Beta blockers

Contents

What are beta blockers

What are beta blockers

Beta-blockers, also called beta-adrenergic blocking agents or beta-adrenergic antagonist, are medicines that make your heart beat more slowly and with less force ¹, ². A slower heartbeat usually also leads to lower blood pressure. Beta-blockers also help widen veins and arteries to improve blood flow.

Several beta blockers are available and each one has its own characteristics. The type prescribed for you will depend on your health condition. Some beta blockers mainly affect your heart. Other beta blockers affect both your heart and blood vessels. The best one for you depends on your health conditions. Beta-blockers are often used to treat high blood pressure when other medicines have not worked. Beta-blockers are also commonly used for heart conditions such as ischemic heart disease, heart failure and arrhythmias (irregular heartbeat). Beta-blockers are also sometimes used for other conditions including migraine prevention, glaucoma, anxiety, blocking the side effects of overactive thyroid (hyperthyroidism) and essential tremor (a neurological disorder that causes involuntary shaking, usually in the hands and head that affects about 1% of people worldwide).

Beta-blockers are sold under various names, including:

Acebutolol
Atenolol
Betaxolol
Bisoprolol
Carvedilol
Esmolol
Labetalol
Metoprolol
Nadolol
Nebivolol
Sotalol
Pindolol
Propranolol
Timolol

Other medicines may also contain beta-blockers.

Beta-blockers are available in oral, intravenous, or ophthalmic forms and are also injectable intramuscularly (IM).

Beta-blockers dosages are available in various ranges, depending on the specific medication. Outpatient prescriptions may include once-a-day dosing for longer-acting beta-blockers, such as metoprolol succinate. However, most beta blockers are often dosed at least twice per day. Certain beta-blockers, such as propranolol, with a half-life of approximately 4 hours, are dosed up to 3 or 4 times a day, depending on the indication and dose.

Beta-blockers common side effects are those that are caused by the beta-adrenergic blockade and include slow heart rate (bradycardia), fatigue, dizziness, depression, memory loss, insomnia, impotence, cold limbs and, less commonly, severe low blood pressure (hypotension), heart failure and acute bronchospasm.

Can beta blockers cause weight gain?

Yes. Weight gain is a side effect of some beta-blockers ³, ⁴, ⁵, ⁶, ⁷, ⁸. The average weight gain is about 2.6 pounds (1.2 kilograms) over six or more months ⁹. You’re more likely to gain weight with older beta-blockers, such as atenolol (Tenormin) and metoprolol (Lopressor, Toprol-XL). The weight gain tends to happen in the first few months after taking the medicine. Then it usually stops. Newer beta blockers, such as carvedilol (Coreg) and nebivolol (Bystolic) don’t usually cause weight gain ⁸. Beta blockers that cause weight gain usually aren’t tried unless other medicines haven’t worked. But they may be used first for some heart conditions. Talk with your doctor about the best beta blocker for you.

Doctors aren’t sure why some beta blockers make a person gain weight. It’s thought that beta blockers slow the body’s ability to change food into energy, called metabolism ⁹.

You also might gain a few pounds if you take a water pill called a diuretic but then switch to a beta blocker ⁹.

If you’re taking a beta blocker for heart failure, tell your heart doctor right away if you gain more than 2 to 3 pounds (about 1 to 1.4 kilograms) in a day or 5 pounds (2.3 kilograms) in a week. Sudden weight gain may be due to fluid buildup in your body, which may mean your heart failure is getting worse. Your heart doctor can determine what’s causing your weight gain.

Do beta-blockers affect my ability to exercise?

The answer to whether beta-blockers can affect your ability to exercise can vary a great deal, depending on the severity of your condition, so checking with your doctor or heart specialist is important. It’s also important to understand how beta blockers affect your heart. Beta blockers relieve stress on your heart by slowing the heartbeat. This decreases the force with which your heart muscle contracts and reduces blood vessel contraction in your heart, brain and throughout your body.

Beta blockers may be used to treat abnormal heart rhythms (arrhythmias) and to prevent abnormally fast heart rates called tachycardia, or irregular rhythms such as atrial fibrillation. Since beta-blockers reduce the demand of your heart muscle for oxygen, they may be useful in treating angina, or chest pain associated with coronary artery disease, which occurs when the oxygen demand of your heart exceeds the supply. Beta blockers improve survival after a heart attack and also are used to treat high blood pressure and other heart conditions. It is important to know you are taking beta-blockers for your specific condition that will differ to other patients using beta-blocker.

It’s important to remember that beta-blockers will slow your heart rate and you may need to adjust your target heart rate or how fast your heart should beat during exercise.

There are a couple of ways to monitor your exercise intensity:

If you have been using a target heart rate to get to the right intensity, your doctor can help to determine your new target heart rate using a brief exercise stress test. This test is used because beta blockers affect everyone differently ¹⁰.
The second way to monitor your exercise intensity is simpler — making sure you’re not too exhausted.

The American Heart Association recommends you get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week ¹⁰. When done at moderate intensity, your heart will beat faster and you’ll breathe harder than normal, but you’ll still be able to talk.

If you are still concerned, talk to your doctor. He or she may prescribe a different beta blocker or another medication that has less of an effect on your heart rate.

How do beta-blockers work?

Beta-blockers work by blocking the action of beta-adrenergic agonists such as epinephrine (adrenaline) and norepinephrine (noradrenaline) on the beta-receptor sites. Beta receptors exist in 3 distinct forms: beta-1 (β1), beta-2 (β2), and beta-3 (β3) adrenergic receptors ¹. Beta-1 (β1) adrenergic receptors are located primarily in your heart muscle and control heart activity. Beta-1 (β1) adrenergic receptors also induce renin (a hormone that helps regulate blood pressure and electrolyte balance in the body) release, and this leads to an increase in blood pressure. Beta-2 (β2) adrenergic receptors, with their diverse location in many organ systems, control various aspects of metabolic activity such as glycogenolysis (breaking down glycogen, a stored carbohydrate, into glucose to produce energy) and causes relaxation of the smooth muscles. Beta-3 (β3) adrenergic receptors induce the breakdown of fat cells and are less clinically relevant at present. Blockade of these beta receptors by beta-blocking medicines is used to treat a broad range of illnesses ¹¹.

Beta-blockers vary in their specificity towards different beta receptors, and accordingly, the effects produced depend on the type of beta receptor(s) blocked as well as the organ system involved ¹. Beta-blockers are often categorized as “selective” or “non-selective” based upon whether they block both beta-1 (β1) receptors that are predominantly present in cardiac muscle and beta-2 (β2) receptors found in bronchial and smooth muscles. Some beta-blockers also bind to alpha (α) receptors to some degree, allowing them to induce a different clinical outcome when used in specific settings ¹. There are also beta-blocking drugs that affect both beta-2 (β2) and/or beta-3 (β3) receptors selectively; neither has a known clinical purpose to date ¹.

“Selective” beta-1 (β1) blockers are preferred for therapy of heart disease. Beta-1 (β1) selective adrenergic blockers like acebutolol, atenolol, betaxolol, bisoprolol, metoprolol, esmolol and nebivolol only bind to the beta-1 (β1) receptors, therefore, they are cardio-selective ¹², ¹³, ¹⁴.

“Non-selective” beta-blockers bind to both beta-1 (β1) and beta-2 (β2) adrenergic receptors and induce antagonizing effects via both receptors. Therefore, the chronotropic (heart rate) and inotropic (the force of heart muscle contractions) effects on the heart undergo inhibition, and the heart rate slows down as a result. Examples of non-selective beta-blockers include propranolol, carvedilol, labetalol, nadolol, sotalol, pindolol, penbutolol and timolol. Nonselective beta-blockers are preferred as therapy to prevent recurrent variceal hemorrhage in patients with cirrhosis and portal hypertension.

Beta-blockers also decrease blood pressure via several mechanisms, including blocking the action of the hormone epinephrine (adrenaline) on nerve cells and causes blood vessels to relax and dilate (widen) and decreasing renin (a hormone that helps regulate blood pressure and electrolyte balance in the body) release and reduced cardiac output. This allows blood to flow more easily and lowers blood pressure and the heart rate. The negative chronotropic and inotropic effects lead to a decreased oxygen demand; that is how angina improves after beta-blocker usage. Beta-blockers also prolong the atrial refractory periods and have a potent antiarrhythmic effect.

Beta-blockers also lower the secretion of melatonin and hence may cause insomnia and sleep changes in some patients ¹⁵.

Alpha-1 (α1) receptors induce vasoconstriction (narrowing of blood vessels, which slows or blocks blood flow) and increased heart chronotropy; this means agonism at the alpha-1 (α1) receptors leads to higher blood pressure and an increased heart rate. In contrast, antagonism (blockade) of the alpha-1 (α1) receptor leads to vasodilation (widening of blood vessels) and negative chronotropic (slower heart rate), which leads to lower blood pressure and decreased heart rate. Some beta-blockers, such as carvedilol, labetalol, and bucindolol, have additional alpha-1 (α1) receptor blockage activity in addition to their non-selective beta receptor blockage. This property is clinically useful because beta-blockers that block the alpha-1 (α1) receptor have a more pronounced clinical effect on treating high blood pressure (hypertension) ¹⁶.

Sotalol is a beta blocker and also blocks potassium channels ¹. Sotalol is a class 3 antiarrhythmic or potassium (K⁺) channel blockers that treat arrhythmias by slowing down electrical impulses in the heart ¹⁷.

Beta-blockers medications

Acebutolol

Acebutolol is a “cardioselective” beta-blocker or beta-1 (β1) adrenergic receptor blocker (with little or no activity against beta-2 adrenergic receptors) which are found in cardiac muscle, on bronchial and vascular smooth muscle that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to your heart. Acebutolol was approved for use in the United States in 1985 and is currently used alone or in combination with other medications to treat high blood pressure, angina pectoris (chest pain caused by narrowing of the arteries supplying the heart) and cardiac arrhythmias (ventricular arrhythmia). Acebutolol also has mild sympathomimetic activity (a partial adrenergic agonist, similar to pinolol).

Acebutolol is available only with your doctor’s prescription. Acebutolol comes as a capsules of 200 and 400 mg in generic forms and under the trade name Sectral to take by mouth. The usual initial oral dose of acebutolol in adults is 200 mg once or twice daily, with subsequent adjustment based upon clinical response and tolerance; the usual maintenance dosage being 200 to 1200 mg daily. In high doses, acebutolol is less cardioselective and can induced acute bronchospasm. As with other beta-blockers, sudden withdrawal can trigger rebound hypertension. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take acebutolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of acebutolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Acebutolol controls your condition but does not cure it. It is very important that your doctor check your progress at regular visits to make sure acebutolol is working properly and to check for side effects. Continue to take acebutolol even if you feel well. Do not stop taking acebutolol without talking to your doctor. If you suddenly stop taking acebutolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Acebutolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing .

Make sure any doctor or dentist who treats you knows that you are using acebutolol. You may need to stop using acebutolol several days before having surgery .

Acebutolol may cause changes in your blood sugar levels. Also, acebutolol may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Acebutolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, insomnia, memory loss and impotence.

