Performance Anxiety

INFORMATION FOR THE USER

Propranolol hydrochloride

1. What Propranolol is and what it is used for
Propranolol contains propranolol hydrochloride which belongs to a group of medicines called betablockers. It has effects on the heart and circulation and also on other parts of the body.
Propranolol can be used for

• Hypertension (high blood pressure)
• Angina (chest pain)
• Some arrythmias (disorders of heart rhythm)
• Protection of the heart after a myocardial infarction (heart attack)
• Migraine
• Essential tremor (involuntary and rhythmic shaking)
• Certain thyroid conditions (thyrotoxicosis and hyperthyroidism, which are caused by an overactive thyroid gland)
• Hypertrophic cardiomyopathy (thickened heart muscle)
• Phaeochromocytoma (high blood pressure due to a tumour usually near the kidney)
• Bleeding in the oesophagus caused by high blood pressure in the live2. What you need to know before you take Propranolol

2. Do not take Propranolol tablets if you:

   · are allergic (hypersensitive) to propranolol hydrochloride or any of the other ingredients of this
   medicine (listed in section 6).
   · have untreated/uncontrolled heart failure
   · have had a shock caused by heart problems
   · have severe heart defects (second or third degree heart blocks) a condition which may be treated
   by a pacemaker
   · suffer with heart conduction or rhythm problems
   · have a very slow or very unever heart rate
   · have an increased acidity of the blood (metabolic acidosis)
   · are on a strict fasting diet
   · suffer from asthma, wheezing or any other breathing difficulties
   · suffer from untreated phaeochromocytoma (high blood pressure due to a tumour near the kidney)
   · suffer from severe blood circulation problems (which may cause your fingers and toes to tingle or
   turn pale or blue)
   · suffer from a tight, painful feeling in the chest in periods of rest (Prinzmetal’s angina)
   · have very low blood pressure
   If you think that one of these situations applies to you, or if you are in any doubt, talk to your doctor before you start using Propranolol.

   3. Warnings and precautions
   Talk to your doctor or pharmacist before taking Propranolol if you:
   · Get allergic reactions to such things as insect stings.
   · Have diabetes as Propranolol may change your normal response to low blood sugar, which
   usually involves an increase in heart rate. Propranolol may cause low blood sugar levels even in
   patients who are not diabetic.
   · Have thyrotoxicosis. Propranolol may hide the symptoms of thyrotoxicosis.
   · Have kidney or liver problems (including cirrhosis of the liver). If so, talk to your doctor because
   you may need to have some check-ups during your treatment.
   · Have heart problems.
   · Suffer from muscle weakness (myasthenia gravis)
   · Have conditions like chronic obstructive pulmonary disease and bronchospasm because the use
   of Propranolol can aggravate these conditions.
   · Use channel blockers with negative inotropic effects like verapamil and diltiazem (please refer to ‘Other medicines and Propranolol’).

Other medicines and Propranolol
Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other
medicines. Propranolol can interfere with the action of some other medicines and some medicines can have an effect on Propranolol.

Propranolol should not be used in combination with calcium channel blockers with negative inotropic effects (e.g. verapamil, diltiazem), as it can lead to an exaggeration of these effects. This may result in severe hypotension and bradycardia.

Other medicines which can cause problems when taken together with your medicine:
· Nifedipine, nisoldipine, nicardipine, isradipine, lacidipine (used to treat hypertension or angina)
· Lidocaine (local anesthetic)
· Disopyramide, quinidine, amiodarone , propafenone and glycosides (to treat heart problems)
· Adrenaline (a heart stimulant)
· Ibuprofen and indometacin (for pain and inflammation)
· Ergotamine, dihydroergotamine or rizatriptan (for migraine)
· Chlorpromazine and thioridazine (for certain psychiatric disorders)
· Cimetidine (for stomach problems)
· Rifampicin (for the treatment of tuberculosis)
· Theophylline (for asthma)
· Warfarin (to thin the blood) and hydralazine (for hypertension)
· Fingolimod (for treating multiple sclerosis)
· Fluvoxamine and barbiturates (to treat anxiety and insomnia)
· MAO inhibitors (to treat depression)
If you are taking clonidine (for hypertension or migraine) and Propranolol together, you must not stop taking clonidine unless your doctor tells you to do so. If it becomes necessary for you to stop taking clonidine, your doctor will give you careful instructions on how to do it.

