Nigrain Forte Tablet

Nigrain Forte Tablet is used for the management of high blood pressure (hypertension), angina pectoris, pheochromocytoma, essential tremor, tetralogy of Fallot cyanotic spells, and arrhythmias (such as atrial fibrillation and flutter, A-V nodal re-entrant tachycardias, and catecholamine-induced arrhythmias).

It is also used in the prevention of myocardial infarction, migraine headache. Nigrain Forte Tablet is also helpful in treating the prevention of myocardial infarction, migraine headache.

This medication is a beta-blocking agent that attaches itself to the heart and inhibits the regular molecules from triggering the receptors. It blocks the beta-adrenergic receptors in the heart, thus slowing your heartbeat down and lowering the blood pressure. This lowers the stress placed on your heart, arteries, veins and blood vessels, decreasing the workload of the heart.

The medicine might not be suitable for everyone as it can have harmful effects on people with certain conditions. Before beginning a course of this medication, you need to notify your doctor if you are-

• Pregnant or breastfeeding, or
• Suffering from conditions such as:
• Asthma,
• Diabetes mellitus,
• Psoriasis,
• Liver or kidney problems,
• Severe heart condition.

The medicine must be taken according to the doctor’s prescription. The doctor might recommend taking it two, three or even four times a day. You must complete the course of this medication otherwise it can cause you to develop withdrawal symptoms.

Symptoms of intoxication include cardiac disturbances, CNS toxicity, bronchospasm, hypoglycemia and hyperkalemia. The most common cardiac symptoms include hypotension and bradycardia; atrioventricular block, intraventricular conduction disturbances, cardiogenic shock, and asystole may occur with severe overdose, especially with membrane-depressant drugs (eg, propranolol); CNS effects include convulsions, coma, and respiratory arrest is commonly seen with propranolol and other membrane-depressant and lipid-soluble drugs.

Treatment includes symptomatic treatment of seizures, hypotension, hyperkalemia and hypoglycemia; bradycardia and hypotension resistant to atropine, isoproterenol or pacing may respond to glucagon; wide QRS defects caused by the membrane-depressant poisoning may respond to hypertonic sodium bicarbonate; repeat-dose charcoal, hemoperfusion, or hemodialysis may be helpful in removal of only those beta-blockers with a small Vd, long half-life or low intrinsic clearance (acebutolol, atenolol, nadolol, sotalol).

Take exactly as directed; do not increase, decrease, or discontinue without consulting prescriber. Take at the same time each day. Tablets may be crushed and taken with liquids. Do not alter dietary intake of protein or carbohydrates without consulting prescriber.

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

• Hypertension

• Angina Pectoris

• Migraine

• Anxiety

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

• Hypersensitivity

• Sinus Bradycardia

• Cardiogenic Shock

• Pregnancy

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

• Chest Pain

• Hypotension

• Cardiogenic Shock

• Light Headedness

• Confusion

• Dizziness

• Insomnia

• Fatigue

• Lethargy

• Cold Extremities

• Vertigo

• Syncope

• Hallucination

• Rash

• Alopecia

• Pruritus

• Urticaria

• Contact Dermatitis

• Diarrhoea

• Nausea

• Vomiting

• Stomach Discomfort

• Anorexia

• Impotence

• Thrombocytopenia

• Weakness

• Wheezing

• Bronchospasm

• Pharyngitis

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

• How long is the duration of effect?

  The effect of this medicine lasts for about 9 hours of duration.

• What is the onset of action?

  The effect of this medicine can be observed within an hour of administration.

• Are there any pregnancy warnings?

  The use of this medicine is not recommended for pregnant women as there is a lack of conclusive evidence from clinical studies.

• Is it habit forming?

  Mild to moderate habit forming tendencies have been reported and hence requires careful administration and withdrawal.

• Are there any breast-feeding warnings?

  This medicine is not likely to be present in the breastmilk in alarming quantities.

• Is It safe with alcohol?

  Consumption of alcohol along with Nigrain Forte Tablet is found to be unsafe. Thus it should be avoided.

• Is it safe to drive while on this medicine?

  use caution when driving, climbing stairs, or changing position - rising from sitting or lying to standing - or engaging in tasks requiring alertness until response to drug is known.

