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Side Effects of Propranolol 40mg + Flunarizine 10mg:Bradycardia, hypotension, syncope, shock, angina pectoris. Lightheadedness, giddiness, ataxia, dizziness, irritability, sleepiness, hearing loss, and visual disturbances to vivid dreams, hallucinations, and confusion. Epigastric distress, abdominal cramping, nausea, vomiting, diarrhoea, constipation, and flatulence. Hypoglycaemia, skin rash, transient eosinophilia, thrombocytopenic and nonthrombocytopenic purpura; elevated levels of K, transaminases, and BUN. Rarely, Peyronie's disease and dry eyes.
Drug Interactions of Propranolol 40mg + Flunarizine 10mg:
May cause additive negative chronotropic and/or inotropic effect w/ amiodarone, disopyramide, quinidine, flecainide and Ca channel blockers. May cause additive hypotensive effect w/ phenothiazines. Î²-adrenergic stimulating effects of sympathomimetic agents are antagonised. Concomitant admin w/ catecholamine-depleting drugs (e.g. reserpine) may cause additive effects and potentiate depression. Reduced antihypertensive effect w/ aluminium and NSAIDs. Coadministration w/ warfarin increases its bioavailability and prothrombin time. Altered antidiabetic response when used w/ antidiabetic agents and insulin. Potentially Fatal: Increased risk of QT interval prolongation and torsades de pointes w/ thioridazine.
Contraindications of Propranolol 40mg + Flunarizine 10mg:
Sinus bradycardia, cardiogenic shock, sick sinus syndrome, Raynaud's syndrome, 2nd and 3rd degree heart block, overt CHF, bronchial asthma, COPD, untreated phaeochromocytoma, Prinzmetal's angina; severe peripheral arterial disease, metabolic acidosis. Concomitant use w/ thioridazine.
Mechanism of Action of Propranolol 40mg + Flunarizine 10mg:
Propranolol is a non-cardioselective Î²-blocker that competitively blocks Î²1- and Î²2-receptors resulting in decreased heart rate, myocardial contractility, BP and myocardial oxygen demand. It has membrane-stabilising properties. Onset: 1-2 hr (oral). Absorption: Almost completely absorbed from the GI tract. Bioavailability: Approx 25%. Time to peak plasma concentration: Approx 1-2 hr (oral). Distribution: Widely distributed, enters breast milk, crosses blood brain barrier and placenta. Volume of distribution: 4 L/kg. Plasma protein binding: Approx 90%. Metabolism: Undergoes hepatic metabolism via CYP2D6 isoenzyme, and CYP1A2 to 4-hydroxypropranolol (biologically active). Excretion: Via urine (96-99% as metabolites and <1% as unchanged drug). Elimination half-life: Approx 3-6 hr.
Special Precautions for Propranolol 40mg + Flunarizine 10mg:
Sinus node dysfunction, DM, history of nonallergic bronchospasm (e.g. chronic bronchitis, emphysema), myasthenia gravis, 1st degree heart block. May mask signs of hyperthyroidism and hypoglycaemia. Renal or hepatic impairment. Abrupt withdrawal may exacerbate angina symptoms or precipitate MI in patients w/ coronary artery disease. Elderly. Pregnancy and lactation. Patient Counselling Avoid cigarette smoking. Monitoring Parameters Monitor ECG, heart rate and BP
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