Posology : מינונים

4.2 Posology and method of administration
Since the half-life may be increased in patients with significant hepatic or renal impairment, caution must be exercised when starting treatment and selecting the initial dose.
As with any other potent beta-blocking agent, the optimum dosage of propranolol has to be determined individually for each patient.
As a guide for the correct dosage, bradycardia (usually less than 45 beats/minute) is indicative that dosage should not be further increased.
When discontinuation of chronic administration of propranolol is planned in patients with ischemic heart disease, the dosage should be reduced gradually and the patients carefully monitored.
Angina Pectoris, Essential Tremor, Migraine Prophylaxis
Adults
The recommended initial dosage is 40 mg, 2-3 times daily. This may be increased by the same amount, at weekly intervals, according to patient’s response. An adequate response in the management of migraine and essential tremor is usually seen in the range of 80-160 mg/day, and in the treatment of angina in the range of 120-240 mg/day.
Children
The dosage for migraine prophylaxis in children is as follows: Under the age of 12 years: 20 mg 2 or 3 times daily.
Over the age of 12 years: The adult dosage.
Hypertension
The recommended initial dosage is 80 mg, twice a day. This may be increased at weekly intervals, according to patient response. The usual dosage range is 160-320 mg/day.
With concurrent diuretic or other antihypertensive drugs, a further reduction of blood pressure is obtained.
Arrhythmias, Hypertrophic Obstructive Cardiomyopathy, Thyrotoxicosis, Thyrotoxic Crises:
Adults
A dosage range of 10-40 mg, 3-4 times daily, usually achieves the desired response.
Children
For these indications as well as for pheochromocytoma, dosage should be individually determined, and the following is only a guide: A dosage of 0.25-0.5 mg per kg body weight 3-4 times daily, as required.
Pheochromocytoma
Use only with an alpha-receptor blocking drug. Preoperatively, a dosage of 60 mg/day, for 3 days, is recommended. In non-operable malignant cases, administer 30 mg/day.
Post-Myocardial Infarction
Treatment should start between days 5 and 21 after myocardial infarction, with an initial dose of 40 mg four times a day for 2 or 3 days. In order to improve compliance, the total daily dosage may thereafter be given as 80 mg twice a day.
Use in the Elderly
Evidence concerning the relation between blood level and age is conflicting. Propranolol should be used to treat the elderly with caution. It is suggested that treatment should start with the lowest dose. With regard to the elderly, the optimum dose should be individually determined according to clinical response.

Method of administration
For oral use.
Food may slow the hepatic metabolism of propranolol therapy, enhancing its bioavailability. In order to standardize conditions, it is recommended that propranolol should be taken with meals.