• Does this affect kidney function?

  This medicine is found to be safe to use in patient with kidney disease. Marked slowing of heart rate may occur in cirrhosis with conventional doses. Low initial dose and regular heart rate monitoring.

• Does this affect liver function?

  Caution must be taken in patient with liver disease. Dosing adjustment in renal impairment:

  • Clcr 31-40 mL/minute: Administer every 24-36 hours or administer 50% of normal dose.
  • Clcr 10-30 mL/minute: Administer every 24-48 hours or administer 50% of normal dose.
  • Clcr <10 mL/minute: Administer every 40-60 hours or administer 25% of normal dose.
  • Hemodialysis: Not dialyzable (0% to 5%); supplemental dose is not necessary.
  • Peritoneal dialysis: Supplemental dose is not necessary.
  Kindly consult your doctor before taking it.

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

• Are there any missed dose instructions?

  Take the missed dose as soon as you remember. The missed dose can be skipped if it is almost time for the next scheduled dose. Try not to miss any dose as the quantity and timings are very specific and non-adherence could cause some side effects.

• Are there any overdose instructions?

  Report any incidence of overdose to the doctor immediately as the symptoms can be fatal especially if it is consumed by a child or a person using it without prescription. Symptoms of overdose may include slow rate of breathing, decreased heartbeat rate, severe drowsiness, and fainting. Immediate medical attention may be required if the symptoms are severe.

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

• India

• United States

• Japan

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

The exact mechanism of action of this medication for all the indications is not established. However, this medicine non-selectively blocks beta receptors sites in the heart, blood vessels, lungs, and other organs. Thus pressure is lowered and blood flow in the heart and other organs is improved.

Information given here is based on the salt content of the medicine. Uses and effects of the medicine may vary from person to person. It is advisable to consult a Cardiologist before using this medicine.

Whenever you take more than one medicine, or mix it with certain foods or beverages, you"re at risk of a drug interaction.

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• Interaction with Alcohol

  Avoid or limit the use of alcohol while you are taking this medicine. Any activity requiring a high level of mental alertness like operating heavy machinery or driving should be avoided.

• Interaction with Lab Test

  This medicine might cause fluctuation in serum level of thyroxine [increased level of thyroxine (S)].

• Interaction with Medicine

  • Alpha-blockers (prazosin, terazosin): Concurrent use of beta-blockers may increase risk of orthostasis.
  • Antipyrine's clearance is reduced by 30% to 40%.
  • Cimetidine increases the plasma concentration of Nigrain Forte Tablet and its pharmacodynamic effects may be increased.
  • Clonidine: Hypertensive crisis after or during withdrawal of either agent.
  • Drugs which slow AV conduction (digoxin): Effects may be additive with beta-blockers.
  • Epinephrine (including local anesthetics with epinephrine): Nigrain Forte Tablet may cause hypertension.
  • Flecainide: Pharmacological activity of both agents may be increased when used concurrently.
  • Fluoxetine may inhibit the metabolism of Nigrain Forte Tablet, resulting in cardiac toxicity.
  • Glucagon: Nigrain Forte Tablet may blunt hyperglycemic action.
  • Haloperidol: Hypotensive effects may be potentiated.
  • Hydralazine: The bioavailability propranolol (rapid release) and hydralazine may be enhanced with concurrent dosing.
  • Insulin: Nigrain Forte Tablet inhibits recovery and may cause hypertension and bradycardia following insulin-induced hypoglycemia. Also masks the tachycardia that usually accompanies insulin-induced hypoglycemia.
  • NSAIDs (ibuprofen, indomethacin, naproxen, piroxicam) may reduce the antihypertensive effects of beta-blockers.
  • Salicylates may reduce the antihypertensive effects of beta-blockers.
  • Sulfonylureas: Beta-blockers may alter response to hypoglycemic agents.
  • Verapamil or diltiazem may have synergistic or additive pharmacological effects when taken concurrently with beta-blockers; avoid concurrent I.V. use of both.

