2.4 Beta-adrenoceptor blocking drugs

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 (£0.79 = 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
Labetalol
  • Tablets 100mg, 200mg, 400mg (£6.76 = 100mg twice daily)
  • Injection 5mg/ml, 20ml amp

Indications

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 (£1.74 = 80mg twice daily)
  • Modified release capsules 80mg, 160mg (£4.95 = 80mg daily)
  • Oral Solution 10mg/ 5ml, 50mg/5ml (£31.50 = 150ml 50mg/5ml)
  • Injection 1mg/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 (£3.75 = 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 (£2.60 = 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/ml, 10ml vial, 250ml infusion bag

 

Home > Formulary > Chapters > 2. Cardiovascular > 2.4 Beta-adrenoceptor blocking drugs

 

  • First line
  • Second line
  • Specialist
  • Hospital