Category:

• Nervous system

Description:

• Antihypertensive, antianginal, antimigraine agent, antidysrhythmic; beta blocker

Indications:

• Hypertension, cardiac dysrhythmias, MI, hypertrophic subaortic stenosis

• Adjunctive therapy of pheochromocytoma, migraine prophylaxis, angina pectoris

• Essential tremor

Contraindications:

• Cardiogenic shock, 2^nd or 3^rd degree heart block, sinus bradycardia, CHF unless secondary to a tachydysrhythmia treatable with beta-blockers

• Bronchial asthma or bronchospasm, severe COPD, cardiac failure

Precautions:

• Pregnancy category C

• Major surgery, diabetes mellitus, renal disease, hepatic disease, thyroid disease

• Well compensated heart failure, peripheral vascular disease, bradycardia

• Down’s syndrome

Adverse Reactions (Side Effects):

• CNS: depression, dizziness, drowsiness, fatigue, lethargy, hallucinations

• CV: bradycardia, CHF, cold extremities, postural hypotension, 2nd or 3rd degree heart block, profound hypotension

• EENT: dry burning eyes, sore throat, visual disturbances

• GI: diarrhea, dry mouth, elevated LFT’s, ischemic colitis, mesenteric arterial thrombosis, nausea, vomiting

• GU: impotence, sexual dysfunction

• HEME: agranulocytosis, thrombocytopenia

• RESP: Bronchospasm, dyspnea, wheezing

• SKIN: alopecia, pruritis, rash

Dosage:

Administered orally, intravenously

• Adult:            

  • Hypertension: 

    • PO 40mg twice daily (LA 80mg once daily) initially, usual range 120-240mg daily divided 2-3 times (LA 120-160 once daily), max 640mg daily

  • Dysrhythmias: 

    • PO 10-30mg 3-4 times daily

    • IV (reserve for life threatening situations or dysrhythmias) 0.5-3mg, a 2^nd dose may be administered after 2 minutes as needed, additional doses at intervals no less than 4 hours until desired response obtained

  • Angina pectoris: 

    • PO 10-20mg 3-4 times daily (LA 80mg once daily) initially, usual range 160-240mg daily divided 3-4 times, maximum 320mg daily

  • Hypertrophic subaortic stenosis: 

    • PO 20-40mg 3-4 times daily (LA 80-160mg once daily)

  • Pheochromocytoma: 

    • PO 30mg daily in divided doses (in conjunction with an a-adrenergic blocking agent)

  • Migraine prophylaxis: 

    • PO 80mg daily in divided doses (LA 80mg once daily) initially, increase to optional prophylaxis, usual range 160-240mg daily

  • MI: 

    • PO 180-240mg daily divided 2-4 times daily beginning 5-21 days after MI

  • Essential tremor: 

    • PO 40mg twice daily initially, usual range 120-320mg daily divided 3 times daily

• Child:            

  • Dysrhythmias: 

    • PO 0.5-1 mg/kg/day divided every 6-8 hours, increase dose at 3-7 day intervals, usual range 2-4 mg/kg/day, max 16 mg/kg/day or 60mg daily

    • IV 0.01-0.1 mg/kg slowly over 10 minutes, max 1mg

  • Hypertension: 

    • PO 0.5-1 mg/kg/day divided every 6-12 hours, increase dose at 3-7 day intervals, usual range 1-5 mg/kg/day

  • Migraine prophylaxis: 

    • PO 0.6-1.5 mg/kg/day

Special Consideration:

• Do not discontinue abruptly, may precipitate angina, sudden death; reduce over 1-2 weeks