• Interaction with Disease

  • Administer cautiously in compensated heart failure and monitor for a worsening of the condition (efficacy of propranolol in CHF has not been demonstrated).
  • Avoid abrupt discontinuation in patients with a history of CAD; slowly wean while monitoring for signs and symptoms of ischemia.
  • Use caution in patient with PVD.
  • Use cautiously in diabetics because it can mask prominent hypoglycemic symptoms.
  • Can mask signs of thyrotoxicosis.
  • Can cause fetal harm when administered in pregnancy.
  • Use cautiously in hepatic dysfunction (dosage adjustment required).
  • Use care with anesthetic agents which decrease myocardial function.

• Interaction with Food

  Avoid natural licorice (causes sodium and water retention and increases potassium loss); protein-rich foods may increase bioavailability; a change in diet from high carbohydrate/low protein to low carbohydrate/high protein may result in increased oral clearance.

• Ques : What is Nigrain Forte Tablet?

  Ans : This medication is a salt drug that acts as a beta-blocker that is used for the treatment and prevention of diseases such as high blood pressure, irregular heartbeats, migraine headaches, and angina pectoris.

• Ques : What are the uses of Nigrain Forte Tablet?

  Ans : This is a medication, which is used for the treatment and prevention from conditions such as high blood pressure, irregular heartbeats, migraine headaches, and angina pectoris.

• Ques : What are the Side Effects of Nigrain Forte Tablet?

  Ans : Side effects include dizziness, lightheadedness, stomach pain, vision changes, sleeping troubles, vomiting, nausea, and swollen ankles or feet.

• Ques : What are the instructions for storage and disposal Nigrain Forte Tablet?

  Ans : This medication should be kept in a cool dry place and in its original packaging. Make sure this medication remains unreachable to children and pets.

• Ques : When can I expect relief in my symptoms after starting Nigrain Forte Tablet for high blood pressure?

  Ans : It usually starts working within a few hours of taking it. However, it may take up to a week to see the full benefits of the symptoms of high blood pressure or heart conditions.

• Ques : Is Nigrain Forte Tablet effective?

  Ans : Yes, it is effective if used in the dose and duration advised by your doctor. Do not stop taking it even if you see improvement in your condition. If you stop using this medication too early, the symptoms may return or worsen.

• Ques : Can Nigrain Forte Tablet be used in asthmatics?

  Ans : No, Nigrain Forte Tablet cannot be used in asthmatics. This is because using this drug in asthma patients can cause breathing problems, which may trigger an asthma attack. It is advised to take medical consultation.

• Ques : What if I forget to take a dose of Nigrain Forte Tablet?

  Ans : If you forget a dose of this drug, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next scheduled dose in the prescribed time.

• Ques : Can I stop taking Nigrain Forte Tablet as my chest pain is under control?

  Ans : No, you should not stop taking this medication suddenly because that may worsen your angina or may cause a heart attack. It is advised to complete the proper dose prescribed by your doctor.

• Ques : Is Nigrain Forte Tablet safe?

  Ans : Yes, it is safe if used in the dose and duration advised by your doctor. Take it exactly as directed and do not skip any dose. Follow your doctor's instructions carefully and let your doctor know if any of the side effects bother you.

• Ques : What if I take an overdose of Nigrain Forte Tablet?

  Ans : If you take an overdose of this drug you may experience symptoms such as slow heartbeat, trembling, difficulty breathing or dizziness.

• Ques : Does Nigrain Forte Tablet relieve anxiety?

  Ans : Yes, it helps relieve the symptoms of anxiety such as irritability, restlessness, excessive worry, lack of concentration, racing or unwanted thoughts, fatigue, insomnia (lack of sleep), palpitations (irregular heart rate), or trembling.

• Propranolol-Drug Information Portal [Internet].druginfo.nlm.nih.gov 2022 [Cited 26 May 2022].Available from:

  https://druginfo.nlm.nih.gov/drugportal/name/propranolol

• Propranolol-DrugBank Online [Internet].go.drugbank.com 2022 [Cited 26 May 2022].Available from:

  https://go.drugbank.com/drugs/DB00571

• PROPRANOLOL Tablet,solution-DailyMed [Internet].dailymed.nlm.nih.gov 2022 [Cited 26 May 2022].Available from:

  https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=PROPRANOLOL