UNSAFE

• It is unsafe to consume alcohol with Indever 40.

CONSULT YOUR DOCTOR

• Indever 40 may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.

SAFE IF PRESCRIBED

• Indever 40 is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby.

UNSAFE

• Indever 40 may cause side effects which could affect your ability to drive. Indever 40 may cause visual disturbances, hallucinations, fatigue, mental confusion, dizziness or tiredness. This may affect your driving ability.

SAFE IF PRESCRIBED

• Indever 40 is safe to use in patients with kidney disease. No dose adjustment of Indever 40 is recommended. However, inform your doctor if you have any kidney disease. Indever 40 may be started with a low dose and then increased further. Regular monitoring of blood pressure is advisable for dose adjustment.

CAUTION

• Indever 40 should be used with caution in patients with liver disease. Dose adjustment of Indever 40 may be needed. Please consult your doctor. Regular monitoring of blood pressure is advisable for dose adjustment.
• Medicine Overview of Indever 40mg Tablet

Introduction

• Indever 40 belongs to a group of medicines called beta-blockers. It helps to decrease anxiety and relieve tremors. It is also used to help prevent migraine, heart-related chest pain (angina), and bleeding in the stomach caused by high blood pressure in the liver (portal hypertension). Indever 40 may also be used to treat high blood pressure and some types of abnormal heartbeat (arrhythmia). The dose will depend on what you are being treated for and how you respond to the medicine. You should always take it as prescribed by the doctor. It should be taken on an empty stomach and try to take it at the same time each day. You should keep taking it even if you feel well, as you are still getting the benefits. If you stop taking it suddenly, your condition may worsen. The most common side effects are tiredness, weakness cold fingers and toes (Raynaud phenomenon), irregular or slow heartbeat, numbness in your fingers, and breathlessness. You may also experience nausea, vomiting and diarrhea. Talk to your doctor if the side effects bother you or do not go away. Most side effects are short-lived and improve as your body gets used to the medicine. You should not use this medicine if you have asthma, very slow or uneven heartbeats or a serious heart condition, including heart failure. Talk to your doctor before taking it if you have kidney or liver problems or chronic obstructive pulmonary disease (COPD). In terms of lifestyle, alcohol may affect the way this medicine works and should be avoided. You should not drive if this medicine makes you feel dizzy. Ask your doctor whether it is safe to take this medicine if you are pregnant or breastfeeding.

Uses of Indever 40

• Hypertension (high blood pressure)
• Angina (heart-related chest pain)

Prevention of migraine

• Anxiety
• Tremors
• Arrhythmia
• Side effects of Indever 40
• Common
• Arrhythmia (irregular heartbeats)
• Raynaud phenomenon
• Weakness

How to use Indever 40

• Use it as advised by your doctor or check the label for directions before use. Indever 40 is to be taken empty stomach. Avoid Indever 40 with high-fat meals such as olive oil, nuts & seeds (Brazil nuts), dark chocolate, butter and meat.

How Indever 40 works

• Indever 40 is a beta blocker. It works by affecting the body’s response to nerve impulses, especially in the heart. It slows down your heart rate and makes it easier for the heart to pump blood around the body. It also widens the blood vessels in the body for better blood flow.

What if you forget to take Indever 40?

• If you miss a dose of Indever 40, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Quick Tips

• It is not the first-choice treatment for high blood pressure according to the latest guidelines.
• It may hide the symptoms of low blood sugar if you have diabetes. Monitor blood sugar levels regularly.
• To lower the chance of feeling dizzy or passing out, rise slowly if you have been sitting or lying down.
• Use caution while driving or doing anything that requires concentration as Betacap TR 40 Capsule can cause dizziness and sleepiness.
• Inform your doctor if you notice increased swelling around your legs or ankles, sudden weight gain or sudden shortness of breath as these may be symptoms of heart failure.
• Do not stop taking the medication suddenly without talking to your doctor.

Brief Description

Indication

• HTN, Cardiac arrhythmias, Myocardial infarction, Angina pectoris, Portal hypertension, Migraine prophylaxis, Phaeochromocytoma, Hyperthyroidism, Essential tremor

Administration

• Tab: Should be taken on an empty stomach. Take before meals. Cap: May be taken with or without food. Take consistently either always w/ or always w/o meals.

