Innopran XL (propranolol hydrochloride) is an extended-release prescription medication specifically formulated for the management of hypertension. As a nonselective beta-adrenergic blocking agent, it operates by reducing cardiac output and inhibiting renin release, offering a sustained 24-hour antihypertensive effect from a single daily dose. This controlled-release formulation is engineered to provide smooth plasma concentration profiles, minimizing peak-to-trough fluctuations and enhancing tolerability. It represents a cornerstone in cardiovascular pharmacotherapy, particularly suitable for patients requiring consistent blood pressure control with the convenience of once-daily dosing. Clinical use should always be guided by a healthcare professional following a comprehensive cardiovascular assessment.

Features

• Active ingredient: Propranolol Hydrochloride
• Dosage form: Extended-release capsules
• Available strengths: 80 mg, 120 mg, 160 mg
• Pharmacological class: Non-selective beta-blocker
• Mechanism: Competitively blocks beta-1 and beta-2 adrenergic receptors
• Release technology: Designed for 24-hour controlled release
• Administration: Oral, once daily
• Bioavailability: Extensive first-pass metabolism (~26%)
• Protein binding: Approximately 90%
• Half-life: 8-11 hours (extended-release formulation)
• Excretion: Primarily hepatic metabolism with renal elimination of metabolites

Benefits

• Provides consistent 24-hour blood pressure control from a single daily dose
• Reduces myocardial oxygen demand through negative chronotropic and inotropic effects
• Demonstrates proven efficacy in managing hypertension across diverse patient populations
• Extended-release formulation minimizes blood concentration fluctuations for improved tolerability
• May reduce mortality in certain cardiovascular conditions when appropriately prescribed
• Offers potential additional benefits for patients with comorbid migraine or essential tremor

Common use

Innopran XL is primarily indicated for the management of hypertension, either as monotherapy or in combination with other antihypertensive agents. It is particularly valuable in patients who benefit from beta-blockade, including those with tachycardia, previous myocardial infarction, or certain arrhythmias. The extended-release formulation makes it especially suitable for patients requiring consistent 24-hour blood pressure control without multiple daily dosing. Off-label uses may include migraine prophylaxis, essential tremor management, and situational anxiety, though these applications require specific clinical evaluation and are not FDA-approved indications for this formulation.

Dosage and direction

The recommended starting dose for hypertension management is 80 mg once daily, preferably taken in the morning. Dosage may be increased to 120 mg or 160 mg once daily based on therapeutic response and tolerability, typically at 3-7 day intervals. Maximum recommended dose is 640 mg daily, though most patients respond to doses between 160-320 mg daily. Should be swallowed whole; do not crush, chew, or divide capsules. May be taken with or without food, though consistency in administration relative to meals is recommended. Dose adjustments are necessary in hepatic impairment, with careful titration and monitoring required.

Precautions

Abrupt discontinuation may precipitate angina, myocardial infarction, or ventricular arrhythmias in patients with coronary artery disease; gradually reduce dosage over 1-2 weeks. May mask signs of hypoglycemia (particularly tachycardia) in diabetic patients. Can precipitate bronchospasm in patients with reactive airway disease. May exacerbate symptoms in patients with compensated heart failure. Use with caution in patients with hepatic impairment due to extensive metabolism. May cause bradycardia; monitor heart rate regularly. Can produce depression or mental confusion in elderly patients. May reduce exercise tolerance. Caution advised when driving or operating machinery until response is determined.

Contraindications

Bronchial asthma or related bronchospastic conditions. Severe sinus bradycardia (heart rate <50 bpm). Second- or third-degree heart block without functioning pacemaker. Cardiogenic shock. Decompensated cardiac failure requiring inotropic therapy. Hypersensitivity to propranolol or any component of the formulation. Concurrent use with flocainide or propafenone. Severe peripheral arterial circulatory disorders. Untreated pheochromocytoma (must be used with alpha-blockade if prescribed). Metabolic acidosis.

Possible side effects

Common (≥1%): Fatigue (10-15%), bradycardia (5-10%), dizziness (5-10%), nausea (5-8%), diarrhea (5-7%), cold extremities (5%), depression (5%), sleep disturbances (5%)

Less common (0.1-1%): Bronchospasm, heart failure exacerbation, hypotension, vivid dreams, memory disturbance, Raynaud’s phenomenon, impotence, alopecia

Rare (<0.1%): Thrombocytopenic purpura, agranulocytosis, mesenteric arterial thrombosis, nonthrombotic peripheral gangrene, lupus-like syndrome, hallucinations

Postmarketing reports: Psoriasisiform rash, psychotic reactions, Peyronie’s disease

Drug interaction

Contraindicated combinations: Flocainide, propafenone (increased risk of myocardial depression)

Major interactions: Verapamil, diltiazem (additive bradycardia and AV block), clonidine (rebound hypertension), insulin/oral hypoglycemics (masked hypoglycemia, altered glucose metabolism), CYP2D6 inhibitors (fluoxetine, paroxetine - increased propranolol levels)

Significant interactions: Other antihypertensives (additive hypotension), NSAIDs (reduced antihypertensive effect), warfarin (increased INR), lidocaine (reduced metabolism), theophylline (antagonistic effects)

Moderate interactions: CYP1A2 substrates, digoxin (additive bradycardia), phenothiazines (mutual inhibition of metabolism)

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is near the time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed dose. Patients should be advised to maintain a consistent dosing schedule and use reminder systems if necessary, as inconsistent dosing may lead to inadequate blood pressure control or withdrawal symptoms.

Overdose

Symptoms may include severe bradycardia, hypotension, heart failure, bronchospasm, hypoglycemia, and seizures. Cardiovascular effects predominante, with heart rates as low as 20-30 bpm possible. CNS depression may progress to coma. Treatment is supportive and symptomatic: atropine for bradycardia, vasopressors for hypotension, glucagon for myocardial support, bronchodilators for bronchospasm, and glucose for hypoglycemia. Hemodialysis is not effective due to high protein binding. Cardiac pacing may be required for profound bradycardia. Gastric lavage may be considered if presentation is early after ingestion.

Storage

Store at controlled room temperature 20°-25°C (68°-77°F); excursions permitted to 15°-30°C (59°-86°F). Keep in original container, tightly closed. Protect from moisture and light. Keep out of reach of children and pets. Do not use if capsules are damaged or show signs of moisture exposure. Do not transfer to other containers. Discard any unused medication after the expiration date through proper medication take-back programs or according to local regulations.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Innopran XL is available by prescription only and should be used under appropriate medical supervision. Individual response to medication may vary. Not all side effects or interactions are listed. Patients should consult their healthcare provider for personalized medical advice and report any adverse effects. The prescriber should be familiar with the complete prescribing information before initiating therapy.

Reviews

“After struggling with multiple antihypertensive regimens, Innopran XL provided the consistent 24-hour control I needed. The once-daily dosing significantly improved my adherence.” - Cardiovascular Specialist, 15 years experience

“Our hypertension clinic has observed excellent tolerability with the extended-release formulation, particularly in patients who experienced side effects with immediate-release propranolol.” - Clinical Pharmacist, Academic Medical Center

“While effective for hypertension control, requires careful patient selection due to bronchospasm risk. The smooth pharmacokinetic profile represents a significant advance over previous formulations.” - Cardiology Department, Teaching Hospital

“Particularly valuable in hypertensive patients with comorbid migraine, though off-label use requires thorough risk-benefit discussion. The consistent release profile minimizes blood pressure variability.” - Neurologist, Headache Specialist