Categories
Medications

Beta-Blockers

Last Updated on October 10, 2022

Classification

• Selective vs non-selective
• Vasodilating vs non-vasodilating
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First generation (e.g. propranolol), Second generation (e.g. Acebutolol, Atenolol, Metoprolol, Bisoprolol, Esmolol), Third generation – vasodilating
Third generation, ß1 selective (e.g. Nebivolol, Betaxolol)
Third generation, non selective — ß1, ß2, α1 (e.g. Labetalol, Carvedilol)

Selective — ß1 > ß2 (e.g. Atenolol, Metoprolol)

**No ß-blocker is cardio-specific

Contraindications

Absolute contraindications

• Uncontrolled asthma
• Heart block 2nd degree & 3rd degree
• Severe peripheral vascular disease

Relative contraindications

• Controlled bronchial asthma / other forms of obstructive airways disease

Precaution

• Pregnancy

Adverse Effects

Dyslipidaemia
• Masking of hypoglycaemia
• Increased incidence of new onset DM
• Erectile dysfunction
• Cold peripheries
• Nightmares

Beta blockers in hypertension

• Can be used as single first line therapy especially in those who are post-MI / heart failure
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Benefits:
• Reduce cardiovascular mortality & morbidity in patients with stable angine / tachyarrhythmias / previous MI
• Certain beta-blockers beneficial in heart failure patients

Doses

ß-blocker

Starting dose

Recommended maximum daily dose

Remark

Acebutolol

200 mg BD

1.2 g in divided dose

Atenolol

50 mg OD

100 mg OD

Betaxolol

10 mg OD

20 mg OD


Bisoprolol

5 mg OD
2.5 mg OD if CrCl <40

20 mg OD


Carvedilol

12.5 mg OD

50 mg OD / in divided doses if necessary

• Different dosage for patients with heart failure / angina

Labetalol

100 mg BD
50 mg BD in elderly

2400 mg per day in 2 - 4 divided doses

• α1, ß1, ß2 blocker
• Oral treatment for hypertensive urgencies: 200 mg (PRN in 4 hours interval)

Metoprolol

50 mg OD

200 mg BD


Nebivolol

5 mg OD

40 mg OD

Propranolol

40 mg BD

320 mg BD

Reference

  1. CPG Management of hypertension (5th ED, 2018)
  2. https://www.jcpcarchives.org/full/beta-blockers-are-good-choice-as-first-line-antihypertensive-102.php
  3. https://specialty.mims.com/topic/benefits-of-3rd-generation-beta-blockers-in-antihypertensive-therapy

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