Beta-blockers should be considered for patients in controlled heart failure. See pharmacological treatment of symptomatic heart failure due to left ventricular systolic dysfunction. In people with controlled heart failure beta-blockers started in low doses can reduce mortality when used with other treatments e.g. ACE inhibitors, diuretics and digoxin.

Where a beta-blocker is indicated in patients with a history of asthma or bronchospasm where there is no alternative available, a cardio-selective beta-blocker, such as bisoprolol, should be used with caution. Regular peak flow monitoring is recommended.

Atenolol

• Tablets 25mg, 50mg, 100mg (£0.89 = 100mg daily)
• Oral solution sugar free 25mg in 5ml (£19.56 = 100mg daily)
• Injection 500 micrograms in 1ml, 10ml amp

Indications

• Angina
• Arrhythmias

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 (£0.74 = 10mg daily)

Indications

• Hypertension
• Angina
• Adjunct in heart failure

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 (£1.27 = 25mg x 28 tablets)

Indications

• Adjunct in heart failure

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

Labetalol

• Tablets 100mg, 200mg, 400mg (£4.35 = 100mg twice daily)
• Injection 5mg in 1ml, 20ml amp

Indications

• Hypertension in pregnancy

Dose

• Oral: initially 100mg twice daily with food, increased at intervals of 14 days to usual dose of 200mg twice daily; up to 800mg daily in 2 divided doses (3–4 divided doses if higher); maximum 2.4g daily

Notes

1. Should only be used during the first trimester of pregnancy if the potential benefits are likely to outweigh the possible risk to the foetus
2. Labetalol is contra-indicated in asthma

Propranolol

• Tablets 10mg, 40mg, 80mg, 160mg (£1.38 = 80mg twice daily)
• Modified-release capsules 80mg, 160mg (£4.95 = 80mg daily)
• Oral solution sugar free 10mg in 5ml, 50mg in 5ml (£50.43 = 50mg in 5ml x 150ml)
• Injection 1mg in 1ml

Notes

1. The modified release capsules should be reserved for patients where a once daily preparation is essential for compliance.

Metoprolol

• Tablets 50mg, 100mg (£10.11 = 50mg three times a day)
• Injection 5mg in 5ml

Notes

1. Metoprolol is a short acting agent which may be used in secondary care post myocardial infarction (unlicensed indication)

Sotalol

• Tablets 40mg, 80mg (£1.86 = 80mg twice daily)

Indications

• Ventricular arrhythmias or prophylaxis of supraventricular arrhythmias

Dose

• With ECG monitoring and measurement of corrected QT interval, arrhythmias, initially 80mg daily in 1–2 divided doses increased gradually at intervals of 2–3 days to usual dose of 160–320mg daily in 2 divided doses; higher doses of 480–640mg daily for life-threatening ventricular arrhythmias under specialist supervision

Esmolol

• Injection 10mg in ml, 10ml vial, 250ml infusion bag