Before taking acebutolol ¹⁸:

tell your doctor and pharmacist if you are allergic to acebutolol, any other medications, or any ingredients in acebutolol capsules. Ask your pharmacist for a list of the ingredients.
tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking while you are taking acebutolol. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
The following nonprescription or herbal products may interact with acebutolol: nasal decongestants such as oxymetazoline (Afrin, Neo-Synephrine, Vicks Sinex, others) or cough and cold combination products that contain phenylephrine or pseudoephedrine. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking acebutolol. Do not start any of these medications while taking acebutolol without discussing with your healthcare provider.
tell your doctor if you have a slow or irregular heart rate or heart failure. Your doctor may tell you not to take acebutolol.
tell your doctor if you have or have ever had heart, kidney, or liver disease; asthma or other lung diseases; problems with blood circulation; diabetes; or hyperthyroidism (an overactive thyroid gland). Also tell your doctor if you have ever had a serious allergic reaction to a food or any other substance.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking acebutolol, call your doctor.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking acebutolol.
you should know that acebutolol may make you drowsy. Do not drive a car or operate machinery until you know how acebutolol affects you.
you should know that acebutolol may increase the risk of hypoglycemia (low blood sugar) and prevent the warning signs and symptoms that would tell you that your blood sugar is low. Let
your doctor know if you are unable to eat or drink normally or are vomiting while you are taking acebutolol. You should know the symptoms of low blood sugar and what to do if you have these symptoms.
you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using acebutolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine.

Acebutolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For acebutolol, the following should be considered:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to acebutolol or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of acebutolol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of acebutolol in the elderly. However, elderly patients are more likely to have age-related liver or kidney problems, which may require an adjustment of dosage in patients receiving acebutolol.
Breastfeeding. Studies in women breastfeeding have demonstrated harmful infant effects. An alternative to this medication should be prescribed or you should stop breastfeeding while using acebutolol.
Other Medical Problems. The presence of other medical problems may affect the use of acebutolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Acebutolol may provoke chest pain if stopped too quickly.
- Blood vessel disease: Use with caution. Acebutolol may worsen this condition.
- Bradycardia (slow heartbeat), heart block or heart failure: Should not use acebutolol in patients with these heart conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Acebutolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease or liver disease: Use acebutolol with caution. The effects may be increased because of slower removal of acebutolol from the body.
- Lung disease (e.g., asthma, bronchitis, emphysema): Acebutolol may cause difficulty with breathing in patients with this condition.

Acebutolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking acebutolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using acebutolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using acebutolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine

Acebutolol Dosage

The dose of acebutolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of acebutolol. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules):

For high blood pressure:
- Adults: At first, 400 milligrams (mg) once or twice a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor .
For ventricular arrhythmia:
- Adults: At first, 200 milligrams (mg) twice a day. Your doctor may increase your dose if needed.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of acebutolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Acebutolol side effects

Acebutolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

dizziness
lightheadedness
excessive tiredness
headache
constipation
diarrhea
upset stomach
nausea
muscle or joint pain
difficulty falling asleep or staying asleep

Some side effects can be serious. If you experience any of the following symptoms, see your doctor immediately:

shortness of breath or wheezing
slow heart rate
muscle or joint pain
unusual weight gain
swelling of the hands, feet, ankles, or lower legs
chest pain.

Acebutolol may cause other side effects. Call your doctor if you have any unusual problems while taking acebutolol.

Atenolol

Atenolol is a “cardioselective” beta-blocker or beta-1 (β1) adrenergic receptor blocker (with little or no activity against beta-2 adrenergic receptors) which are found in cardiac muscle, on bronchial and vascular smooth muscle that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to your heart. Atenolol was approved for use in the United States in 1981 and is currently used alone or in combination with other medications to treat high blood pressure and angina pectoris (chest pain caused by narrowing of the arteries supplying the heart). Atenolol is also used to reduce the risk of death from cardiovascular disease in patients with coronary artery disease.

Atenolol is available in 25, 50 and 100 mg tablets in generic forms as well as under the trade name of Tenormin. Atenolol is also available in fixed combinations with a diuretic (water pill) such as chlorthalidone (Tenoretic and others). Parenteral formulations for intravenous (IV) use are also available. For the treatment of high blood pressure and to prevent angina, the usual oral dose of atenolol in adults is 25 to 50 mg once daily initially, with subsequent adjustment based upon clinical response and tolerance, but rarely beyond 100 mg daily. To improve survival after a heart attack, atenolol is usually taken once or twice a day. To help you remember to take atenolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atenolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of atenolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Atenolol controls high blood pressure and angina but does not cure them. It may take 1-2 weeks before you feel the full benefit of atenolol. Continue to take atenolol even if you feel well. Do not stop taking atenolol without talking to your doctor. If you suddenly stop taking atenolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

It is very important that your doctor check your progress at regular visits to make sure atenolol is working properly. Blood tests may be needed to check for unwanted effects.

Atenolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss and impotence. At high doses, atenolol is less cardioselective and can cause bronchospasm. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension.

Atenolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For atenolol, the following should be considered ¹⁹:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to atenolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of atenolol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of atenolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment of dosage in patients receiving atenolol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking atenolol while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of atenolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Bradycardia (slow heartbeat) or cardiogenic shock (shock caused by heart attack) or heart block or heart failure or pheochromocytoma (adrenal gland tumor) untreated: Should not use atenolol in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Atenolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease: Use atenolol with caution. The effects may be increased because of slower removal of atenolol from the body.
- Lung disease (eg, asthma, bronchitis, emphysema): Atenolol may cause difficulty with breathing in patients with this condition.
- Patients who are fasting (eg, surgery, not eating regularly, vomiting): Atenolol may increase risk of hypoglycemia (low blood sugar).

Using atenolol while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using atenolol, tell your doctor right away.

Atenolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, or weight gain.

Do not suddenly stop taking atenolol without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

Make sure any doctor or dentist who treats you knows that you are using atenolol. Do not stop taking atenolol before surgery without your doctor’s approval.

Atenolol may cause changes in blood sugar levels. Also, atenolol may cover up the symptoms of low blood sugar (including fast heartbeat) and increase the risk for serious or prolonged hypoglycemia (low blood sugar). Check with your doctor if you notice a change in your normal symptoms or a change in the results of your blood or urine sugar tests. Call your doctor right away if you have anxiety, blurred vision, chills, cold sweats, coma, confusion, cool, pale skin, depression, dizziness, fast heartbeat, headache, increased hunger, nausea, nervousness, nightmares, seizures, shakiness, slurred speech, or unusual tiredness or weakness.

Atenolol may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking atenolol.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may increase your blood pressure.

Atenolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking atenolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using atenolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using atenolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Disopyramide
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone

Atenolol dosage

The dose of atenolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of atenolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For acute heart attack:
- Adults: At first, 50 milligrams (mg) 10 minutes after the last intravenous (IV) dose followed by another 50 mg 12 hours later. Then, 100 mg once a day or 50 mg 2 times a day for another 6 to 9 days or until discharge from the hospital.
- Children: Use and dose must be determined by your doctor.
For chest pain (angina):
- Adults: At first, 50 milligrams (mg) once a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor.
For high blood pressure:
- Adults: At first, 50 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 100 mg per day.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of atenolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Atenolol side effects

Atenolol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

dizziness
lightheadedness
tiredness
lack of energy
drowsiness
depression
nausea
diarrhea
rash

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

shortness of breath
wheezing
swelling of the hands, feet, ankles, or lower legs
unusual weight gain
fainting
rapid, pounding, or irregular heartbeat
dry eyes

Atenolol may cause other side effects. See your doctor if you have any unusual problems while taking atenolol.

Betaxolol

Betaxolol is a “cardioselective” beta-blocker or beta-1 (β1) adrenergic receptor blocker (with little or no activity against beta-2 adrenergic receptors) which are found in cardiac muscle, on bronchial and vascular smooth muscle that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to your heart. Betaxolol was approved for use in the United States in 1985 and is currently used alone or in combination with other medications to treat high blood pressure (hypertension). Liquid eye solutions of betaxolol and its stereoisomer levobetaxolol are available for use in ocular hypertension and glaucoma.

Betaxolol is available in 10 and 20 mg tablets in generic forms as well as under the trade name of Kerlone. The usual initial oral dose of betaxolol in adults is 10 mg once daily, with subsequent adjustment based upon clinical response and tolerance; the usual maintenance dosage being 10 to 40 mg daily. Take betaxolol at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take betaxolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of betaxolol and may increase your dose after 1–2 weeks if your blood pressure is not controlled.

Betaxolol controls high blood pressure but does not cure it. It may take 1–2 weeks or longer before the full benefit of betaxolol is noted. Continue to take betaxolol even if you feel well. Do not stop taking betaxolol without talking to your doctor. If you suddenly stop taking betaxolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably decrease your dose gradually over about 2 weeks and will monitor you carefully during this time. Your doctor may also tell you to limit physical activity while your dose is being decreased.

Betaxolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, insomnia, memory loss and impotence. At high doses, betaxolol is less cardioselective and can induce bronchospasm. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension.

Betaxolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For betaxolol, the following should be considered ²⁰:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to betaxolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of betaxolol in the pediatric population. Safety and efficacy have not been established .
Elderly. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of betaxolol in the elderly. However, elderly patients may experience bradycardia (unusually slow heartbeat) more frequently than in younger adults, which may require caution and an adjustment of dosage in patients receiving betaxolol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking betaxolol while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of betaxolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Betaxolol may provoke chest pain if stopped too quickly.
- Bradycardia (slow heart rate) or heart block or heart failure: Should not use betaxolol in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Betaxolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Sever kidney disease: Use betaxolol with caution. The effects of betaxolol may be increased because of slower removal from the body.
- Lung disease (e.g., asthma, bronchitis, emphysema): Betaxolol may cause difficulty with breathing in patients with this condition.

Betaxolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking betaxolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using betaxolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Disopyramide
Dronedarone
Epinephrine
Fenoldopam
Fingolimod
Formoterol
Indacaterol
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using betaxolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Aceclofenac
Acemetacin
Acetyldigoxin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Celecoxib
Choline Salicylate
Clonixin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Droxicam
Etodolac
Etofenamate
Etoricoxib
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine
Flufenamic Acid
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Lornoxicam
Loxoprofen
Lumiracoxib
Meclofenamate
Mefenamic Acid
Meloxicam
Metildigoxin

Betaxolol dosage

The dose of betaxolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of betaxolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 10 milligrams (mg) once a day. Your doctor may increase your dose if needed.
- Children: Use and dose must be determined by your doctor .

If you miss a dose of betaxolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Betaxolol side effects

Betaxolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

extreme tiredness
difficulty falling asleep or staying asleep
unusual dreams
heartburn
nausea
diarrhea
joint pain
decreased sexual ability in men
cold hands and feet
numbness, burning, or tingling in the arms, legs, hands, or feet
rash

Some side effects can be serious. If you experience any of these symptoms, see your doctor immediately:

difficulty breathing, especially during activity or when lying down
swelling of the arms, hands, feet, ankles, or lower legs
unexplained weight gain
fast, slow, pounding, or irregular heartbeat
chest pain

Betaxolol may cause other side effects. See your doctor if you have any unusual problems while taking betaxolol.