Adult Dose

• Oral Hypertension As conventional tab or oral soln: Initially, 40-80 mg bid. Usual range: 160-320 mg/day. Max: 640 mg/day. As extended release cap: Initially, 80 mg once daily. Usual range: 120-160 mg once daily. Max: 640 mg/day. Phaeochromocytoma As conventional tab or oral soln: 60 mg/day in divided doses given 3 days pre-op w/ alpha-blocker. If tumour is inoperable, 30 mg/day in divided doses may be given. Myocardial infarction As conventional tab or oral soln: 40 mg 4 times daily for 2-3 days followed by 80 mg bid. Alternatively, 180-240 mg/day in divided doses. Doses are given w/in 5-21 days of MI. Cardiac arrhythmias Adult: As conventional tab or oral soln: 30-160 mg/day in divided doses. Prophylaxis of migraine As conventional tab or oral soln: Initially, 40 mg bid or tid. Usual range: 120-240 mg/day. As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day. Portal hypertension As conventional tab or oral soln: Initially, 40 mg bid increased at wkly intervals up to 160 mg bid. As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 320 mg once daily. Angina pectoris As conventional tab or oral soln: Initially, 40 mg bid or tid. Usual range: 120-240 mg/day. Max: 320 mg/day. As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day. Hypertrophic cardiomyopathy Adult: As conventional tab or oral soln: 10-40 mg, 3-4 times daily. Hyperthyroidism As conventional tab or oral soln: 10-40 mg, 3-4 times daily. As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day. Anxiety As conventional tab or oral soln: 10-40 mg bid or tid. As extended release cap: 80 mg once daily. Max: 160 mg once daily. Essential tremor As conventional tab or oral soln: Initially, 40 mg bid or tid. Usual range: 120-240 mg/day. As extended release cap: 80 mg once daily, may be increased to 160 mg once daily. Max: 240 mg/day. Hepatic impairment: Severe: 20 mg tid. As extended release cap: 80 mg once daily or 160 mg every other day.

Child Dose

• Oral Hypertension Child: As conventional tab: Initially, 1 mg/kg/day in 2 divided doses. Usual range: 2-4 mg/kg/day in 2 divided doses. Max: 4 mg/kg/day in 2 or 3 divided doses. Phaeochromocytoma Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily. Cardiac arrhythmias Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily. Prophylaxis of migraine Child: As conventional tab or oral soln: ?12 yr 10-20 mg bid or tid. >12 yr Initially, 40 mg bid or tid increased to wkly intervals up to 160 mg/day. Max: 240 mg/day. Hyperthyroidism Child: As conventional tab or oral soln: 0.25-0.5 mg/kg 3-4 times daily.

Contraindication

• 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.

Mode of Action

• Propranolol is a non-cardioselective beta-blocker that competitively blocks beta1- and beta2-receptors resulting in decreased heart rate, myocardial contractility, BP and myocardial oxygen demand. It has membrane-stabilising properties

Precaution

• 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.

Side Effect

• Most adverse effects have been mild and transient and have rarely required the withdrawal of therapy. Cardiovascular: Bradycardia; congestive heart failure; intensification of AV block; hypotension; paresthesia of hands; thrombocytopenic purpura; arterial insufficiency, usually of the Raynaud type. Central Nervous System: Lightheadedness; mental depression manifested by insomnia, lassitude, weakness, fatigue; reversible mental depression progressing to catatonia; visual disturbances; hallucinations; vivid dreams; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, slightly clouded sensorium, and decreased performance on neuropsychometrics. For immediate formulations, fatigue, lethargy, and vivid dreams appear dose related. Gastrointestinal: Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation, mesenteric arterial thrombosis, and ischemic colitis. Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid reactions, pharyngitis and agranulocytosis, erythematous rash, fever combined with aching and sore throat, laryngospasm, and respiratory distress. Respiratory: Bronchospasm. Hematologic: Agranulocytosis, nonthrombocytopenic purpura, and thrombocytopenic purpura. Skin: Stevens-Johnson Syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria.

Pregnancy Category Note

• Pregnancy category: C, D in 2nd & 3rd trimesters.

Interaction

• 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. β-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. Increased risk of hypotension and attenuation of the reflex tachycardia w/ anaesth drugs. Potentially Fatal: Increased risk of QT interval prolongation and torsades de pointes w/ thioridazine.