YANCEY, MAJ, MC, USA, Fort Belvoir Community Hospital, Fort Belvoir, Virginia RICHARD SHERIDAN, CPT, MC, USA, 1/25 Stryker Brigade Combat Team, Fort Wainwright, Alaska KELLY G. KOREN, LT, MC, USN, Fort Belvoir Community Hospital, Fort Belvoir, Virginia Am Fam Physician. Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least three months. The most common types of chronic daily headache are chronic migraines and chronic tension-type headaches. If a red flag for a secondary cause of headache is present, magnetic resonance imaging of the head should be performed. All patients should be asked about medication overuse, which can increase the frequency of headaches. Patients who overuse medications for abortive therapy for headache should be encouraged to stop the medications entirely and consider prophylactic treatment. Several prophylactic treatments for chronic daily headache can reduce headache frequency and severity, as well as improve overall quality of life. Prophylaxis 80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day Withdraw therapy if satisfactory response not seen after 6 weeks Hemangeol: Indicated for treatment of proliferating hemangioma requiring systemic therapy Initiate treatment at aged 5 weeks to 5 months Starting dose: 0.6 mg/kg (0.15 m L/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 m L/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 m L/kg) BID PO: 0.5-1 mg/kg/day divided q6-8hr; may be increased every 3-7 days; usual range: 2-6 mg/kg/day; not to exceed 16 mg/kg/day or 60 mg/day IV: 0.01-0.1 mg/kg over 10 minutes; repeat q6-8hr PRN; not to exceed 1 mg for infants or 3 mg for children PO: 1 mg/kg/day divided q6hr; after 1 week, may be increased by 1 mg/kg/day to maximum of 10-15 mg/kg/day if patient refractory; allow 24 hours between dosing changes IV: 0.01-0.2 mg/kg over 10 minutes; not to exceed 5 mg Immediate-release: 40 mg PO q12hr initially, increased every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day Inno Pran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO Consider lower initial dose PO: 10 mg q6-8hr; may be increased every 3-7 days IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg Once response or maximum dose achieved, do not give additional dose for at least 4 hours Aggravated congestive heart failure Bradycardia Hypotension Arthropathy Raynaud phenomenon Hyper/hypoglycemia Depression Fatigue Insomnia Paresthesia Psychotic disorder Pruritus Nausea Vomiting Hyperlipidemia Hyperkalemia Cramping Bronchospasm Dyspnea Pulmonary edema Respiratory distress Wheezing Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid; agranulocytosis, erythematous rash, fever with sore throat Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria Musculoskeletal: Myopathy, myotonia May exacerbate ischemic heart disease after abrupt withdrawal Hypersensitivity to catecholamines has been observed during withdrawal Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuance When discontinuing long-term administration of beta blockers (particularly with ischemic heart disease), gradually reduce dose over 1-2 weeks and carefully monitor If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina) Warn patients against interruption or discontinuance of beta-blocker therapy without physician advice Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension Asthma, COPD Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker) Cardiogenic shock Uncompensated congestive heart failure Hypersensitivity Overt heart failure Sick sinus syndrome without permanent pacemaker Do not use Inno Pran XL in pediatric patients Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions Sudden discontinuance can exacerbate angina and lead to myocardial infarction Use in pheochromocytoma Increased risk of stroke after surgery Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported Exacerbation of myopathy and myotonia has been reported Less effective than thiazide diuretics in black and geriatric patients May worsen bradycardia or hypotension; monitor HR and BP Avoid beta blockers without alpha1-adrenergic receptor blocking activity in patients with prinzmetal variant angina; unopposed alpha-1 adrenergic receptors may worsen anginal symptoms May induce or exacerbate psoriasis; cause and effect not established Prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations, and sweating May cause or worsen bradycardia or hypotension Pregnancy category: C; intrauterine growth retardation, small placentas, and congenital abnormalities