Bisoprolol

Bisoprolol is a “cardioselective” beta-blocker or beta-1 (β1) adrenergic receptor blocker (with little or no activity against beta-2 adrenergic receptors) which are found in cardiac muscle, on bronchial and vascular smooth muscle that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to your heart. Bisoprolol was approved for use in the United States in 1992 and is currently used alone or in combination with other medications to treat high blood pressure (hypertension).

Bisoprolol is available in 5 and 10 mg tablets in generic forms as well as under the trade name of Zebeta. Bisoprolol is also available in fixed combinations with hydrochlorthiazide (Ziac and other generic forms). The usual initial oral dose of bisoprolol in adults is 2.5 to 5 mg once daily, with subsequent adjustment based upon clinical response and tolerance, the usual maintenance dosage being 5 to 20 once mg daily. To help you remember to take bisoprolol, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take bisoprolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of bisoprolol and gradually increase your dose. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Bisoprolol controls high blood pressure but does not cure it. It may take a few weeks before you feel the full benefit of bisoprolol. Continue to take bisoprolol even if you feel well. Do not stop taking bisoprolol without talking to your doctor. If you suddenly stop taking bisoprolol, you may experience serious heart problems such as angina (chest pain), heart attack, or irregular heartbeat. Your doctor will probably decrease your dose gradually over 1 week. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Bisoprolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, insomnia, memory loss and impotence. At high doses, bisoprolol is less cardioselective and can induced acute bronchospasm. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension.

Bisoprolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For bisoprolol, the following should be considered ²¹:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to bisoprolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of bisoprolol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of bisoprolol in the elderly.
Breastfeeding. There are no adequate studies in women for determining infant risk when using bisoprolol during breastfeeding. Weigh the potential benefits against the potential risks before taking bisoprolol while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of bisoprolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Bisoprolol may provoke chest pain if stopped too quickly.
- Blood vessel disease: Use bisoprolol with caution. Bisoprolol may make this condition worse.
- Bradycardia (slow heartbeat) or heart block or heart failure: Should not use bisoprolol in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Bisoprolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease or liver disease: Use bisoprolol with caution. The effects may be increased because of slower removal of bisoprolol from the body.
- Lung disease (e.g., asthma, bronchitis, emphysema): Bisoprolol may cause difficulty with breathing in patients with this condition.

Bisoprolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking bisoprolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using bisoprolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using bisoprolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine

Bisoprolol dosage

The dose of bisoprolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of bisoprolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 5 milligrams (mg) once a day. Some patients may take 2.5 mg once day as a starting dose. Your doctor may increase your dose up to 20 mg once a day if needed.
- Children: Use and dose must be determined by your doctor .

If you miss a dose of bisoprolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Bisoprolol side effects

Bisoprolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

headache
dizziness
excessive tiredness
weakness
nausea or vomiting
diarrhea
muscle or joint pain
runny nose, cough, or sore throat
dry mouth
difficulty falling asleep or staying asleep

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, see your doctor immediately:

shortness of breath
swelling of the hands, feet, ankles, or lower legs
unusual weight gain
fainting
chest pain

Bisoprolol may cause other side effects. See your doctor if you have any unusual problems while taking bisoprolol.

Carvedilol

Carvedilol is a unique antihypertensive medication with activity against both alpha- and beta-adrenergic receptors. The beta-blockade is nonselective, acting on both beta-1 and beta-2 adrenergic receptors. Beta-1 adrenergic blockade reduces the heart rate and heart contraction by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade affects peripheral vascular resistance and can cause bronchospasm and hypoglycemia. The alpha-adrenergic blockade acts on alpha-1 receptors which results in relaxation of arterial smooth muscle and vasodilation.

Carvedilol was approved for use in the United States in 1995. Carvedilol is used alone or in combination with other medications to treat heart failure (condition in which the heart cannot pump enough blood to all parts of the body) and high blood pressure. Carvedilol is also approved for use after a heart attack (myocardial infarction) to improve survival. Carvedilol is also used off label to treat migraine and vascular headaches.

Carvedilol is available in tablets of 3.125, 6.25, 12.5 and 25 mg in generic forms and under the trade name Coreg. The typical initial oral dose in adults is 6.25 mg twice daily, with subsequent dose modification based upon clinical response and tolerance, the average total daily maintenance dose being 25 to 50 mg. Extended release capsules of 10, 20, 40 and 80 mg capsules which can be given once daily are also available. The extended-release capsule is usually taken once a day in the morning with food. Try to take carvedilol at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take carvedilol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the extended-release capsules whole. Do not chew or crush the capsules, and do not divide the beads inside a capsule into more than one dose. If you are unable to swallow the capsules, you may carefully open a capsule and sprinkle all of the beads it contains over a spoonful of cool or room temperature applesauce. Swallow the entire mixture immediately without chewing.

Your doctor will probably start you on a low dose of carvedilol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Carvedilol may help to control your condition but will not cure it. Continue taking carvedilol even if you feel well. Do not stop taking carvedilol without talking to your doctor. If you suddenly stop taking carvedilol, you may experience serious heart problems such as severe chest pain, a heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Carvedilol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and less commonly severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes.

Carvedilol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For carvedilol, the following should be considered ²²:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to carvedilol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of carvedilol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of carvedilol in the elderly.
Breastfeeding. There are no adequate studies in women for determining infant risk when using carvedilol during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of carvedilol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain) or bradycardia (slow heartbeat) or breathing or other lung problems (eg, bronchitis or emphysema) or coronary artery disease or diabetes or edema (fluid retention or body swelling) or heart or blood vessel disease or hyperthyroidism (overactive thyroid) or hypotension (low blood pressure) or major surgery or peripheral vascular disease (blood circulation problem) or pheochromocytoma (adrenal gland tumor): Use carvedilol with caution. Carvedilol may make these conditions worse.
- Asthma or atrioventricular (AV) block, second or third-degree or bradycardia (slow heartbeat), severe (without a pacemaker) or cardiogenic shock (shock caused by heart attack) or decompensated heart failure or hypersensitivity reactions (eg, anaphylaxis, angioedema, Stevens-Johnson syndrome), history of severe liver disease or sick sinus syndrome (type of abnormal heart rhythm): Should not use carvedilol in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Carvedilol may cover up some of the symptoms of these diseases, including a fast heartbeat.
- Kidney disease or liver disease: Use carvedilol with caution. Effects may be increased because of slower removal of carvedilol from the body.
- Patients who are fasting (eg, surgery, not eating regularly, vomiting): Carvedilol may increase risk of hypoglycemia (low blood sugar).

The following nonprescription or herbal products may interact with carvedilol: St. John’s Wort. Be sure to let your doctor and pharmacist know that you are takin St. John’s Wort before you start taking carvedilol. Do not start St. John’s Wort while taking carvedilol without discussing with your doctor.

Carvedilol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking carvedilol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using carvedilol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Colchicine
Mavorixafor

Using carvedilol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abiraterone Acetate
Abiraterone Acetate, Micronized
Afatinib
Albuterol
Amiodarone
Betrixaban
Bupropion
Capecitabine
Carbamazepine
Ceritinib
Clonidine
Cobicistat
Crizotinib
Dabigatran Etexilate
Darunavir
Desvenlafaxine
Digoxin
Diltiazem
Doxorubicin
Doxorubicin Hydrochloride Liposome
Dronedarone
Duloxetine
Epinephrine
Escitalopram
Fedratinib
Fenoldopam
Fexinidazole
Fingolimod
Fluconazole
Fluoxetine
Fluvoxamine
Formoterol
Indacaterol
Iobenguane I 123
Iobenguane I 131
Iohexol
Lacosamide
Lefamulin
Levalbuterol
Mavacamten

Using carvedilol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Cimetidine
Clonixin
Dapagliflozin
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Dipyrone
Dobutamine
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine
Flufenamic Acid
Flurbiprofen

Carvedilol dosage

The dose of carvedilol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of carvedilol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (extended-release capsules):

For heart failure:
- Adults: At first, 10 milligrams (mg) once a day for at least 2 weeks. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day.
- Children: Use and dose must be determined by your doctor.
For hypertension:
- Adults: At first, 20 milligrams (mg) once a day for 7 to 14 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day.
- Children: Use and dose must be determined by your doctor.
For left ventricular dysfunction after a heart attack:
- Adults: At first, 20 milligrams (mg) once a day for 3 to 10 days. Your doctor may adjust your dose as needed. However, the dose is usually not more than 80 mg once a day
- Children: Use and dose must be determined by your doctor.

For oral dosage form (tablets):

For congestive heart failure:
- Adults: At first, 3.125 milligrams (mg) 2 times a day for 2 weeks. Your doctor may adjust your dose as needed. However, the dose is usually not more than 50 mg 2 times a day.
- Children: Use and dose must be determined by your doctor.
For high blood pressure (hypertension):
- Adults: At first, 6.25 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 mg 2 times a day.
- Children: Use and dose must be determined by your doctor.
For left ventricular dysfunction after a heart attack:
- Adults: At first, 6.25 milligrams (mg) 2 times a day. Some patients may start at 3.125 mg two times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 25 mg 2 times a day.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of carvedilol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Carvedilol side effects

Carvedilol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

tiredness
weakness
lightheadedness
dizziness
headache
diarrhea
nausea
vomiting
vision changes
joint pain
difficulty falling asleep or staying asleep
stuffy or runny nose
cough
dry eyes
numbness, burning, or tingling in the arms or legs

Some side effects may be serious. If you experience any of the following symptoms, see your doctor immediately:

fainting
shortness of breath
weight gain
swelling of the arms, hands, feet, ankles, or lower legs
chest pain
slow or irregular heartbeat
rash
hives
itching
swelling of the face, lips, tongue, or throat
difficulty breathing and swallowing

Carvedilol may cause other side effects. See your doctor if you experience any unusual problems while you are taking carvedilol.

Esmolol

Esmolol is a intravenous “cardioselective” beta-blocker or beta-1 (β1) adrenergic receptor blocker (with little or no activity against beta-2 adrenergic receptors) which are found in cardiac muscle, on bronchial and vascular smooth muscle that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to your heart. Esmolol has a rapid time of onset and short duration of action, which makes it useful for intravenous (IV) therapy of acute arrhythmias and severe high blood pressure (hypertension) or in patients with hypertension who are unable to take oral medications. Esmolol was approved for use in the United States in 1986 and is currently used for the intravenous therapy of supraventricular tachycardias (SVTs), hypertension in the perioperative period and during episodes of acute myocardial ischemia or heart attack.

Esmolol is available in liquid formulations in vials and ampules for injection generically and under the trade name of Brevibloc. The usual intravenous dose of esmolol is 50 to 200 mcg/kg/minute, sometimes after a loading dose of 500 mcg/kg/minute. Your doctor will only give you a few doses of esmolol until your condition improves, and then you will be switched to another medicine that works the same way. If you have any concerns about this, talk to your doctor .

Esmolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, agitation, and confusion. At high doses, esmolol is less cardioselective and can induce acute bronchospasm. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension.

Esmolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For esmolol, the following should be considered ²³:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to esmolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of esmolol in the pediatric population. Safety and efficacy have not been established.
Elderly. No information is available on the relationship of age to the effects of esmolol in geriatric patients. However, elderly patients are more likely to have age-related kidney problems, which may require an adjustment in the dose for patients receiving esmolol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking esmolol while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of esmolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Bradycardia (slow heartbeat) or heart block or heart failure: Esmolol should not use in patients with these conditions.
- Diabetes or hypoglycemia (low blood sugar): Esmolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Hypotension (low blood pressure): Esmolol may worsen this condition.
- Kidney disease: Use esmolol with caution. The effects may be increased because of slower removal of esmolol from the body.
- Lung disease (e.g. asthma, bronchitis, emphysema): Esmolol may cause difficulty with breathing in patients with this condition.

Esmolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving esmolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using esmolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using esmolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine

Esmolol dosage

Esmolol is given as an infusion into a vein. Your doctor will give you this injection. Tell your doctor if you feel any burning or pain when esmolol is injected.

Your breathing, blood pressure, oxygen levels, and other vital signs will be watched closely while you are receiving esmolol.

Your blood pressure will need to be checked often and you may need medical tests to check your progress. Your blood sugar and heart function will also be checked on a regular basis.

Adult Dose for Atrial Fibrillation

Use: For the rapid control of ventricular rate in patients with atrial fibrillation or atrial flutter in perioperative, postoperative, or other emergent circumstances where short-term control of ventricular rate with a short-acting agent is desirable; it is also indicated in noncompensatory sinus tachycardia where the rapid heart rate requires specific intervention

Esmolol is administered by continuous IV infusion (with or without a loading dose); additional loading doses and/or titration of the maintenance infusion may be necessary based on desired ventricular response.

Recommended Dosing:

Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV

Maintenance dose: 25 to 200 mcg/kg/min IV
Maximum dose: 200 mcg/kg/min IV
Duration: Maintenance infusions may be continued for up to 48 hours

Comment:

In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

Adult Dose for Atrial Flutter

Recommended Dosing:

Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV

Maintenance dose: 25 to 200 mcg/kg/min IV
Maximum dose: 200 mcg/kg/min IV
Duration: Maintenance infusions may be continued for up to 48 hours

Comment:

In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

Adult Dose for Supraventricular Tachycardia

Recommended Dosing:

Step 1) Optional loading dose (500 mcg/kg IV over 1 minute), then 50 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 50 mcg/kg/min; if the response is inadequate, see step 2.
Step 2) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 100 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 100 mcg/kg/min; if the response is inadequate, see step 3.
Step 3) Optional loading dose (500 mcg/kg IV over 1 minute) if necessary, then 150 mcg/kg/min IV for 4 minutes; if the response is adequate, the infusion may be maintained at 150 mcg/kg/min; if the response is inadequate, see step 4.
Step 4) If necessary, increase dose to 200 mcg/kg/min IV

Maintenance dose: 25 to 200 mcg/kg/min IV
Maximum dose: 200 mcg/kg/min IV
Duration: Maintenance infusions may be continued for up to 48 hours

Comment:

In the absence of loading doses, continuous infusion of a single concentration of this drug reaches steady-state in about 30 minutes.

Adult Dose for Intra- or Post-op SVT or Hypertension

Use: For the short-term treatment of tachycardia and hypertension that occur during induction and tracheal intubation, during surgery, on emergence from anesthesia and in the postoperative period, when such specific intervention is considered indicated.

For intraoperative and postoperative tachycardia and hypertension it is not always advisable to slowly titrate to a therapeutic effect; therefore 2 dosing options are presented (immediate control and gradual control).

IMMEDIATE CONTROL:
- Administer 1 mg/kg IV as a bolus dose over 30 seconds followed by 150 mcg/kg/min if needed
- Adjust the infusion rate as required to maintain desired heart rate and blood pressure (refer to maximum recommended doses)
GRADUAL CONTROL:
Administer 500 mcg/kg IV as a bolus dose over 1 minute followed by a maintenance infusion of 50 mcg/kg/min IV for 4 minutes
Infusion may be continued at 50 mcg/kg/min or, if the response is inadequate, titrated upward in 50 mcg/kg/min increments (increased no more frequently than every 4 minutes) to a maximum of 300 mcg/kg/min; may administer an optional loading dose equal to the initial bolus (500 mcg/kg over 1 minute) prior to each increase in infusion rate

MAXIMUM RECOMMENDED DOSES:

For the treatment of tachycardia, maintenance infusion dosages greater than 200 mcg/kg/min IV are not recommended; dosages greater than 200 mcg/kg/min IV provide little additional heart rate-lowering effect, and the rate of adverse reactions increases.
For the treatment of hypertension, higher maintenance infusion dosages (250 to 300 mcg/kg/min) may be required; the safety of doses above 300 mcg/kg/min has not been studied.

Esmolol side effects

Esmolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

Common side effects of Esmolol:

blurred vision
confusion
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
increased sweating
unusual tiredness or weakness

Less common side effects of Esmolol:

itching of skin
numbness and tingling of face, fingers, or toes
pain in arms, legs, or lower back, especially pain in calves and/or heels upon exertion
pale, bluish-colored, or cold hands or feet
weak or absent pulses in legs

Rare side effects of Esmolol:

blue lips and fingernails
burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
changes in skin color
changes in vision
chest pain or discomfort
convulsions
coughing that sometimes produces a pink frothy sputum
decrease in frequency of urination
decrease in urine volume
delusions
dementia
difficult, fast, noisy breathing, sometimes with wheezing
difficulty in passing urine (dribbling)
difficulty with speaking
feeling of warmth
feeling unusually cold
lightheadedness, dizziness, or fainting
loss of bladder control
muscle spasm or jerking of all extremities
no heartbeat
pain, tenderness, or swelling of foot or leg
painful urination
paleness of skin
peeling of skin
redness of the face, neck, arms and occasionally, upper chest
shivering
shortness of breath
slow or irregular heartbeat
small clicking, bubbling, or rattling sounds in the lung when listening with a stethoscope
sudden loss of consciousness
swelling, redness, or burning of skin where the needle is placed
tightness in chest

Get emergency help immediately if any of the following symptoms of Esmolol overdose occur.

Symptoms of Esmolol overdose:

dilated neck veins
extreme fatigue
irregular breathing
no blood pressure or pulse
stopping of heart
swelling of face, fingers, feet, or lower legs
unconsciousness
weight gain

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your doctor may be able to tell you about ways to prevent or reduce some of these side effects. Check with your doctor if any of the following side effects continue or are bothersome or if you have any questions about them.

More common side effects:

hardening or thickening of skin where the needle is placed
nausea

Less common side effects:

anxiety
dry mouth
headache
hyperventilation
irritability
nervousness
restlessness
shaking
sleepiness or unusual drowsiness
trouble sleeping
vomiting

Rare side effects:

acid or sour stomach
belching
change in taste or bad, unusual, or unpleasant (after) taste
difficulty having a bowel movement (stool)
discouragement
feeling sad or empty
heartburn
indigestion
lack of appetite
lack or loss of strength
loss of interest or pleasure
shoulder pain
stomach soreness, discomfort, upset, or pain
stuffy nose
tiredness
trouble concentrating
weight loss

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your doctor.

Labetalol

Labetalol is an antihypertensive agent with both alpha- and beta-adrenergic receptor blocking activity. The beta-blockade is nonselective, acting on both beta-1 and beta-2 adrenergic receptors. Beta-1 adrenergic blockade reduces the heart rate and heart contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade affects peripheral vascular resistance and can cause bronchospasm and hypoglycemia. The alpha blockade is largely directed at the alpha-1 receptors and leads to relaxation of arterial smooth muscle and vasodilation.

Labetalol was approved for use in the United States in 1984. Current indications for labetalol are in the therapy of hypertension alone or in combination with other agents. Parenteral forms of labetalol are indicated for therapy of hypertensive emergencies, severe hypertension and pheochromocytoma. Labetalol is also used sometimes to treat angina (chest pain) and to treat patients with tetanus.

Labetalol is available in tablets of 100, 200 and 300 mg in generic formulations and under the trade name Trandate. Parenteral formulations for intravenous administration are also available. The typical oral labetalol dose in adults is 100 mg twice daily initially with subsequent dose adjustments based upon clinical response and tolerance to a range of 200 to 1200 mg daily. Labetalol usually is taken two or three times a day. To help you remember to take labetalol, take it around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take labetalol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of labetalol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Labetalol controls high blood pressure but does not cure it. Continue to take labetalol even if you feel well. Do not stop taking labetalol without talking to your doctor. If you suddenly stop taking labetalol, you may experience serious heart problems such as angina (chest pain) or heart attack. Your doctor will probably want to decrease your dose gradually. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Labetalol common side effects include bradycardia, hypotension, fatigue, dizziness, orthostatic hypotension, depression, memory loss, impotence, weight gain and diarrhea. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension. Ask your doctor about the possible risks of using labetalol for your condition.

Labetalol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For labetalol, the following should be considered ²⁴:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to labetalol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of labetalol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of labetalol in the elderly.
Breastfeeding. Studies in women suggest that labetalol poses minimal risk to the infant when used during breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of labetalol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Labetalol may provoke chest pain if stopped too quickly.
- Asthma or bradycardia, severe (slow heartbeat) or cardiogenic shock (shock caused by heart attack) or obstructive airway disease, or heart block or heart failure or hypotension (low blood pressure), severe and prolonged: Labetalol should not be used in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Labetalol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Hypotension (low blood pressure) or ischemic heart disease or lung disease or pheochromocytoma (adrenal gland tumor): Use labetalol with caution. Labetalol may make these conditions worse.
- Liver disease: Use labetalol with caution. The effects may be increased because of slower removal of labetalol from the body.
- Patients who are fasting (eg, surgery, not eating regularly, vomiting): Labetalol may increase risk of hypoglycemia (low blood sugar).

Labetalol drug interaction

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking labetalol, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using labetalol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Carbamazepine
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Halothane
Indacaterol
Iobenguane I 123
Iobenguane I 131
Iohexol
Lacosamide
Levalbuterol
Levoketoconazole
Lonafarnib
Mavacamten
Methotrexate
Olodaterol
Oxymetazoline
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using labetalol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Cimetidine
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Enflurane
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol

Labetalol dosage

The dose of labetalol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of labetalol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 100 milligrams (mg) 2 times a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of labetalol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Labetalol side effects

Labetalol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

dizziness or lightheadedness
tingling scalp or skin
tiredness
headache
nausea
upset stomach
stuffy nose

Some side effects can be serious. If you experience any of the following symptoms, see your doctor immediately:

shortness of breath or difficulty breathing
wheezing
swelling of the feet and lower legs
sudden weight gain
chest pain
rapid, pounding, or irregular heartbeat
yellowing of the skin or whites of eyes, tenderness on the right upper side of the stomach, itching, loss of appetite, pale stools, or dark urine
hives; rash; itching; difficulty swallowing or breathing; or swelling of the face, throat, tongue, lips, or eyes

Metoprolol

Metoprolol is a “cardioselective” beta-blocker or beta-1 (β1) adrenergic receptor blocker (with little or no activity against beta-2 adrenergic receptors) which are found in cardiac muscle, on bronchial and vascular smooth muscle that works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to your heart. Metoprolol was approved for use in the United States in 1978 and is still widely used alone or in combination with other medications to treat high blood pressure (hypertension) and to treat chronic (long-term) angina pectoris. Metoprolol is also used to improve survival after an acute heart attack (myocardial infarction) and to treat certain types of irregular heartbeats (arrhythmias). Metoprolol also is used in combination with other medications to treat heart failure.

