Category:

• Nervous system

Description:

• Antihypertensive, antianginal, class II antidysrhythmic: (beta blocker)

Indications:

• Angina pectoris due to coronary atherosclerosis,

• Hypertension, acute MI

• Several non-FDA approved uses

Contraindications:

• Cardiogenic shock, 2^nd or 3^rd degree heart block, sinus bradycardia

• CHF unless secondary to a tachyarrhythmia treatable with beta-blockers, overt cardiac failure

Precautions:

• Pregnancy category C

• Major surgery, diabetes mellitus, renal disease, thyroid disease, COPD, asthma

• Well compensated heart failure, abrupt withdrawal, peripheral vascular disease

• Do not discontinue drug abruptly, may precipitate angina

Adverse Reactions (Side Effects):

• CNS: depression, dizziness, drowsiness, fatigue, hallucinations, insomnia, lethargy, memory loss, mental changes, strange dreams

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

• EENT: dry burning eyes, sore throat visual disturbances

• GI: diarrhea, dry mouth, ischemic colitis, mesenteric arterial thrombosis, nausea, vomiting

• GU: impotence, sexual dysfunction

• HEME: agranulocytosis, thrombocytopenia

• METAB: hyperglycemia, hyperlipidemia, masked hypoglycemic response

• RESP: bronchospasm, dyspnea, wheezing

• SKIN: alopecia, pruritis, rash  

Dosage:

Administered orally and intravenously

• Adult: 

  • IV 

    • 5mg over 5 min

    • repeat in 10 minutes if initial dose is well tolerated

    • then start PO dose 10 minutes after last IV dose

  • PO 

    • 50mg daily

    • increase every 1-2 weeks to 100mg daily

    • may increase to 200mg daily for angina

• Child: 

  • PO 

    • initial 1-1.2 mg/kg/dose given daily

    • maximum 2 mg/kg/day