Tips for tapering off propranolol

[Altostrata]

Also see  Tapering Alpha Blockers or Beta Blockers

 

Anti-hypertensives or drugs that lower  blood pressure, such as propranolol, a beta blocker, and clonidine, an alpha-agonist, are often prescribed for calming. Overall, hypotensives affect blood pressure and the body accommodates to them, becoming physiologically dependent, just as any psychiatric drug. They must be tapered; too-fast reduction can cause a dangerous rebound in blood pressure.

 

According to https://www.drugs.com/monograph/propranolol-hydrochloride.html

• Immediate-release propranolol is available in 10mg, 20mg, 40mg, 60mg, and 80 mg tablets
• Propranolol has a very short half-life of only a few hours
• The extended-release version has a half-life of about 10 hours
• Solution and solution concentrate: Maximum stability at pH 3, rapidly decomposes at alkaline pH. (Pure water is about pH 7, higher than that is akaline.) Keep in tight, light-resistant containers at 20–25°C.

   

Immediate-release tablets are usually scored for splitting.

 

Rate of tapering

Anti-hypertensives may be tapered somewhat faster than psychiatric drugs. A 10% reduction per week allows blood pressure regulation to adjust.

 

However, some people may be sensitive to reducing at that rate and must reduce slower, as the anti-hypertensives might react with other drugs the person is taking and reduction of one drug affects the balance and metabolism of the others.

 

It is also possible an anti-hypertensive might be masking another symptom or side effect, and when the anti-hypertensive is reduced, these symptoms re-emerge.

 

When changing the dosage of an anti-hypertensive, always keep daily notes on paper about your symptoms, when you take your drugs, and their dosages.If blood pressure spikes or other symptoms occur, stop tapering immediately. If the symptoms are severe, reinstate the prior dosage. You will need to taper the anti-hypertensive slower.

 

Taper by splitting tablets

At least at first, depending on your dosage, you may be able to taper by cutting up immediate-release tablets. Half of a 10mg tablet would give you steps of 5mg.

 

(If you are substituting immediate-release tablets for the extended-release capsules, you will have to take them at least twice a day.)

 

Taper by dividing an extended-release capsule

The extended-release capsules are filled with powder containing material to prolong absorption of the drug.

 

To divide an extended-release capsule, the best method would be to use a digital scale. Cutting up immediate-release tablets or using a liquid to taper are much easier methods.

 

Taper with a combination of liquid and tablets

The best way to taper would be to use a combination of liquid and tablets until you get down to a dosage smaller than a 10mg tablet, then use liquid only.

 

To taper with a tablet-liquid combination, use low-dosage tablets and make up the rest with liquid. You will need to ask your doctor for a prescription specifying taking the tablets more than once a day.

 

How to make a liquid

Propranolol is easily made into a liquid with water or pharmacy liquid. Use an oral syringe to measure dosage.

 

 

Quote

 

J Paediatr Child Health. 2011 Jul;47(7):484-5. doi: 10.1111/j.1440-1754.2011.02135.x.

 

Giving Propranolol Tablets to Infants With Hemangiomas – Solubility in Water

Mr Neil B Greenhill

Professor Glen B Deacon

Dr Roderic J Phillips

First published: 19 July 2011

https://doi.org/10.1111/j.1440-1754.2011.02135.x

 

A propranolol syrup can be made up by some pharmacies. However, this has a relatively short shelf life and, unless it is subsidised (e.g. by a hospital), it can greatly increase the cost. For example, families have paid $60–$70 per month for syrup compared with $6 per month for tablets. For this reason, most of our parents dissolve 10mg tablets in water and then withdraw the appropriate dose for the baby. Prepared in this way, the aqueous solution is always a little cloudy. Some parents expressed the concern that most of the active propranolol might be in the undissolved fraction and hence lead to uneven dosing. We have therefore undertaken an analysis of these solutions to determine whether significant propranolol was remaining undissolved.

 

All commercially available tablets of propranolol are marketed as the hydrochloride salt to increase its solubility. We obtained pure propranolol hydrochloride from AstraZeneca Pty Ltd and 10 mg and 40 mg tablets (Inderal‐AstraZeneca, North Ryde, NSW, Australia), Deralin (Alphapharm, Glebe, NSW, Australia)) from a local pharmacy. The identity of the propranolol hydrochloride was confirmed by mass spectrometry and ultraviolet spectrometry. Quantification of the amount of propranolol in solutions was by ultraviolet spectroscopy. We present here a summary of our findings.

 

• 1

  Forty milligrams of pure propranolol hydrochloride powder dissolved fully (>98%) in 10 mL of tap water within 1 min of mixing.

• 2

  When tablets were soaked for 1 min in 10 mL of tap water, crushed and filtered, most of the expected propranolol was found to be in the filtrate (85–100% Inderal, 73–90% Deralin). Shorter soaking/crushing periods led to lower recovery rates.

• 3

  Parents do not filter the solutions they prepare and we can expect the doses received by infants to be close to 100% for two reasons. Firstly, the filtration step in our experiment leads to losses of solution of 3–4%. Secondly, the infants will also receive any remaining undissolved propranolol in suspension.

 

Soaking 10 mg propranolol tablets in 10 mL of water for 1 min, before crushing and then withdrawing a dose from the unfiltered solution is therefore an acceptable way of dosing infants. We advise parents in writing how to do this. Most of our families have found this method simple and easy to use. The aqueous solution is either given directly, or added to milk or food. At review visits, we assess the dosing technique of all families and no family has had any problems following our written instructions.

 

 

The stability of propranolol in pharmacy liquids has been found to be 120 days, stored at either 25°C or 4°C. This is very stable.

 

If you make a liquid with water, keep it in a tinted bottle in the refrigerator. Discard after 7 days.

[Cat416]

Thank you for this information. Very helpful for me. Appreciated. 

[Doctorsrcrap]

On 7/9/2018 at 7:26 PM, Altostrata said:

Rate of tapering

Anti-hypertensives may be tapered somewhat faster than psychiatric drugs. A 10% reduction per week allows blood pressure regulation to adjust.

 

@Shep

@Altostrata

This is the information I used. So over a month I tapered it 16% but by this it could have been a lot more. I thought the cuts I was making were sensible. 

[Altostrata]

It's very possible the symptoms you reported in your Introductions topic came from something other than the propranolol taper. Please respond to your Introductions topic.