甲狀腺亢進使用beta blocker約兩周(inderal/propranolol)

Beta blocker 乙型阻斷劑, 有不同劑型.
Inderal 10 mg 常使用於焦慮,緊張的病患
cordalol 40 mg.

作用
可以使交感神經興奮症狀改善。
具膜穩定(membrane stabilizing)作用的阻斷劑，如propranolol有少許抑制T4變成T3 的作用。
臨床上propranolol是最常用的藥 物，由於在甲狀腺機能亢進時，其代謝 速度會加速，所需劑量可能要較大

劑量
一般建議一天使用 80-160mg，分3-4次給予
例如 20 mg qid. 或 40 mg bid~qid

因作用機轉的關係，抗甲狀腺藥物會抑制甲狀腺中的濾泡釋放甲狀腺素，大約兩個禮拜之後原來在濾泡內之甲狀腺素便會釋放完畢，因此propranolol 使用約兩個禮拜後，如已無心悸、緊 張、手抖、怕熱等交感神經興奮的症狀 時即可停藥，不像抗甲狀腺藥物須長期使用。

(甲狀腺亢進服用procil 或 newmazole 至少需治療3周以上, 甲狀腺素才會降低, 通常是治療 6-8 周, 甲狀腺素才會降低)


另外. inderal 血中半衰期 3-6 小時. 最大濃度 peak 1~4 小時.
使用inderal 治療高血壓的維持劑量(120-240mg qd)會遠遠超過抗焦慮的劑量

參考資料1 MayoClinic-Drugs and Supplements Propranolol (Oral Route) 

For acute heart attack:

• For oral dosage form (solution):
  • Adults—180 to 240 milligrams (mg) per day, given in divided doses.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—At first, 40 milligrams (mg) three times a day. Your doctor may increase your dose as needed.
  • Children—Use and dose must be determined by your doctor.

For adrenal gland tumor (pheochromocytoma):

• For oral dosage form (solution):
  • Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—60 milligrams (mg) per day, given in divided doses for 3 days before having surgery. In patients who cannot have surgery, the usual dose is 30 mg per day, given in divided doses.
  • Children—Use and dose must be determined by your doctor.

For chest pain (angina):

• For oral dosage form (long-acting oral capsules):
  • Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose as needed. The dose is usually not more than 320 mg per day.
  • Children—Use and dose must be determined by your doctor.
• For oral dosage form (solution):
  • Adults—80 to 320 milligrams (mg) per day, given in divided doses.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—80 to 320 milligrams (mg) per day, given in divided doses.
  • Children—Use and dose must be determined by your doctor.

For high blood pressure (hypertension):

• For oral dosage form (extended-release capsules):
  • Adults—At first, 80 milligrams (mg) once a day, given at bedtime. Your doctor may increase your dose as needed. However, the dose is usually not more than 120 mg per day.
  • Children—Use and dose must be determined by your doctor.
• For oral dosage form (long-acting oral capsules):
  • Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose as needed.
  • Children—Use and dose must be determined by your doctor.
• For oral dosage form (solution):
  • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed.
  • Children—Use and dose must be determined by your doctor.

For hypertrophic subaortic stenosis (thickened heart muscle):

• For oral dosage form (long-acting oral capsules):
  • Adults—80 to 160 milligrams (mg) once a day.
  • Children—Use and dose must be determined by your doctor.
• For oral dosage form (solution):
  • Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—20 to 40 milligrams (mg) three or four times a day, given before meals and at bedtime.
  • Children—Use and dose must be determined by your doctor.

For irregular heartbeats:

• For oral dosage form (solution):
  • Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—10 to 30 milligrams (mg) three or four times a day, given before meals and at bedtime.
  • Children—Use and dose must be determined by your doctor.

For migraine headaches:

• For oral dosage form (long-acting oral capsules):
  • Adults—At first, 80 milligrams (mg) once a day. Your doctor may increase your dose as needed. The dose is usually not more than 240 mg per day.
  • Children—Use and dose must be determined by your doctor.
• For oral dosage form (solution):
  • Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose as needed.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—At first, 80 milligrams (mg) per day, given in divided doses. Your doctor may increase your dose as needed.
  • Children—Use and dose must be determined by your doctor.

For proliferating infantile hemangioma:

• For oral dosage form (solution):
  • Children 5 weeks to 5 months of age—Dose is based on your child's body weight and must be determined by the doctor. The starting dose is usually 0.6 milligram (mg) (0.15 milliliters [mL]) per kilogram (kg) of your child's body weight 2 times a day, taken at least 9 hours apart. Give the dose during or immediately after a feeding. Do not administer the dose if the infant is vomiting or not eating. After 1 week, the doctor will increase the dose to 1.1 mg (0.3 mL) per kg of body weight two times a day. After 2 weeks, the doctor will increase the dose to 1.7 mg (0.4 mL) per kg of body weight 2 times a day, taken for 6 months.
  • Children under 5 weeks of age—Use is not recommended.

For tremors:

• For oral dosage form (solution):
  • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed.
  • Children—Dose is based on body weight and must be determined by your doctor.
• For oral dosage form (tablets):
  • Adults—At first, 40 milligrams (mg) two times a day. Your doctor may increase your dose as needed.
  • Children—Use and dose must be determined by your doctor.

參考資料 2 應該是美國FDA的資料 Inderal®(propranolol hydrochloride)Tablets
DOSAGE AND ADMINISTRATION

General Because of the variable bioavailability of propranolol, the dose should be individualized based on response.


Hypertension
The usual initial dosage is 40 mg Inderal twice daily, whether used alone or added to a diuretic. Dosage may be increased gradually until adequate blood pressure control is achieved. The usual maintenance dosage is 120 mg to 240 mg per day. In some instances a dosage of 640 mg a day may be required. The time needed for full antihypertensive response to a given dosage is variable and may range from a few days to several weeks. While twice-daily dosing is effective and can maintain a reduction in blood pressure throughout the day, some patients, especially when lower doses are used, may experience a modest rise in blood pressure toward the end of the 12-hour dosing interval. This can be evaluated by measuring blood pressure near the end of the dosing interval to determine whether satisfactory control is being maintained throughout the day. If control is not adequate, a larger dose, or 3-times-daily therapy may achieve better control.


Angina Pectoris
Total daily doses of 80 mg to 320 mg Inderal, when administered orally, twice a day, three times a day, or four times a day, have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG. If treatment is to be discontinued, reduce dosage gradually over a period of several weeks. (See WARNINGS.)


Atrial Fibrillation
The recommended dose is 10 mg to 30 mg Inderal three or four times daily before meals and at bedtime.