reported, but no adequate and well-controlled studies conducted Lactation: Use is controversial; an insignificant amount is excreted in breast milk Nonselective beta adrenergic receptor blocker; competitive beta1 and beta2 receptor inhibition results in decreases in heart rate, myocardial contractility, myocardial oxygen demand, and blood pressure Class 2 antidysrhythmic Bioavailability: 30-70% (food increases bioavailability) Onset: Hypertension, 2-3 wk; beta blockade, 2-10 min (IV) or 1-2 hr (PO) Duration: 6-12 hr (immediate release); 24-27 hr (extended release) Peak plasma time: 1-4 hr (immediate release); 6-14 hr (extended release) Solution: Most common solvents Additive: Dobutamine, verapamil Syringe: Inamrinone, milrinone Y-site: Alteplase, fenoldopam, gatifloxacin, heparin, hydrocortisone, sodium succinate, inamrinone, linezolid, meperidine, milrinone, morphine, potassium chloride, propofol, tacrolimus, tirofiban, vitamins B and C IV administration rate should not exceed 1 mg/min IV dose is much smaller than oral dose Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution Continuous IV infusion generally is not recommended The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Can you buy zovirax tablets over the counter uk Metoprolol long acting Definition and instructions for use of propranolol Inderal, provided by staff. pressure or fast heartbeat and can also be used to treat migraine headaches. Medscape - Hypertension-specific dosing for Inderal, Inderal LA propranolol, frequency-based adverse effects, comprehensive interactions, contraindications. Propranolol, sold under the brand name Inderal among others, is a medication of the beta blocker class. It is used to treat high blood pressure, a number of types of. Choosing a therapeutic agent that is best for each individual patient requires consideration of the patient's history, lifestyle, comorbid conditions, and individual preferences. The beta-blocker propranolol also is FDA-approved as a preventive agent for migraines. Long-acting oral propranolol (Inderal), for example, is very useful in combination with the tricyclic antidepressant amitriptyline. Dosage begins with the long-acting agent given at 60 mg per day, and usually is kept between 60 and 120 mg per day. Lower doses, such as 20 mg twice per day of propranolol, sometimes are effective. Other b-blockers, such as metoprolol (Toprol XL) and atenolol, also are effective. Some of these are easier to work with than propranolol because they are scored tablets, and metoprolol and atenolol have fewer respiratory effects. Beta-blockers are useful for migraine patients with concurrent hypertension, tachycardia, mitral valve prolapse, and panic/anxiety disorders. Propranolol has a lot of actions on the body and can be used for lots of conditions like high blood pressure, prevention of heart attacks, and preventing migraine headaches. In the mental health field, propranolol is used to manage the symptoms of anxiety (shaking, sweating, fast heartbeat). Propranolol has also been used to treat movement problems called akathisia and tardive dyskinesia, which can be side-effects of other mental health medicines (like antipsychotic medicines). Not everyone will experience side effects with propranolol. Some of the more common side effects are listed at the bottom of this page. If you are experiencing a problem that might be a side effect, but that is not listed here, please take a look at the patient information leaflet that was in the medicine packet or speak to your pharmacist or doctor. If you think you have a side effect that has not got better within a few days go back to your doctor. Propranolol headaches The dose of propranolol for migraine prophylaxis. Efficacy of low doses., Inderal, Inderal LA propranolol dosing, indications, interactions. Where to buy metformin ukAzithromycin injectionCan u buy viagra over the counter in australia Is Propranolol helpful for Cluster Headaches? can Propranolol cause Cluster Headaches? Propranolol is mentioned in 95 posts about Cluster Headaches. Propranolol and Cluster Headaches - Reviews - Treato. Propranolol - Wikipedia. Chronic Daily Headache Diagnosis and Management - American.. Propranolol Cardiovascular learn about side effects, dosage, special precautions, and more on MedlinePlus Hey all, Has anyone had success with propranolol for chronic Propranolol is an oral medication that's used to treat high blood pressure, atrial fibrillation, tremor, and other conditions. It works by reducing your heart's.