Metoprolol is available in standard 50 and 100 mg tablets as well as 25, 50, 100 and 200 mg extended release tablets in generic forms as well as under the trade name of Lopressor and Toprol XL, and as a fixed combination with a hydrochlorothiazide as Lopressor HCT and Dutoprolol. Parenteral formulations for intravenous (IV) use are also available. The usual initial oral dose of metoprolol in adults is 100 mg daily in one or two divided doses daily, with subsequent adjustment based upon clinical response and tolerance, the usual maintenance dosage being 100 to 400 mg daily. The entended release forms are given in doses of 25 to 100 mg once daily. The extended-release tablet may be split. Swallow the whole or half extended-release tablets whole; do not chew or crush them. Swallow the extended-release capsules whole; do not split, chew, or crush them. If you are unable to swallow the capsules, you may open the capsule and sprinkle the contents over a spoonful of soft food, such as applesauce, pudding, or yogurt and swallow the mixture immediately. Do not swallow the mixture more than 60 minutes after you sprinkle the contents of the capsule.

To help you remember to take metoprolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metoprolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of metoprolol and gradually increase your dose.

Metoprolol helps to control your condition but will not cure it. Continue to take metoprolol even if you feel well. Do not stop taking metoprolol without talking to your doctor. If you suddenly stop taking metoprolol you may experience serious heart problems such as severe chest pain, a heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks and will monitor you closely.

Metoprolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, insomnia, memory loss and impotence. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension.

Metoprolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For metoprolol, the following should be considered ²⁵:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to metoprolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of metoprolol tablets in the pediatric population. Safety and efficacy have not been established. Appropriate studies have not been performed on the relationship of age to the effects of metoprolol extended-release tablets and extended-release capsules in children younger than 6 years of age. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of metoprolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving metoprolol.
Breastfeeding. Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of metoprolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Metoprolol may provoke chest pain if stopped too quickly.
- Hypotension (low blood pressure) or ischemic heart disease or lung disease (eg, asthma, bronchitis, emphysema) or pheochromocytoma (adrenal gland tumor): Use metoprolol with caution. May make these conditions worse.
- Severe blood circulation problems or bradycardia (slow heartbeat) or cardiogenic shock (shock caused by heart attack) or heart block or heart failure, severe or peripheral vascular disorders (clogged blood vessels) or sick-sinus syndrome (heart rhythm problem): Metoprolol should not be used in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Metoprolol may cover up some of the symptoms of these diseases, such as a fast heartbeat.
- Liver disease: Use metoprolol with caution. The effects may be increased because of slower removal of metoprolol from the body.
- Patients who are fasting (eg, surgery, not eating regularly, vomiting): Metoprolol may increase risk of hypoglycemia (low blood sugar).
- Wolff-Parkinson-White syndrome (WPW) (rare heart condition): Metoprolol may cause very slow heartbeat in patients with this condition.

Metoprolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking metoprolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using metoprolol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Mavorixafor

Using metoprolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abiraterone Acetate
Abiraterone Acetate, Micronized
Albuterol
Ceritinib
Clonidine
Cobicistat
Crizotinib
Darunavir
Desvenlafaxine
Diltiazem
Dronedarone
Duloxetine
Epinephrine
Escitalopram
Fedratinib
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Givosiran
Indacaterol
Iohexol
Lacosamide
Lercanidipine
Levalbuterol
Lidocaine
Olodaterol
Panobinostat
Ponesimod
Rifampin
Rivastigmine
Salmeterol
Sertraline
Siponimod
Terbinafine
Terbutaline
Venlafaxine
Verapamil
Vilanterol

Using metoprolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Bupropion
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone

Metoprolol dosage

The dose of metoprolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of metoprolol. If your dose is different, do not change it unless your doctor tells you to do so.

For acute heart attack or heart failure:

For oral dosage form (extended-release capsules):
- Adults: At first, 25 milligrams (mg) once a day for 2 weeks. Your doctor may adjust your dose as needed. However, the dose is usually not more than 200 mg per day.
- Children: Use and dose must be determined by your doctor.
For oral dosage form (extended-release tablets):
- Adults: At first, 25 milligrams (mg) once a day for 2 weeks. In patients with severe heart failure, the starting dose is 12.5 mg once a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor.
For oral dosage form (tablets):
- Adults: At first, 50 milligrams (mg) every 6 hours for 2 days. Then, 100 mg 2 times a day. The medicine will be started in the hospital.
- Children: Use and dose must be determined by your doctor.

For chest pain:

For oral dosage form (extended-release capsules):
- Adults: At first, 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
- Children: Use and dose must be determined by your doctor.
For oral dosage form (extended-release tablets):
- Adults: At first, 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
- Children: Use and dose must be determined by your doctor.
For oral dosage form (tablets):
- Adults: At first, 100 milligrams (mg) per day, given in two divided doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
- Children: Use and dose must be determined by your doctor.

For high blood pressure:

For oral dosage form (extended-release capsules):
- Adults: At first, 25 to 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
- Children 6 years of age and older: Dose is based on body weight and must be determined by your doctor. The dose is usually 1 milligram (mg) per kilogram (kg) of body weight once a day. The first dose should not be more than 50 mg once a day. Your doctor may adjust your dose as needed.
- Children younger than 6 years of age: Use and dose must be determined by your doctor.
For oral dosage form (extended-release tablets):
- Adults: At first, 25 to 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.
- Children 6 years of age and older: Dose is based on body weight and must be determined by your doctor. The dose is usually 1 milligram (mg) per kilogram (kg) of body weight per day, given as a single dose. The first dose should not be more than 50 mg per day.
- Children younger than 6 years of age: Use and dose must be determined by your doctor.
For oral dosage form (tablets):
- Adults: At first, 100 milligrams (mg) per day, given as a single dose or in divided doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 450 mg per day.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of metoprolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Metoprolol side effects

Metoprolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

dizziness or lightheadedness
tiredness
depression
diarrhea
nausea
dry mouth
stomach pain
vomiting
gas or bloating
heartburn
constipation
rash or itching
cold hands and feet
runny nose

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, see your doctor immediately:

shortness of breath or difficulty breathing
wheezing
swelling of the hands, feet, ankles, or lower legs
weight gain
fainting
rapid, pounding, or irregular heartbeat

Metoprolol may cause other side effects. See your doctor if you have any unusual problems while taking metoprolol.

Nadolol

Nadolol is a nonselective beta-adrenergic receptor blocker (acting on both the beta-1 and beta-2 adrenergic receptors) that is widely used alone or in combination with other medications to treat high blood pressure (hypertension), prevent angina (chest pain) and vascular headaches. Beta-1 adrenergic blockade reduces the heart rate and myocardial contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade affects peripheral vascular resistance and can cause bronchospasm and hypoglycemia. The beta-2 blockade is responsible for the majority of adverse effects associated with nadolol. Nadolol was approved for use in the United States in 1979. Nadolol is indicated for the management of hypertension and angina pectoris, and is used off label for prophylaxis against migraine and vascular headaches.

Nadolol is available in multiple generic forms and under the trade name of Corgard in tablets of 20, 40, 80, 120 and 160 mg. Fixed combinations with diuretics (water pills) are also available (nadolol and bendroflumethiazide: Corzide). The typical dose of nadolol in adults is 40 to 80 mg once daily. It is usually taken once a day with or without food. To help you remember to take nadolol, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nadolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of nadolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Nadolol controls your condition but does not cure it. Continue to take nadolol even if you feel well. Do not stop taking nadolol without talking to your doctor. If you suddenly stop taking nadolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Common side effects of nadolol include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and, less commonly, severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure, and should be used cautiously in the elderly and in patients with diabetes.

Nadolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For nadolol, the following should be considered ²⁶:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to nadolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of nadolol in the pediatric population. Safety and efficacy have not been established.
Elderly. No information is available on the relationship of age to the effects of nadolol in geriatric patients.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of nadolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Asthma or bradycardia (slow heartbeat) or cardiogenic shock (shock caused by heart attack) or heart block or heart failure: Nadolol should not be used in patients with these conditions.
- Blood vessel disease or lung disease (eg, bronchitis, emphysema): Use nadolol with caution. Nadolol may worsen these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Nadolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease: Use nadolol with caution. The effects may be increased because of slower removal of nadolol from the body.
- Patients who are fasting (eg, surgery, not eating regularly, vomiting): Nadolol may increase risk of hypoglycemia (low blood sugar).
Using nadolol with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use nadolol, or give you special instructions about the use of green tea, alcohol, or tobacco.

Nadolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nadolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using nadolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iobenguane I 131
Iohexol
Itraconazole
Lacosamide
Levalbuterol
Lidocaine
Olodaterol
Oxymetazoline
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using nadolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine

Nadolol dosage

The dose of nadolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of nadolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 40 milligrams (mg) once a day. Your doctor may increase your dose as needed.
- Children: Use and dose must be determined by your doctor.
For severe chest pain (angina):
- Adults: At first, 40 milligrams (mg) once a day. Your doctor may increase your dose as needed.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of nadolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Nadolol side effects

Nadolol may cause side effects. See your doctor if either of these symptoms is severe or does not go away:

dizziness or lightheadedness
excessive tiredness
cold hands and feet

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, see your doctor immediately:

shortness of breath
swelling of the hands, feet, ankles, or lower legs
unusual weight gain
fainting
chest pain
slow or irregular heartbeat

Nadolol may cause other side effects. See your doctor if you have any unusual problems while taking nadolol.

Nebivolol

Nebivolol is a cardioselective beta-blocker acting largely on beta-1 adrenergic receptors and antihypertensive medication that has additional vasodilatory (dilating or widening blood vessels) activity mediated by nitric oxide release. Beta-1 adrenergic blockade reduces your heart rate and heart contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Nebivolol also has vasodilatory activity that is not explained by typical beta blockade and appears to be mediated by release of nitric oxide from endothelial cells. Nebivolol works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure and was approved for use in the United States in 2007. Nebivolol it is currently used alone or in combination with other medications to treat high blood pressure.

Nebivolol is available in tablets of 2.5, 5, 10 and 20 mg under the trade name Bystolic. The typical initial oral dose in adults is 5 mg once daily with or without food, with subsequent dose modification based upon clinical response and tolerance; the total daily maintenance dose ranges from 5 to 40 mg. To help you remember to take nebivolol, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take nebivolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of nebivolol and gradually increase your dose not more than once every 2 weeks. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Nebivolol controls high blood pressure but does not cure it. It may take 2 weeks before the full benefit of nebivolol is seen in blood pressure readings. Continue to take nebivolol even if you feel well. Do not stop taking nebivolol without talking to your doctor. If you suddenly stop taking nebivolol it may cause angina (chest pain), heart attack, or irregular heartbeat. Your doctor will probably decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Nebivolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and, less commonly, severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension.

Nebivolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For nebivolol, the following should be considered ²⁷:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to nebivolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of nebivolol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nebivolol in the elderly.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of nebivolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Nebivolol may provoke chest pain if stopped too quickly.
- Peripheral vascular disease (clogged blood vessels): Use nebivolol with caution. Nebivolol may make this condition worse.
- Severe bradycardia (slow heartbeat) or cardiogenic shock (shock caused by heart attack) or heart block or heart failure or liver disease, severe or lung disease (e.g., bronchitis, emphysema) or sick-sinus syndrome (heart rhythm problem), without a pacemaker: Nebivolol should not be used in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Nebivolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease, severe or liver disease, moderate: Use nebivolol with caution. The effects may be increased because of slower removal of nebivolol from the body.
- Pheochromocytoma (adrenal gland tumor): Use an alpha-blocker medicine before taking nebivolol.

Nebivolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking nebivolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using nebivolol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Mavorixafor

Using nebivolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abiraterone Acetate
Abiraterone Acetate, Micronized
Albuterol
Bupropion
Ceritinib
Cinacalcet
Clonidine
Cobicistat
Crizotinib
Darunavir
Desvenlafaxine
Diltiazem
Doxepin
Dronedarone
Duloxetine
Epinephrine
Escitalopram
Fedratinib
Fenoldopam
Fexinidazole
Fingolimod
Fluoxetine
Formoterol
Givosiran
Indacaterol
Iohexol
Lacosamide
Levalbuterol
Moclobemide
Olodaterol
Panobinostat
Paroxetine
Ponesimod
Quinidine
Quinine
Rivastigmine
Rolapitant
Salmeterol
Sertraline
Siponimod

Using nebivolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Cimetidine
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone

Nebivolol dosage

The dose of nebivolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of nebivolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 5 milligrams (mg) once a day. Your doctor may increase your dose if needed.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of nebivolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Nebivolol side effects

Nebivolol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

headache
tiredness
weakness
dizziness
diarrhea
nausea
stomach pain
difficulty falling asleep or staying asleep
numbness, burning, or tingling in the hands, arms, feet, or legs

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

chest pain
slow heart rate
difficulty breathing
unusual weight gain
shortness of breath
rash; hives; swelling of the face, throat, tongue, lips, or eyes
swelling of the hands, feet, ankles, or lower legs
rapid, pounding, or irregular heartbeat
vomiting

Nebivolol may cause other side effects. See your doctor if you have any unusual problems while taking nebivolol.

Penbutolol

Penbutolol is a nonselective beta-adrenergic receptor blocker (blocking both beta-1 and beta-2 adrenergic receptors) that is used to treat high blood pressure (hypertension). Beta-1 adrenergic blockade reduces the heart rate and heart contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade relaxes blood vessels to decrease blood pressure and can cause bronchospasm and hypoglycemia. Penbutolol also has mild sympatheticomimetic activity acting as a partial beta-adrenergic receptor agonist. Penbutolol is used for the management of hypertension and was approved for use in the United States in 1987.

Penbutolol is available in tablets of 20 mg under the trade name Levatol. The typical initial oral dose of penbutolol in adults is 20 mg once daily, with subsequent dose modification based upon clinical response and tolerance, the average total daily maintenance dose being 20 to 60 mg. Follow the directions on your prescription label carefully and ask your doctor or pharmacist to explain any part you do not understand. Take penbutolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Penbutolol helps control your condition but will not cure it. Continue to take penbutolol even if you feel well. Do not stop taking penbutolol without talking to your doctor.

Penbutolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and, less commonly, severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes.

Penbutolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For penbutolol, the following should be considered ²⁸:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to penbutolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of penbutolol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of penbutolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving penbutolol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using penbutolol during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of penbutolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Anaphylactic reaction (severe), history of: Penbutolol may increase risk for repeated anaphylactic reactions.
- Angina (severe chest pain) or heart attack, recent or heart failure, history of or heart or blood vessel disease (e.g., coronary artery disease): Use penbutolol with caution. May make these conditions worse.
- Asthma or bradycardia (slow heartbeat) or cardiogenic shock (shock caused by heart attack) or heart block: Penbutolol should not be used in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Penbutolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease: Use penbutolol with caution. The effects may be increased because of slower removal of penbutolol from the body.
- Lung disease (e.g., bronchitis, emphysema): Use penbutolol with caution. May cause difficulty with breathing in patients with this condition.

Penbutolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking penbutolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using penbutolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iobenguane I 131
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Oxymetazoline
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using penbutolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine

Penbutolol dosage

The dose of penbutolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of penbutolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 20 milligrams (mg) once a day. Your doctor may increase your dose if needed.
- Children: Use and dose must be determined by your doctor.

If you miss a dose of penbutolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Penbutolol side effects

Penbutolol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

upset stomach
diarrhea
cough
dizziness or lightheadedness
excessive tiredness
headache
difficulty sleeping
sweating
decreased sexual ability
memory loss

If you experience any of the following symptoms, see your doctor immediately:

chest pain
difficulty breathing or swallowing
fainting
slow or irregular heartbeat
depression
easy bruising or bleeding

Pindolol

Pindolol is a nonselective beta-adrenergic receptor blocker (blocking both beta-1 and beta-2 adrenergic receptors) that is widely used for the therapy of hypertension and angina pectoris. Beta-1 adrenergic blockade reduces the heart rate and heart contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade relaxes blood vessels to decrease blood pressure and can cause bronchospasm and hypoglycemia. Pindolol is also a partial adrenergic receptor agonist and has mild sympathomimetic activity.

Pindolol was approved for use in the United States in 1982 and is used alone or in combination with other medications to treat high blood pressure.

Pindolol is available in tablets of 5 and 10 mg in generic forms and under the trade name Visken. The typical initial oral dose of pindolol in adults is 5 mg two times a day, with subsequent dose modification based upon clinical response and tolerance, the average total daily maintenance dose being 10 to 60 mg. To help you remember to take pindolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take pindolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor will probably start you on a low dose of pindolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Pindolol helps control your condition but will not cure it. Continue to take pindolol even if you feel well. Do not stop taking pindolol without talking to your doctor. If you suddenly stop taking pindolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Pindolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and, less commonly, severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes.

Pindolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For pindolol, the following should be considered ²⁹:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to pindolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of pindolol in the pediatric population. Safety and efficacy have not been established.
Elderly. No information is available on the relationship of age to the effects of pindolol in geriatric patients.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of pindolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Pindolol may provoke chest pain if stopped too quickly.
- Asthma or bradycardia (slow heartbeat) or heart block or heart failure: Pindolol should not use in patients with these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Pindolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease or liver disease: Use pindolol with caution. The effects may be increased because of slower removal of pindolol from the body.
- Lung disease (e.g., bronchitis, emphysema): Pindolol may cause difficulty with breathing in patients with this condition

Pindolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking pindolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using pindolol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Thioridazine

Using pindolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Albuterol
Bupropion
Ceritinib
Clonidine
Crizotinib
Darunavir
Diltiazem
Dronedarone
Epinephrine
Fenoldopam
Fexinidazole
Fingolimod
Formoterol
Indacaterol
Iobenguane I 131
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Oxymetazoline
Ponesimod
Rivastigmine
Salmeterol
Siponimod
Terbutaline
Verapamil
Vilanterol

Using pindolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine

Pindolol dosage

The dose of pindolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of pindolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For high blood pressure:
- Adults: At first, 5 milligrams (mg) two times a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor .

If you miss a dose of pindolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Pindolol side effects

Pindolol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

dizziness or lightheadedness
excessive tiredness
difficulty sleeping
unusual dreams
nervousness
weakness
upset stomach
nausea
cold hands or feet
muscle or joint pain
numbness, burning, or tingling in the hands, arms, feet, or legs

If you experience any of the following symptoms, see your doctor immediately:

difficulty breathing
shortness of breath
swelling of the hands, feet, ankles, or lower legs
unusual weight gain
chest pain
fast, slow, pounding, or irregular heartbeat

Propranolol

Propranolol is a nonselective beta-adrenergic receptor blocker (blocking both beta-1 and beta-2 adrenergic receptors) that is widely used for the therapy of hypertension, cardiac arrhythmias, angina pectoris and symptoms of hyperthyroidism. Propranolol was the prototype beta-blocker developed for therapy of hypertension and is considered nonselective, acting on both the beta-1 and beta-2 adrenergic receptors. Beta-1 adrenergic blockade reduces the heart rate and heart contractility by slowing atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade relaxes blood vessels to decrease blood pressure and can cause bronchospasm and hypoglycemia. The beta-2 blockade is responsible for the majority of adverse effects associated with propranolol.

Propranolol was approved for use in the United States in 1967 and is still used alone or in combination with other medications to treat high blood pressure, irregular heartbeats, to improve survival after a heart attack (myocardial infarction), angina pectoris (chest pain), idiopathic hypertrophic subaortic stenosis (a heart muscle disease), pheochromocytoma (tumor on a small gland near the kidneys) and prevention of migraine headaches and vascular headaches. Propranolol is also used to treat essential tremor, to decrease the heart rate in patients with hyperthyroidism, and to prevent recurrent variceal hemorrhage.

Propranolol comes as a tablet, solution (liquid),and as an extended-release (long-acting) capsule to take by mouth. Propranolol is available in multiple generic forms and under the trade name of Inderal in tablets of 10, 20, 40, 60, 80 and 90 mg, as well as extended or sustained release capsules of 60, 80, 120 and 160 mg. The extended-release capsule (Innopran XL, Inderal XL) is usually taken at bedtime and should consistently be taken either always with or always without food each time. Swallow the extended-release capsules whole; do not split, chew, or crush them. Immediate-acting propranolol tablets or solution may be taken two, three, or four times a day. Take propranolol at around the same time(s) every day. Liquid formulations for oral and parenteral administration are also available. The typical dose of propranolol in adults is 60 to 240 mg daily in 2 divided doses (one with extended release formulations), with subsequent dose modification based upon efficacy and tolerance. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take propranolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of propranolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time.

Propranolol helps control your condition but will not cure it. Continue to take propranolol even if you feel well. Do not stop taking propranolol without talking to your doctor. If you suddenly stop taking propranolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Common side effects of propranolol include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and less commonly severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes.

Propranolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For propranolol, the following should be considered ³⁰:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to propranolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of propranolol capsules, extended-release capsules, and tablets in the pediatric population. Safety and efficacy have not been established. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of propranolol oral solution in children. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of propranolol oral solution to treat proliferating infantile hemangioma in children 5 weeks to 5 months of age. However, safety and efficacy have not been established in children older than 1 year of age.
Elderly. No information is available on the relationship of age to the effects of propranolol oral solution in geriatric patients. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of propranolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for patients receiving propranolol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of propranolol. Make sure you tell your doctor if you have any other medical problems, especially:
- - Anaphylactic reaction (severe), history of: Propranolol may increase risk for repeated anaphylactic reactions.
  - Angina (severe chest pain) or glaucoma or heart attack, recent or muscle problems (eg, myopathy, myotonia): Use propranolol with caution. May make these conditions worse.
  - Asthma or bradycardia (slow heartbeat), without a pacemaker or cardiogenic shock (shock caused by heart attack) or heart block, without a pacemaker or heart failure, decompensated or sick sinus syndrome (type of abnormal heart rhythm), without a pacemaker or tremors due to Parkinson’s disease: Propranolol should not be used in patients with these conditions.
  - Asthma, or history of or bradycardia (slow heartbeat), severe or bronchospasm, history of or hypotension (low blood pressure) or infants weighing less than 2 kilograms or pheochromocytoma (an adrenal problem) or premature infants with corrected age younger than 5 weeks of age: Propranolol should not be given to patients with these conditions.
  - Colds or infection or poor oral food intake (eg, not eating, vomiting) or stress: Propranolol may increase the risk of low blood sugar in patients with these conditions.
  - Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Propranolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
  - Kidney disease or liver disease: Use propranolol with caution. The effects may be increased because of slower removal of propranolol from the body.
  - Lung disease (eg, bronchitis, emphysema): Use propranolol with caution. May cause difficulty with breathing in patients with this condition.
  - Patients who are fasting (eg, surgery, not eating regularly, vomiting): Propranolol may increase risk of hypoglycemia (low blood sugar).
  - Tachycardia (fast heartbeat) or Wolff-Parkinson-White syndrome (WPW) (rare heart condition): Propranolol may cause very slow heartbeat in patients with these conditions.

Propranolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking propranolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using propranolol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Fezolinetant
Mavorixafor
Rizatriptan
Thioridazine

Using propranolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abametapir
Albuterol
Bupivacaine
Bupivacaine Liposome
Bupropion
Capmatinib
Ceritinib
Clonidine
Crizotinib
Darunavir
Desvenlafaxine
Diatrizoate
Diltiazem
Dronedarone
Epinephrine
Escitalopram
Eslicarbazepine Acetate
Fedratinib
Fenoldopam
Fexinidazole
Fingolimod
Fluoxetine
Formoterol
Haloperidol
Indacaterol
Iobenguane I 131
Iohexol
Lacosamide
Lercanidipine
Levalbuterol
Lidocaine
Mefloquine
Mepivacaine
Olodaterol
Oxymetazoline
Pixantrone
Ponesimod
Prilocaine
Rifampin
Rivastigmine

Using propranolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acarbose
Aceclofenac
Acemetacin
Acetyldigoxin
Albiglutide
Alfuzosin
Alogliptin
Aluminum Carbonate, Basic
Aluminum Hydroxide
Aluminum Phosphate
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Calcium Carbonate
Canagliflozin
Celecoxib
Chlorpromazine
Chlorpropamide
Cholestyramine
Choline Salicylate
Cimetidine
Clonixin
Dapagliflozin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dihydroergotamine
Dihydroxyaluminum Aminoacetate
Dihydroxyaluminum Sodium Carbonate
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin

Propranolol dosage

The dose of propranolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of propranolol. If your dose is different, do not change it unless your doctor tells you to do so.

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.

If you miss a dose of propranolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Propranolol side effects

Propranolol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

dizziness or lightheadedness
tiredness
diarrhea
constipation

Some side effects can be serious. If you experience any of the following symptoms, see your doctor immediately or get emergency medical treatment:

difficulty breathing or swallowing
rash
blistering or peeling skin
hives
itching
swelling of the face, throat, tongue, or lips
feeling faint
unusual weight gain
shortness of breath
irregular heartbeat

Propranolol may cause other side effects. See your doctor if you have any unusual problems while you are using propranolol.

Sotalol

Sotalol is a nonselective beta-adrenergic receptor blocker (blocking both beta-1 and beta-2 adrenergic receptors) that is used to treat abnormal heartbeats (heart arrhythmias) in people who currently have normal heart rhythm, but have had symptomatic atrial fibrillation or atrial flutter in the past and for treatment of severe or life-threatening ventricular arrhythmias. Beta-1 adrenergic blockade reduces the heart rate and heart contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade relaxes blood vessels to decrease blood pressure and can cause bronchospasm and hypoglycemia. In addition, sotalol has unique antiarrhythmic activity not shared by all beta-blockers. While it has antihypertensive effects, sotalol is not generally used for treatment of high blood pressure alone.

Sotalol was approved for use in the United States in 1992 and its current indications include the management of atrial and ventricular arrhythmias.

Sotalol is available in tablets of 80, 120, 160 and 240 mg and solution (liquid) in generic forms and under the trade names Betapace, Betapace AF and Sorine. The typical initial dose of sotalol in adults is 80 mg twice daily, with subsequent dose adjustment based upon clinical response and tolerance, the typical maintenance dose being 160 to 320 mg daily. Sotalol oral solution is usually taken once a day in adults and three times a day in children. Take sotalol consistently, either with food or without food each time. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take sotalol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

For the first three days, you will receive sotalol in a hospital where your heart rhythm can be monitored. Your doctor will probably start you on a low dose of sotolol and gradually increase your dose to allow your body to adjust to the medication.

Your pharmacist may prepare the tablets to make an oral liquid. Talk with your doctor or pharmacist if you have any concerns about this.

Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

If you are also taking an antacid aluminum or magnesium hydroxide, take it 2 hours before or 2 hours after taking sotalol.

Use only the brand of sotalol that your doctor prescribed. Different brands may not work the same way.

Sotalol controls your condition but does not cure it. Continue to take sotalol even if you feel well. Do not stop taking sotalol without talking to your doctor. If you suddenly stop taking sotalol, you may experience serious heart problems such as angina (chest pain) or heart attack. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Sotalol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and, less commonly, severe hypotension, heart failure and bronchospasm. Sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes.

IMPORTANT WARNING

Sotalol may cause QT prolongation (an irregular heart rhythm that can lead to fainting, loss of consciousness, seizures, or sudden death). For the first three days you take sotalol, you will have to be in a facility where your heart can be monitored. Tell your doctor if you or anyone in your family has or has ever had long QT syndrome (an inherited condition in which a person is more likely to have QT prolongation) or if you have or have ever had or you have or have ever had low levels of potassium in your blood, slow or irregular heartbeat, heart failure, or kidney disease. Your doctor may tell you not to take sotalol. Make sure you have discussed any medications you are currently taking or plan to take before taking sotalol with your doctor and pharmacist. If you experience any of the following symptoms, call your doctor immediately: fast, pounding, or irregular heartbeat; fainting; or loss of consciousness.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body’s response to sotalol. Your heart rhythm should be checked regularly to determine your response to sotalol. Your doctor will also want to follow your kidney function and blood level of potassium closely while you are taking sotalol.

Talk to your doctor about the risks of taking sotolol.

Sotalol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For sotalol, the following should be considered ³¹:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to sotalol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of sotalol in the pediatric population. Safety and efficacy have not been established.
Elderly. No information is available on the relationship of age to the effects of sotalol tablets in geriatric patients. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of sotalol oral solution or Betapace® and Betapace® AF tablets in the elderly. However, elderly patients are more likely to have age-related kidney problems, which may require caution and an adjustment in the dose for patients receiving sotalol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of sotalol. Make sure you tell your doctor if you have any other medical problems, especially:
- - Angina or bronchospasm or heart attack, recent or heart disease (eg, coronary insufficiency, heart failure, ischemic heart disease) or heart rhythm problem (eg, QT prolongation) or hypomagnesemia (low magnesium levels in the blood) or hypotension (low blood pressure): Use sotalol with caution. Sotalol may make these conditions worse.
  - Asthma or bradycardia (slow heartbeat), without a pacemaker or cardiogenic shock (shock caused by heart attack) or heart block, without a pacemaker or heart failure, uncontrolled or heart rhythm problem (eg, long QT syndrome) or hypokalemia (low potassium levels in the blood) or kidney disease, severe or sick sinus syndrome (type of abnormal heart rhythm), without a pacemaker: Sotalol should not be used in patients with these conditions.
  - Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Sotalol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
  - Kidney disease: Use sotalol with caution. The effects may be increased because of slower removal of sotalol from the body.
  - Lung disease (eg, bronchitis, emphysema): Sotalol may cause difficulty with breathing in patients with this condition.

Sotalol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking sotalol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using sotalol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Bepridil
Cisapride
Dronedarone
Fingolimod
Grepafloxacin
Levoketoconazole
Levomethadyl
Mesoridazine
Pimozide
Piperaquine
Saquinavir
Sparfloxacin
Terfenadine
Thioridazine
Vernakalant
Ziprasidone

Using sotalol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acecainide
Acetazolamide
Adagrasib
Albuterol
Alfuzosin
Amiloride
Amiodarone
Amisulpride
Amitriptyline
Amoxapine
Anagrelide
Apomorphine
Arformoterol
Aripiprazole
Aripiprazole Lauroxil
Arsenic Trioxide
Artemether
Asenapine
Astemizole
Atazanavir
Azithromycin
Azosemide
Bambuterol
Bedaquiline
Bemetizide
Bendroflumethiazide
Benzthiazide
Bitolterol
Broxaterol
Bumetanide
Buprenorphine
Buserelin
Canrenoate
Ceritinib
Chloral Hydrate
Chloroquine
Chlorpromazine
Chlorthalidone
Ciprofloxacin
Citalopram

Using sotalol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abarelix
Acarbose
Aceclofenac
Acemetacin
Albiglutide
Alogliptin
Aluminum Carbonate, Basic
Aluminum Hydroxide
Aluminum Phosphate
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Bunazosin
Canagliflozin
Celecoxib
Chlorpropamide
Choline Salicylate
Clonixin
Dapagliflozin
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Dihydroxyaluminum Aminoacetate
Dihydroxyaluminum Sodium Carbonate
Dipyrone
Doxazosin
Droxicam
Dulaglutide
Empagliflozin
Ertugliflozin
Etodolac
Etofenamate
Etoricoxib
Exenatide
Felbinac
Fenoprofen
Fepradinol
Feprazone

Sotalol dosage

The dose of sotalol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of sotalol. If your dose is different, do not change it unless your doctor tells you to do so.

For abnormal heart rhythms:

For oral dosage forms (solution or tablets):
- Adults: At first, 80 milligrams (mg) once or 2 times a day. Your doctor may adjust your dose every 3 days as needed.
- Children: Use and dose must be determined by your doctor.
For oral dosage forms (Betapace® and Betapace® AF tablets):
- Adults: At first, 80 milligrams (mg) 2 times a day. Your doctor may adjust your dose every 3 days as needed.
- Children 2 years of age and older: Dose is based on body weight and must be determined by your doctor. At first, the dose is usually 1.2 mg per kilogram (kg) of body weight 3 times a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 2.4 mg per kg of body weight 3 times a day.
- Children younger than 2 years of age: Use and dose must be determined by your doctor.

If you miss a dose of sotalol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Sotalol side effects

Sotalol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

dizziness
lightheadedness
weakness
excessive tiredness
headache
diarrhea
nausea
vomiting

If you experience any of the following symptoms, see your doctor immediately:

shortness of breath or wheezing
swelling of the feet and lower legs
unusual weight gain
chest pain
dizziness
fainting
fast, slow, or irregular heartbeat
severe diarrhea, unusual sweating, vomiting, decreased appetite, or excessive thirst

Timolol

Timolol is a nonselective beta-adrenergic receptor blocker (blocking both beta-1 and beta-2 adrenergic receptors) that is widely used for the therapy of high blood pressure, angina pectoris, reduction in the risk of cardiovascular mortality after myocardial infarction, irregular heartbeats (heart arrhythmias), prevention of migraine and vascular headaches and for lessening the risk of recurrent variceal hemorrhage in patients with cirrhosis and portal hypertension. In addition, timolol is available in an eye drop (ophthalmic) formulation for therapy of ocular hypertension and glaucoma. Beta-1 adrenergic blockade reduces the heart rate and heart contractility by slowing the atrioventricular (AV) conduction and suppressing automaticity. Beta-2 blockade relaxes blood vessels to decrease blood pressure and can cause bronchospasm and hypoglycemia.

