2.4 Beta-adrenoceptor blocking drugs

Atenolol
  • Tablets 25mg, 50mg, 100mg (£0.79 = 100mg daily)
  • Syrup, sugar free, 25mg/5ml (£5.59 = 100mg daily)
  • Injection 500 micrograms/ml, 10ml amp

Indications

Dose

  • Angina, 100mg daily in 1 or 2 doses
  • Arrhythmias, 50–100mg daily
Bisoprolol
  • Tablets 1.25mg, 2.5mg, 3.75mg,5mg, 7.5mg, 10mg (£0.81 = 10mg daily)

Indications

Dose

  • Hypertension and angina, usually 10mg once daily (5mg may be adequate in some patients); maximum 20mg daily
  • Adjunct in heart failure, initially 1.25mg once daily (in the morning) for 1 week then, if well tolerated, increased to 2.5mg once daily for 1 week, then 3.75mg once daily for 1 week, then 5mg once daily for 4 weeks, then 7.5mg once daily for 4 weeks, then 10mg once daily; maximum 10mg daily
Carvedilol
  • Tablets 3.125mg, 6.25mg, 12.5mg, 25mg (£1.19 = 25mg, 28 tablets)

Indications

Dose

  • Adjunct in heart failure, initially 3.125mg twice daily, increased at intervals of at least 2 weeks to 6.25mg twice daily, then to 12.5mg twice daily, then to 25mg twice daily; increase to highest dose tolerated, maximum 25mg twice daily in patients with severe heart failure or body-weight less than 85kg and 50mg twice daily in patients over 85kg
Metoprolol
  • Tablets 50mg, 100mg (£3.75 = 50mg three times a day)
  • Injection 5mg in 5ml

Indications

  • Angina
  • Post myocardial infarction beta-blocker (see note below)

Notes

  1. Use of beta-blockers post MI is well established. Only agents without intrinsic sympathomimetic activity, e.g. metoprolol, propranolol and timolol, have been shown to have a beneficial effect on mortality. Atenolol, although commonly used post MI, has not been extensively trialled in this setting.
Propranolol
  • Tablets 10mg, 40mg, 80mg, 160mg (£1.74 = 80mg twice daily)
  • Modified release capsules 80mg, 160mg (£4.95 = 80mg daily)

Indications

Labetalol
  • Tablets 100mg, 200mg, 400mg (£8.88 = 200mg)
  • Injection 5mg/ml, 20ml amp

Indications

Dose

  • Initial dose 100mg twice daily, increasing as required to a max dose of 2.4g daily in divided doses

Notes

  1. Labetalol is better tolerated than methyldopa, but there is concern that it can inhibit fetal growth if used long term. Hence its usage is better reserved until the second or third trimesters.
  2. Labetalol is contra-indicated in asthma.
Nebivolol
  • Tablets 5mg (£1.40 = 5mg daily)

Indications

Notes

  1. Nebivolol has been included for patients found intolerant of other beta blockers. It is only licensed for use in the management of stable mild to moderate heart failure in patients aged over 70 years.
  2. Nebivolol 5mg tablets are scored meaning tablets can be halved or quartered.
  3. Nebivolol 2.5mg tablets are available but cost over 35 times more than the 5mg tablets.
Sotalol
  • Tablets 40mg, 80mg, 160mg (£2.60 = 80mg twice daily)

Indications

  • Arrhythmias
Esmolol
  • Injection 10mg/ml, 10ml vial, 250ml infusion bag

 

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