Dosing & Uses
Dosage Forms & Strengths
5 mg PO q12hr initially; may increase by 10 mg/day q3-4wk to up to 30 mg PO q12hr
Chronic Stable Angina (Off-label)
15-40 mg/day PO divided q6-8hr
Use caution; may consider dose reduction
Use caution; in severe impairment dose reduction may be necessary
Safety & efficacy not established
5 mg PO q12hr initially; may increase by 5 mg/day q3-4wk
Serious - Use Alternative
Significant - Monitor Closely
Muscle pain (10%)
Elevated liver enzymes (7%)
Joint pain (7%)
Vivid dreams (5%),
Abdominal discomfort (4-5%)
Muscle cramps (3%)
Cold extremities (2%)
Impotence/reduced libido (1-2%)
Frequency Not Defined
Bronchospasm, depression, decreased exercise tolerance, Raynaud's phenomenon
May increase triglyceride levels and insulin resistance, and decrease HDL levels
Overt heart failure, asthma/COPD, cardiogenic shock, hypersensitivity, sinus bradycardia, 2nd-3rd degree heart block, cardiogenic shock, sick sinus syndrome without permanent pacemaker
Use caution in anesthesia/surgery (myocardial depression), bronchospastic disease, cerebrovascular insufficiency, CHF, cardiomegaly, DM, hyperthyroidism/thyrotoxicosis, myasthenia gravis, liver disease, renal impairment, peripheral vascular disease, use in pheochromocytoma, IDDM, history of psychiatric disease, pre-existing sick sinus syndrome or similar cardiac conditions
Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery; the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures
Sudden discontinuation can exacerbate angina and lead to myocardial infarction
Less effective than thiazide diuretics in black and geriatric patients
Increased risk of stroke after surgery
Pregnancy & Lactation
Pregnancy Category: B
Lactation: do not nurse
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Mechanism of Action
Non-selective beta adrenergic receptor with mild sympathomimetic activity; has negative inotropic and chronotropic effects and can significantly slow AV nodal conduction.
Protein Bound: 40%
Peak Plasma (single 20 mg dose) Concentration: 45-167 mcg/L
Peak Plasma (single 20 mg dose) Time: 1 hr
Vd: 1.2-2 L/kg
Half-Life: 3-4 hr in healthy adults
Metabolism: 60-65% in liver, primarily to hydroxy metabolites which are excreted as glucuronides & ethereal sulfates
Clearance: Tubular secretion
Excretion: Urine (35-40% as unchanged drug); feces (6-9%)
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|1||This drug is available at the lowest co-pay. Most commonly, these are generic drugs.|
|2||This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.|
|3||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.|
|4||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|5||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|6||This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.|
|NC||NOT COVERED – Drugs that are not covered by the plan.|
Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.