Beta Blockers

Question 1

List the beta blockers.

Answer 1

Atenolol (Noten, Tenormin)
Bisoprolol (Bicor, Bispro, Bicard)
Carvedilol (Dilatrent, Dilasig)
Esmolol 
Labetalol
Metoprolol (Betaloc, Metohexal, Minax, Toprol XL)
Nebivolol (Nebilet)
Oxprenolol
Pindolol 
Propranolol (Deralin)
Sotalol

Question 2

What are the indications of beta blockers?

Answer 2

> HF (Bisoprolol, Carvedilol, Metoprolol CR, Nebivolol)
HTN
- atenolol, metoprolol
- propranolol, oxyprenolol, pindolol ie. POP!!!!!
- carvedilol, nebivolol, metoprolol ie. HF drugs except Bisoprolol
- labetolol
angina
- atenolol, metoprolol
- propranolol, oxyprenolol, pindolol ie. POP!!!!!)
MI
arrhythmia (esmolol, sotalol)
migraine prevention (atenolol, metoprolol)
glaucoma (betaxolol, timolol)

Question 3

What are the dose ranges of beta blockers?

Answer 3

bisoprolol, nebivolol:
1.25mg d -10mg d

Carvedilol:
3.125mg bd - 50mg bd

Propranolol:
20mg bd - 320mg d (2/3doses)

Atenolol:
25mg d - 100mg d

Metoprolol CR:
23.75-190mg d
Metoprolol immediate release:
25mg bd - 100mg bd/tds

Sotalol:
40mg bd
Max. 640mg d

Labetolol:
100-400mg bd
Max. 2.4g d (3/4 doses)

Question 4

What are the AEs of beta blockers?

Answer 4

Common

• fatigue
• dizziness
• bronchospasm
• dyspnoea
• cold extremities, exacerbation of Raynaud’s phenomenon,
• bradycardia
• hypotension, orthostatic hypotension (carvedilol, labetalol)
• heart failure, heart block
• abnormal vision, decreased concentration
• hallucinations, insomnia, nightmares, depression
• alteration of glucose and lipid metabolism, oedema (carvedilol)

Rare

• liver function abnormality
• cardiac arrest

Question 5

What are the counseling points of beta blockers?

Answer 5

• may cause dizziness/tiredness especially at the start of tx/dose increase, if affected don’t drive/operate machinery
• if you feel dizzy, get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy
• don’t stop taking this medicine suddenly unless your doctor tells you to