Pregnancy Risk Category D
How supplied
Tablets: 25 mg, 50 mg, 100 mg
Injection: 5 mg/10 ml
Action
A beta blocker that selectively blocks beta1-adrenergic receptors; decreases cardiac output, peripheral resistance, and cardiac oxygen consumption; and depresses renin secretion.
Indications & dosage
Hypertension--
Adults: initially, 50 mg P.O. daily as a single dose, increased to 100 mg once daily after 7 to 14 days. Dosages over 100 mg are unlikely to produce further benefit.
Angina pectoris--
Adults: 50 mg P.O. once daily, increased, p.r.n., to 100 mg daily after 7 days for optimal effect. Maximum dose is 200 mg daily.
To reduce CV mortality and risk of reinfarction in patients with acute MI--
Adults: 5 mg I.V. over 5 minutes; then another 5 mg after 10 minutes. After an additional 10 minutes, 50 mg P.O.; then 50 mg P.O. in 12 hours. Thereafter, 100 mg P.O. daily (as a single dose or 50 mg b.i.d.) for at least 7 days.
Adjust-a-dose: For renally impaired patients with creatinine clearance of 15 to 35 ml/minute, maximum dose is 50 mg/day; if it is below 15 ml/minute, maximum dose is 25 mg/day.
Hemodialysis patients need 25 to 50 mg after each dialysis session; monitor closely because of risk of hypotension.
Adverse reactions
CNS: fatigue, lethargy, vertigo, drowsiness, dizziness.
CV: bradycardia, hypotension, heart failure, intermittent claudication.
GI: nausea, diarrhea.
GU: elevated BUN and creatinine.
Hematologic: elevated platelet count.
Hepatic: elevated transaminase, alkaline phosphatase, LD levels.
Metabolic: elevated serum levels of potassium, uric acid; increased or decreased serum glucose levels in diabetic patients.
Respiratory: dyspnea, bronchospasm.
Skin: rash.
Other: fever, leg pain.
Interactions
Drug-drug. Antihypertensives: enhanced hypotensive effect. Use together cautiously.
Cardiac glycosides, diltiazem, verapamil: excessive bradycardia and increased depressant effect on myocardium. Use together cautiously.
Insulin, oral antidiabetics: can alter dosage requirements in previously stabilized diabetic patient. Observe patient carefully.
Reserpine: may cause hypotension. Use with caution.
Effects on diagnostic tests
Drug may cause changes in exercise tolerance and ECG.
Contraindications
Contraindicated in patients with sinus bradycardia, greater than first-degree heart block, overt cardiac failure, or cardiogenic shock.
Nursing considerations
I.V. administration
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING