프로프라놀롤

Propranolol

Propranolol Hydrochloride

다른 이름: Inderal LA · InnoPran XL · Syprol · AY-64043 · ICI-45520 · NSC-91523 · propranololi hydrochloridum · Propranolol hydrochloride

VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료

감사 완료 v13 용량 근거

구조화 용량 계산 근거

Hypertrophic cardiomyopathy (extra-label)

0.5–2 mg/kgPOSC

인증된 수의사 확인 필요

q12-24h

반드시 함께 고려할 임상 맥락 (6)

NOTE: Because of a high first-pass effect after oral dosing, IV dosages are ≈10% of oral dosages. Do not confuse the dosages.
■ This medicine can be given with or without food.
■ When starting this medicine, your veterinarian may start with a low dose and gradually increase it over time to see how your animal reacts to it. Do not administer more than your veterinarian prescribes.
■ Do not suddenly stop giving propranolol to your animal as it can make your animal’s condition worse.
■ Your veterinarian will need to monitor your animal closely while it is receiving this medicine. Do not miss these important follow-up visits.
All propranolol preparations should be stored at room temperature (15°C-30°C [59°F-86°F]) and protected from light. Propranolol solutions will decompose rapidly at alkaline pH.

고위험인증된 수의사 확인 필요formulary프로토콜 2023감사 dose-audit-plumb-v13

용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.

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개요

프로프라놀롤은 비선택적 베타 교감신경 길항제(베타 차단제)로, 수의학에서는 주로 항부정맥 특성 때문에 사용됩니다. 제2형 항부정맥제로 분류됩니다.

주요 용도: 상심실성 및 심실성 빈맥(예: APC, VPC, 심방세동), 비대성 심근병증(HCM) 및 전신 고혈압의 관리.
내분비 용도: 고양이 갑상선 기능 항진증 및 갈색세포종에서 교감신경 과자극으로 인한 심혈관계 및 신경근육계 증상을 조절하는 데 자주 사용됩니다.
행동학적 용도: 개의 상황적 불안이나 큰 소리 공포증에 오프라벨로 사용되기도 합니다.

임상 팁: 프로프라놀롤은 비선택적이므로 심장과 폐의 수용체를 모두 차단합니다. 고양이 천식이나 기타 기관지 경련성 기도 질환이 있는 환자에게는 극도로 주의해서 사용하거나 피해야 합니다.

작용 기전

Propranolol acts via competitive blockade of both $\beta_1$ and $\beta_2$ adrenergic receptors.

$\beta_1$ Blockade (Cardiac): $\rightarrow$ Decreases sinus heart rate (negative chronotropy) $\rightarrow$ Depresses AV node conduction (negative dromotropy) $\rightarrow$ Decreases myocardial contractility (negative inotropy) $\rightarrow$ Ultimately reduces cardiac output and myocardial oxygen demand.
$\beta_2$ Blockade (Pulmonary/Vascular): $\rightarrow$ Can cause bronchoconstriction and peripheral vasoconstriction.
Additional Effects: Possesses membrane-stabilizing (quinidine-like) effects at higher doses, which alters the cardiac action potential. It lacks intrinsic sympathomimetic activity (ISA) and inhibits glycogenolysis.

안전성·주의사항

금기사항

Overt heart failure
Hypersensitivity to beta-blockers
Greater than 1st degree heart block
Sinus bradycardia
Congestive heart failure (unless secondary to a tachyarrhythmia responsive to beta-blockers)
Bronchospastic lung disease (e.g., feline asthma)
Bradyarrhythmias
Acute or decompensated congestive heart failure
Concurrent administration with alpha-adrenergic agonists (e.g., adrenaline)

부작용

Bradycardia
Lethargy and depression
Impaired AV conduction
Congestive heart failure (CHF) or worsening of heart failure
Hypotension
Syncope
Diarrhea
Hypoglycemia
Bronchoconstriction
AV block
Myocardial depression
Hypoglycaemia
Bronchospasm
Diarrhoea
Peripheral vasoconstriction

주의

Use with Caution:

Patients with significant renal or hepatic insufficiency.
Patients with sinus node dysfunction.
Labile diabetic patients (can cause or mask clinical signs of hypoglycemia).
Digitalized or digitalis-intoxicated patients (severe bradycardia may result).
May mask clinical signs of thyrotoxicosis.
Withdrawal: If discontinuing the drug after chronic use, gradual withdrawal is recommended to prevent exacerbation of clinical signs.

약물 상호작용

Antacids

May reduce oral propranolol absorption; separate doses by at least one hour

Anesthetics, General

Additive myocardial depression may occur

Anticholinergics

May negate cardiac effects of beta-blockers

Calcium Channel Blockers

Concurrent use should be done with caution due to additive negative inotropic effects, particularly in patients with cardiomyopathy or CHF

CimetidineModerate

May decrease the metabolism of propranolol and increase blood levels

DiureticsModerate

May increase risk for hypotension

Epinephrine

Unopposed alpha effects of epinephrine may lead to rapid increases in blood pressure and decrease in heart rate

