📋 Indications & Clinical Dosage
*Hypertension:*
Adult: Initially 80 mg once daily, then increased in steps of up to 80 mg every week if required, max. 240 mg per day.
*Angina:*
Adult: Initially 40 mg once daily, then increased if necessary up to 160 mg daily, doses should be increased at weekly intervals, max. dose, max. 240 mg per day.
*Arrhythmias:*
Adult: Initially 40 mg once daily, then increased if necessary up to 160 mg once daily, doses should be increased at weekly intervals; reduced to 40 mg daily if
bradycardia occurs.
*Migraine prophylaxis:*
Adult: Initially 40 mg once daily, then increased in steps of 40 mg every week, adjusted according to response; maintenance 80-160 mg once daily.
*Thyrotoxicosis (adjunct):*
Adult: 80-160 mg once daily.
⛔ Contraindications
Asthma, cardiogenic shock,
Hypotension, marked bradycardia, metabolic acidosis,
Phaeochromocytoma, Prinzmetal-s angina, second or third-degree AV block,
severe peripheral arterial disease, sick sinus syndrome, heart failure
⚠️ Precautions & Warnings
History of obstructive airways disease, renal or hepatic impairment,
diabetes, first-degree AV block, myasthenia gravis, portal hypertension,
psoriasis, symptoms of hypoglycaemia and thyrotoxicosis may be masked
⚠️ Adverse Reactions / Side Effects
Headache, depression, fatigue, dizziness,
dry eye, dyspnoea, erectile dysfunction, heart failure, nausea,
paraesthesia, peripheral coldness, peripheral vascular
disease, rash, sleep disorders, syncope, visual impairment, diarrhoea, vomiting
Atrioventricular block, bronchospasm. Rare: Hallucination, hypoglycaemia
🤰 Pregnancy & Lactation Safety
Pregnancy Risk:
Caution advised
Lactation / Breastfeeding:
Aviod
📚 Official Regulatory & Clinical References
- Drug Regulatory Authority of Pakistan (DRAP): Drug Registration, S.R.O. Price Gazettes & National Essential Medicines List (NEML).
- World Health Organization (WHO): Collaborating Centre for Drug Statistics Methodology (ATC/DDD Index).
- Formulary Standards: British National Formulary (BNF) & Pakistan National Formulary (PNF) guidelines.