Propranolol with food, drink and alcohol
Alcohol may affect how this medicine works.

Operations
If you go into hospital to have an operation, tell the anaesthetist or the medical staff that you are taking Propranolol.

Driving and using machines
Your medicine is unlikely to affect your ability to drive or to operate machinery. However, some people may occasionally feel dizzy or tired when taking Propranolol. If this happens to you, ask your doctor for advice.

Pregnancy, breast-feeding and fertility
If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Pregnancy:
The use of this medicine is not recommended during pregnancy, unless your doctor considers it essential.

Breastfeeding:
Breastfeeding is not recommended when taking this medicine.

Important information about some of the ingredients of Propranolol:
Propranolol contains lactose. If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3. How to take Propranolol
   Always take this medicine exactly as your doctor or pharmacist or nurse has told you. Check with your doctor or pharmacist or nurse if you are not sure.
   Swallow your propranolol tablets with a drink of water before meals. Swallow whole. Do not chew.
   Do not stop taking this medicine unless your doctor tells you to stop.
4. Possible side effects
   Like all medicines, this medicine can cause side effects, although not everybody gets them. The following side effects may happen with this medicine.
   Common (may affect up to 1 in 10 people):
   · Cold fingers and toes
   · The heart beating more slowly
   · Numbness and spasm in the fingers which is followed by warmth and pain (Raynaud’s syndrome)
   · Disturbed sleep/nightmares
   · Fatigue
   · Breathlessness
   Uncommon (may affect up to 1 in 100 people):
   · Nausea, vomiting and diarrhoea
   Rare (may affect up to 1 in 1,000 people):
   · Worsening of breathing difficulties, sometimes with fatal outcome, if you have or have had asthma
   or asthmatic complaints
   · Heart failure, worsening of heart problems
   · Swelling of the skin which may occur in the face, tongue, larynx, abdomen, or arms and legs
   (angioedema)
   · Dizziness, particularly on standing up
   · Worsening of your blood circulation, if you already suffer from poor circulation
   · Hair loss (Alopecia)
   · Mood changes
   · Confusion
   · Memory loss
   · Psychosis or hallucinations (disturbances of the mind)
   · Paraesthesia (an abnormal sensation, typically tingling or pricking (‘pins and needles’)
   · Disturbances of vision
   · Dry eyes
   · Skin rash, including worsening of psoriasis
   · Your medicine may alter the number and types of your blood cells such as reduce the number of
   platelets (thrombocytopaenia) in your blood which may make you bruise and bleed more easily.
   · Purple spots on the skin (purpura)
   Very rare (may affect up to 1 in 10,000 people):
   · Severe muscle weakness (myasthenia gravis).
   · Low levels of blood sugar may occur in diabetic and non diabetic patients including the newborn, toddlers and children, elderly patients, patients on artificial kidneys (haemodialysis) or patients on medication for diabetes. It may also occur in patients who are fasting or have been fasting recently or who have a long-term liver disease.
   · Excessive sweating

Not known (frequency cannot be estimated from the available data):
· Headache or seizure linked to low levels of sugar in the blood.
· Inability in a man to achieve an erection (impotence)
· Decrease in renal blood flow
· Joint pain(arthralgia)
· Constipation
· Dry mouth
· Shortness of breath or breathlessness (dyspnoea)
· Conjunctivitis (inflammation of the eya also called ‘pink eye’)
· Depression
· Severe and dangerous lowered white blood cell count (agranulocytosis)
· Worsening of angina pectoris (chest pains)

Reporting of side effects
If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any
possible side effects not listed in this leaflet. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Propranolol
   · Keep this medicine out of the sight and reach of children.
   · This medicinal product does not require any special storage conditions.
   · Do not use this medicine after the expiry date stated on the label after ‘EXP’. The expiry date refers to the last day of that month.
   · Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help to protect the environment.