toxicology studies, propranolol hydrochloride was given to rats by gavage or in the diet throughout pregnancy and lactation. At doses of 150 mg/kg/day, but not at doses of 80 mg/kg/day (equivalent to the MRHD on a body surface area basis), treatment was associated with embryotoxicity (reduced litter size and increased resorption rates) as well as neonatal toxicity (deaths).
There are no adequate and well-controlled studies in pregnant women. Intrauterine growth retardation, small placentas, and congenital abnormalities have been reported in neonates whose mothers received propranolol during pregnancy.
Neonates whose mothers received propranolol at parturition have exhibited bradycardia, hypoglycemia, and/or respiratory depression. Adequate facilities for monitoring such infants at birth should be available.
Ciplar (Generic Propranolol Hydrochloride Tablets) should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Buy Ciplar 40 mg (Generic Propranolol Hydrochloride Tablets) Online
You can buy Generic Propranolol Hydrochloride tablets online at a cheap rate from the Swiss Pharmacy. Ciplar 40 mg pills are priced at only $0.39 per unit if you place an order for 360 tablets.
This Product was added to our catalogue on Wednesday, 13. November 2013.
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