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Propranolol is a medication that is quickly absorbed when taken orally. It has a peak effect on beta blockade within one to four hours. It is distributed throughout the body and metabolized in the liver. It is primarily excreted in urine. When used with fluoxetine, there can be increased effects of propranolol, leading to low blood pressure, slow heart rate, and other side effects. EKG monitoring is recommended for patients taking these medications together. Let's discuss the pharmacokinetics of propranolol and its interactions with fluoxetine. Propranolol is rapidly absorbed through oral administration. Onset of beta blockade effects when taken orally is approximately one to two hours. Bioavailability is increased when taken with food. Peak plasma time is approximately one to four hours in the immediate release form. And six to 14 hours in the extended release form. Propranolol is mostly bound to plasma proteins and is widely distributed throughout bodily tissues. It is metabolized in the liver. And in patients with hepatic impairment, dosages should be adjusted to prevent toxicity. Excretion is conducted primarily in the urine. Half-life is four to six and a half hours for immediate release. And eight to 10 hours for extended release. When using propranolol and fluoxetine together, the effects of propranolol may be increased, leading to hypotension, bradycardia, AV block, and other adverse effects. The QT interval may be prolonged by EKG. And therefore, patients on this group should have routine monitoring of vital signs and EKG or consider using an alternative.
