Dosing & Uses
Dosage Forms & Strengths
tablet
- 5mg
- 10mg
Hypertension
2.5-5 mg PO qDay; may increase to 10 mg and if necessary to 20 mg PO qDay
Heart Failure
1.25 mg PO qDay; increase gradually if necessary not to exceed 10 mg/day
Renal Impairment
>40 mL/min: Dose adjustment not necessary
<40 mL/min: 2.5 mg/day initially; titrate slowly and monitor
Safety & efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
1-10%
Dizziness (10%)
Insomnia (8%-10%)
Bradyarrhythmia (9%)
Upper respiratory infection (5%)
Diarrhea (4%)
Rhinitis (4%)
Arthralgia (3%)
Cough (3%)
Dyspnea (2%)
Nausea (2%)
Pharyngitis (2%)
Sinusitis (2%)
Vomiting (2%)
<1%
Cold extremities
Hypotension
Depression
Dyspepsia
Bronchospasm
Frequency Not Defined
Aggravate CHF
Decrease HDL
Hypertriglyceridemia
Mask symptoms of hypoglycemia
Decreased exercise tolerance
Raynaud's phenomenon
May increase triglyceride levels and insulin resistance
Warnings
Contraindications
Sinus bradycardia, 2°/3° heart block, cardiogenic shock, overt cardiac failure, hypersensitivity, sick sinus syndrome without permanent pacemaker
Cautions
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Chronically administered beta-blocking therapy should not be routinely withdrawn prior to major surgery; the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical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
Exacerbation of psoriasis reported with use
Less effective than thiazide diuretics in black and geriatric patients
Shown to decrease mortality in hypertension and post-myocardial infarction
Pregnancy & Lactation
Pregnancy Category: C
Lactation: excretion in milk unknown; use caution
Pregnancy Categories
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.
Pharmacology
Mechanism of Action
Blocks response to beta-adrenergic stimulation; cardioselective for beta-1 at low doses with little or no effect on beta-2 receptors at doses ≤ 20 mg
Pharmacikinetics
Half-Life: 9-12 hr (normal renal function); 27-36hr (<40 mL/min); 8-22 hr (hepatic cirrhosis)
Peak Plasma Time: 2-4 hr
Bioavailability: 80%
Onset of action: 1-2 hr
Metabolism: Hepatic
Protein Bound: 30%
Excretion: Renal (50%); feces (<2%)
Images
Patient Handout
Formulary
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.
