Beta-adrenoceptor blocking drugs

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Use beta-blockers with caution in patients with asthma or with a history of obstructive airways disease. Combinations with diltiazem or verapamil (Nitrates, calcium-channel blockers and other antianginal drugs) may produce excessive bradycardia and should only be used under specialist advice.

Beta-blockers (bisoprolol or carvedilol) for stable heart failure are used under specialist advice.  Warn patients that heart failure symptoms may worsen for up to 3 days following dose initiation/titration and consider extra diuretic cover for 3 days.

Beta-blockers appear protective if taken for 1 to 2 years following a myocardial infarction (MI); note NICE CG172 ‘Myocardial infarction: cardiac rehabilitation and prevention of further MI’.

Refer to guidance on the use of beta-blockers in hypertension and as secondary prevention post-MI.  Bisoprolol is preferred to atenolol due to a reduced incidence of side-effects.

BISOPROLOL (First Line)

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 1·25mg, 2·5mg, 3·75mg, 5mg, 7·5mg, 10mg

Dosage:

Adjunct in stable heart failure, initially 1·25mg once daily (in the morning) then if tolerated, double the dose at a minimum of two-weekly intervals to 10mg once daily [off-label].

Hypertension, initially 5mg increased to 10mg once daily.

ATENOLOL

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 25mg, 50mg, 100mg

Dosage:

By mouth,
Hypertension, 50mg daily. 
Angina, 25 to 100mg daily, in 1 or 2 doses. 
Arrhythmias, 50 to 100mg daily. 
Post-myocardial infarction, 25mg initially increasing to 100mg daily.

Important: Formulation and dosage details

Formulation:

Oral solution 25mg/5mL

Dosage:

By mouth,
Hypertension, 50mg daily. 
Angina, 25 to 100mg daily, in 1 or 2 doses. 
Arrhythmias, 50 to 100mg daily. 
Post-myocardial infarction, 25mg initially increasing to 100mg daily.

Important: Formulation

Injection 5mg/10mL

CARVEDILOL

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 3·125mg, 6·25mg, 12·5mg, 25mg

Dosage:

Adjunct in stable heart failure, initially 3·125mg twice daily (with food), dose increased at intervals of at least 2 weeks to 6·25mg twice daily, then 12·5mg twice daily, then to 25mg twice daily; increase to highest dose tolerated, maximum 25mg twice daily in patients with severe heart failure or bodyweight less than 85kg and 50mg twice daily in patients over 85kg.

METOPROLOL

Important: Therapy notes

For assuring bradycardia during CT coronary angiography.

Important: Formulation

Tablets 50mg (s)

Important: Formulation

Injection 5mg/5mL (s)

PROPRANOLOL

Important: Therapy notes

Anxiety (Hypnotics and anxiolytics)
Essential tremor (Drugs used in Parkinsonism and related disorders)
Thyrotoxicosis (Thyroiod and antithyroid drugs)
Prophylaxis of migraine (Analgesics)

Important: Formulation

Tablets 10mg, 40mg

Important: Formulation

Modified release capsules 80mg, 160mg

SOTALOL

Important: Therapy notes

Initiated only under direct hospital advice for the treatment of arrhythmias.

Important: Formulation

Tablets 40mg, 80mg (s)

ESMOLOL

Important: Therapy notes

Important: Formulation

Injection 100mg/10mL (for specialist use in High Dependency Units only)

LABETALOL

Important: Therapy notes

Hypertension in pregnancy, refer to guidance.

Important: Formulation

Tablets 100mg, 200mg (s)

Important: Formulation

Injection 100mg/20mL (s)