Fluoxetine

May decrease propranolol metabolism; complete heart block reported in one human

Insulin and Antidiabetic Drugs

Propranolol may prolong the hypoglycemic effects of insulin therapy

LidocaineMajor

Clearance may be impaired by propranolol

Methimazole, Propylthiouracil

Propranolol doses may need to be decreased when initiating therapy

PhenobarbitalModerate

May increase the metabolism of propranolol

PhenothiazinesModerate

May increase risk for hypotension

Reserpine

May have additive effects with propranolol

Succinylcholine, Tubocurarine

Effects may be enhanced with propranolol therapy

Sympathomimetics

May have their actions blocked by propranolol

TheophyllineMajor

Effects of theophylline (bronchodilation) may be blocked by propranolol

Thyroid HormonesModerate

May decrease the effects of beta blocking agents

Anaesthetic agentsModerate

Enhanced hypotensive effect

Antihypertensive drugsModerate

Enhanced hypotensive effect

DiazepamMinor

Enhanced hypotensive effect

Calcium-channel blockersMajor

Increased risk of bradycardia, severe hypotension, heart failure, and AV block

DigoxinMajor

Potentiates bradycardia

CarbimazoleModerate

May necessitate a decrease in propranolol dose when initiating therapy

Aluminium hydroxide (oral)Moderate

Reduces propranolol absorption

Muscle relaxants (suxamethonium, tubocurarine)Major

Enhances the effects of the muscle relaxants

PhenytoinModerate

Hepatic enzyme induction increases the rate of metabolism of propranolol

InsulinModerate

Propranolol may enhance the hypoglycaemic effect of insulin

Adrenaline (Epinephrine)Major

Concurrent use is contraindicated; risk of severe hypertension and bradycardia

모니터링

ECG (Electrocardiogram)
Signs of toxicity (bradycardia, hypotension, lethargy)
Blood pressure (especially if administering IV)
Heart rate and rhythm (ECG)
Signs of congestive heart failure (e.g., respiratory rate/effort)
Blood glucose (especially in diabetic patients receiving insulin)

약동학

반감기

고양이Hyperthyroid cats have decreased clearance compared to normal cats말< 2 hours개0.77-2 hours

흡수

Well absorbed after oral administration, but undergoes a rapid first-pass effect through the liver, reducing systemic bioavailability to approximately 2-27% in dogs. Hyperthyroid cats may have increased bioavailability compared to normal cats.

분포

Highly lipid soluble and readily crosses the blood-brain barrier. Apparent volume of distribution is 3.3-11 L/kg in dogs. Crosses the placenta and enters milk at very low levels. Approximately 90% bound to plasma proteins in humans.

대사

Principally metabolized by the liver. An active metabolite, 4-hydroxypropranolol, has been identified after oral administration.

배설

Less than 1% of a dose is excreted unchanged into the urine.

과다투여

Clinical Signs: The most predominant expected signs are hypotension and bradycardia. Other possible effects include CNS depression (ranging from depressed consciousness to seizures), bronchospasm, hypoglycemia, hyperkalemia, respiratory depression, pulmonary edema, AV block, or asystole.

Treatment:

Decontamination: If recent oral ingestion, consider emptying the gut and administering activated charcoal.
Monitoring: Monitor ECG, blood glucose, potassium, and blood pressure.
Cardiovascular Support: Use IV fluids and pressor agents for hypotension. Treat bradycardia with atropine; if atropine fails, cautiously administer isoproterenol. A transvenous pacemaker may be necessary.
Heart Failure: Treat with digoxin, diuretics, oxygen, and IV aminophylline if necessary.
Antidotal Therapy: Glucagon (5-10 mg IV; human dose) may increase heart rate and blood pressure, reducing the cardiodepressant effects of propranolol.
Seizures: Generally respond to IV diazepam.

제품

제형

Oral Tablets
Extended/Sustained-Release Capsules
Injection
1 mg/ml injectable solution
10 mg tablet
40 mg tablet
80 mg tablet
160 mg tablet
5 mg/5 ml oral solution
10 mg/5 ml oral solution
40 mg/5 ml oral solution
50 mg/5 ml oral solution

인용의약품

Propranolol HCl Oral Tablets: 10 mg, 20 mg, 40 mg, 60 mg & 80 mg
Propranolol HCl Extended/Sustained-Release Capsules: 60 mg, 80 mg, 120 mg & 160 mg (Inderal LA, InnoPran XL)
Propranolol for Injection: 1 mg/mL in 1 mL amps or vials (Inderal)
Propranolol Oral Solution: 4 mg/mL & 8 mg/mL in 500 mL
Syprol oral solution
Propranolol tablets (10 mg, 40 mg, 80 mg, 160 mg)
Propranolol injection (1 mg/ml)

규제 현황

European Union✓ 승인됨처방전의약품EMA

🐕 Dogs🐈 Cats

Available as POM (Prescription Only Medicine)

United Kingdom✓ 승인됨처방전의약품VMD

🐕 Dogs🐈 Cats

Available as POM-V or POM (human generics like Syprol used under the cascade)

규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU

보관·안정성

Store all propranolol preparations at room temperature (15-30°C) and protect from light. Propranolol solutions will decompose rapidly at alkaline pH.

보호자 정보

일관성이 중요합니다: 효과를 보려면 반려동물이 수의사가 처방한 대로 모든 용량을 정확히 복용해야 합니다. 심장에 위험한 반동 효과를 일으킬 수 있으므로 수의사와 상의 없이 갑자기 이 약을 중단하지 마십시오.
주의 깊게 살펴볼 사항: 반려동물이 비정상적으로 무기력해지거나, 운동 시 쉽게 지치거나, 쌕쌕거리기 시작하거나, 숨가쁨이나 기침이 발생하거나, 행동이나 태도에 갑작스러운 변화를 보이면 즉시 수의사에게 연락하십시오.
복용을 잊은 경우: 복용을 잊은 경우 생각나는 즉시 투여하되, 절대 한 번에 두 배의 용량을 투여하지 마십시오.

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