Timolol was approved for use in the United States in 1995 and is still in wide use to treat high blood pressure and to improve survival after a heart attack.

Timolol is available in tablets of 5, 10 and 20 mg in generic forms and formerly under the trade name Blocadren. The typical initial oral dose of timolol in adults is 10 mg twice daily, with subsequent dose modification based upon clinical response and tolerance, the average total daily maintenance dose being 10 to 60 mg. For the treatment of high blood pressure and to improve survival after a heart attack, it is usually taken two times a day. To prevent migraine headaches, it is usually taken one or two times a day. To help you remember to take timolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take timolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Your doctor may start you on a low dose of timolol and gradually increase your dose to allow your body to adjust to the medication. Talk to your doctor about how you feel and about any symptoms you experience during this time. It is very important that your doctor check your progress at regular visits to make sure timolol is working properly and to check for unwanted effects.

Timolol helps control your condition but will not cure it. Continue to take timolol even if you feel well. Do not stop taking timolol without talking to your doctor. If you suddenly stop taking timolol, you may experience serious heart problems such as angina (chest pain), heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks. Your doctor will watch you carefully and will probably tell you to avoid physical activity during this time.

Timolol may cause heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing, an irregular heartbeat, shortness of breath, swelling of the face, fingers, feet, or lower legs, weight gain; or wheezing.

Timolol may cause changes in your blood sugar levels. Also, timolol may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using timolol. You may need to stop using timolol several days before having surgery.

Timolol common side effects include bradycardia, hypotension, fatigue, dizziness, depression, memory loss, impotence, cold limbs and less commonly severe hypotension, heart failure and bronchospasm. As with all beta-blockers, sudden withdrawal can trigger rebound hypertension. Beta-blockers are contraindicated in patients with asthma, bradycardia and heart failure and should be used cautiously in the elderly and in patients with diabetes.

Timolol special precautions

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For timolol, the following should be considered ³²:

Allergies. Tell your doctor if you have ever had any unusual or allergic reaction to timolol or any other medicines. Also tell your doctor if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Children. Appropriate studies have not been performed on the relationship of age to the effects of timolol in the pediatric population. Safety and efficacy have not been established.
Elderly. Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of timolol in the elderly. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment of dosage in patients receiving timolol.
Breastfeeding. There are no adequate studies in women for determining infant risk when using timolol during breastfeeding. Weigh the potential benefits against the potential risks before taking timolol while breastfeeding.
Other Medical Problems. The presence of other medical problems may affect the use of timolol. Make sure you tell your doctor if you have any other medical problems, especially:
- Angina (severe chest pain): Timolol may provoke chest pain if stopped too quickly.
- Asthma or bradycardia (slow heartbeat) or chronic obstructive pulmonary disease (COPD), severe or heart block or heart failure: Timolol should not use in patients with these conditions.
- Blood vessel disease (especially blood vessels in the brain) or stroke, history of: Use timolol with caution. Timolol may worsen these conditions.
- Diabetes or hyperthyroidism (overactive thyroid) or hypoglycemia (low blood sugar): Timolol may cover up some of the signs and symptoms of these diseases, such as a fast heartbeat.
- Kidney disease, severe or liver disease: Use timolol with caution. The effects may be increased because of slower removal of timolol from the body.
- Lung disease (e.g. bronchitis, emphysema): Timolol may cause difficulty with breathing in patients with this condition.
- Myasthenia gravis: Timolol may worsen symptoms of this condition, such as muscle weakness.

Timolol drug interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking timolol, it is especially important that your doctor know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using timolol with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Mavorixafor

Using timolol with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Abiraterone Acetate
Abiraterone Acetate, Micronized
Albuterol
Bupropion
Ceritinib
Clonidine
Cobicistat
Crizotinib
Darunavir
Desvenlafaxine
Diltiazem
Dronedarone
Duloxetine
Escitalopram
Fedratinib
Fenoldopam
Fingolimod
Fluoxetine
Formoterol
Indacaterol
Iobenguane I 131
Iohexol
Lacosamide
Levalbuterol
Olodaterol
Oxymetazoline
Paroxetine
Ponesimod
Rivastigmine
Salmeterol
Sertraline
Terbutaline
Venlafaxine
Verapamil
Vilanterol

Using timolol with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Aceclofenac
Acemetacin
Acetyldigoxin
Amtolmetin Guacil
Aspirin
Bromfenac
Bufexamac
Celecoxib
Choline Salicylate
Clonixin
Deslanoside
Dexibuprofen
Dexketoprofen
Diclofenac
Diflunisal
Digitoxin
Digoxin
Dipyrone
Droxicam
Etodolac
Etofenamate
Etoricoxib
Felbinac
Fenoprofen
Fepradinol
Feprazone
Floctafenine
Flufenamic Acid
Flurbiprofen
Ibuprofen
Indomethacin
Ketoprofen
Ketorolac
Lornoxicam
Loxoprofen
Lumiracoxib
Meclofenamate
Mefenamic Acid
Meloxicam
Metildigoxin

Timolol dosage

The dose of timolol will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of timolol. If your dose is different, do not change it unless your doctor tells you to do so.

For oral dosage form (tablets):

For heart attack:
- Adults: 10 milligrams (mg) two times a day.
- Children: Use and dose must be determined by your doctor .
For high blood pressure:
- Adults: At first, 10 milligrams (mg) two times a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor .
For migraine headache:
- Adults: At first, 10 milligrams (mg) two times a day. Your doctor may adjust your dose as needed.
- Children: Use and dose must be determined by your doctor.

Timolol eye drops for glaucoma or ocular hypertension:

For ophthalmic gel-forming solution dosage form (eye drops):
- Adults: Use 1 drop in the affected eye once a day.
- Children: Use and dose must be determined by your doctor. .
For ophthalmic solution dosage form (eye drops):
- Adults and children 2 years of age and older: Use 1 drop in the affected eye two times a day. Your doctor may need to adjust your dose as needed.
- Children younger than 2 years of age: Use and dose must be determined by your doctor.

If you miss a dose of timolol, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Timolol side effects

Timolol may cause side effects. See your doctor if any of these symptoms are severe or do not go away:

dizziness or lightheadedness
excessive tiredness
weakness
heartburn
nausea
headache
cold hands and feet

If you experience any of the following symptoms, see your doctor immediately:

difficulty breathing or shortness of breath
wheezing
swelling of the hands, feet, ankles, or lower legs
unusual weight gain
chest pain
slow, irregular heartbeat

Beta-blockers uses

Beta blockers are not recommended as a first treatment if you have only high blood pressure. Beta blockers are not usually used for high blood pressure unless other medicines, such as diuretics (water pills), have not worked well. A beta blocker may be one of several medicines used to lower blood pressure. High blood pressure is a common condition that adds to the workload of your heart and arteries and when not treated, can cause damage to your brain, heart, blood vessels, kidneys and other parts of your body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. High blood pressure may also increase the risk of heart attacks. These problems may be less likely to occur if blood pressure is controlled. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

Beta blockers may be used to treat ¹¹:

Irregular heart rhythms called arrhythmias.
Irregular heartbeat called atrial fibrillation or AFib.
Congestive heart failure (failure of the heart to pump enough blood around the body)
Chest pain caused by narrowing of coronary arteries supplying the heart, called angina.
Heart attack (a medical emergency where the blood supply to the heart is suddenly blocked)
Migraine prevention
Essential tremor
Generalized anxiety disorder
Glaucoma (as eyedrops)
Overactive thyroid symptoms (hyperthyroidism).

Beta blockers may also shrink certain types of vascular tumors, such as hemangiomas (a non-cancerous tumor made up of a cluster of abnormal blood vessels that can appear on or in the body).

Nonspecific beta-blockers are also recommended for treatment of portal hypertension in patients with cirrhosis.

Beta-blockers side effects

Common side effects of beta blockers can include:

Cold hands or feet.
Extreme tiredness.
Weight gain.
Dizziness or light-headedness.

Less common beta blockers side effects include:

Depression.
Shortness of breath.
Trouble sleeping.

Beta blockers, especially ones that affect both your heart and blood vessels, generally are not used if you have asthma. There are concerns that beta blockers may trigger severe asthma attacks.

If you have diabetes, beta blockers may block signs of low blood sugar (hypoglycemia), such as a rapid heartbeat. It’s important to check your blood sugar regularly if you have diabetes and you’re taking a beta blocker.

Some beta blockers can affect cholesterol and triglyceride levels. They can cause a slight rise in triglycerides, a type of fat in the blood. Beta blockers also can cause a modest decrease in good cholesterol, called high-density lipoprotein (HDL) cholesterol. These changes may only last for a short time.

You should not suddenly stop taking a beta blocker. Doing so could increase your risk of a heart attack or other heart problem.

Talk to your doctor if you have any questions about the medicines you take.

Beta-blockers overdose

Beta-blocker overdose occurs when someone takes more than the normal or recommended amount of beta blocker. This can be by accident or on purpose.

Beta-blocker overdose symptoms may include:

Irregular heartbeat
Lightheadedness
Low blood pressure
Rapid or slow heartbeat
Heart failure (shortness of breath and swelling of the legs)
Shock (extremely low blood pressure)
Breathing trouble (shortness of breath, gasping)
Wheezing (in people who have asthma)
Blurred vision
Double vision
Weakness
Nervousness
Excessive sweating
Drowsiness
Confusion
Convulsions (seizures)
Fever
Coma (decreased level of consciousness or unresponsiveness)

A beta-blocker overdose can be very dangerous. It can cause death.

Low blood sugar (hypoglycemia) is common in children with beta-blocker overdose, and it can lead to nervous system symptoms.

If you suspect someone is experiencing beta-blocker overdose, take action immediately:

Call your local emergency services number and ask for an ambulance.
Begin CPR if the person has stopped breathing or if breathing is very weak (best performed by someone who has training)

Take the container with you to the hospital, if possible.

The doctor in the emergency room will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure.

Tests that may be done include ³³, ³⁴:

Blood and urine tests
Chest x-ray
Electrocardiogram (ECG) or heart tracing

Additional treatment for beta-blocker overdose may include ³³, ³⁴:

Activated charcoal
Breathing support, which may include oxygen or a ventilator (tube through the mouth into the lungs and breathing machine
Intravenous fluids (IV, given through a vein)
Laxatives
Medicine to treat symptoms and reverse the effect of the drug
Pacemaker to the heart for serious heart rhythm disturbances.

Beta-blockers prognosis

If the person’s heart rate and blood pressure can be corrected, survival is likely. Survival depends on how much and what type of beta-blocker the person took and how quickly they receive treatment.

An overnight hospital stay may be needed even in less serious cases, as some long-acting beta-blockers remain in the body for many hours.

Risk factors for a more severe outcome, including multiple organ failure and death, include ³³, ³⁴:

Co-ingestion with other drugs which affect the heart; for example, digoxin, calcium channel blockers, tricyclic antidepressants
People with other health conditions, such as congestive heart failure and heart rhythm disturbances.

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