Beta-Blockers: Types, Uses, and Contraindications in Cardiology

Atenolol (Tenormin)

β1-Blocker, Tabs 25-100 mg daily, causes bradycardia and fatigue, contraindicated in sinus bradycardia and heart block, don't stop suddenly, Beers: Yes (can cause bradycardia, CNS effects)

Carvedilol (Coreg)

Non-selective β + α1 blocker, Tabs 3.125-25 mg BID, causes dizziness and hypotension, contraindicated in severe bradycardia and asthma, take with food

Labetalol (Trandate, Normodyne)

Mixed α/β blocker, Tabs, IV, 200-400 mg; causes dizziness and fatigue, contraindicated in asthma and heart block, may cause orthostasis

Metoprolol Succinate (Toprol XL, Kapspargo)

β1-Blocker (ER), ER tabs 25-200 mg daily, causes fatigue and bradycardia, contraindicated in bradycardia and shock, don't crush/stop suddenly

Metoprolol Tartrate (Lopressor)

β1-Blocker (IR), Tabs, injection, causes fatigue and hypotension, same contraindications as above, take with food

Nebivolol (Bystolic)

β1-Blocker with NO effect, Tabs 5-40 mg daily, causes headache and bradycardia, contraindicated in bradycardia and heart block, don't stop abruptly

Propranolol (Inderal)

Non-selective β-blocker, Tabs, ER caps, injection, causes fatigue and sleep disturbance, contraindicated in asthma and bradycardia, may mask hypoglycemia, Beers: Yes

Timolol ophthalmic (Timoptic)

β-blocker (ophth.), Eye drops, causes eye irritation and bradycardia, contraindicated in asthma and bradycardia, don't touch dropper to eye, Beers: caution (CNS effects)

Clonidine HCl (Catapres)

α2-Agonist (HTN/ADHD); available in tabs and patch; side effects include drowsiness and dry mouth; contraindicated in hypersensitivity; should not be stopped suddenly due to risk of rebound hypertension; Beers criteria: Yes.

Guanfacine HCl (Intuniv, Tenex)

α2-Agonist (HTN/ADHD); available in IR and ER tabs; side effects include sedation and dry mouth; contraindicated in severe bradycardia; avoid alcohol; No Fatty Food; Beers criteria: Yes.

Hydralazine HCl (Apresoline)

Direct vasodilator; available in tabs and injection; side effects include lupus-like reaction and headache; contraindicated in coronary artery disease; may cause flushing; Beers criteria: No.

Midodrine (ProAmatine)

α1-Agonist; available in tabs; side effects include supine hypertension and itching; contraindicated in severe heart disease; avoid lying down after dose; Beers criteria: Yes.

Bimatoprost (Lumigan)

Prostaglandin analog; Ophth. drops; Eye redness, darkening lashes; Remove contacts, apply at night.

Latanoprost (Xalatan)

Prostaglandin analog; Ophth. drops; Burning, color change; Store in fridge until opened.

Cyclosporine (ophth.) (Restasis)

Immunosuppressant; Ophth. emulsion; Burning, blurred vision; Shake well, avoid touching tip.

Amlodipine + Benazepril (Lotrel)

CCB + ACE; Caps; Cough, dizziness; Avoid potassium supplements

Verapamil (Calan, Verelan)

Non-DHP, CCB; Tabs, ER; Constipation, edema; Avoid grapefruit

Nifedipine (Procardia)

DHP CCB; ER caps; Flushing, edema; May cause gingival hyperplasia

lisinopril + HCTZ (Prinizide, Zestoretic)

ACE + diuretic; Tabs; Dizziness, cough; Pregnancy

Losartan + HCTZ (Hyzaar)

ARB + diuretic; Tabs; Dizziness; Pregnancy

Ranolazine (Ranexa)

Antianginal; ER tabs; Constipation, QT prolongation; Hepatic impairment

Nitroglycerin (Nitrostat)

Nitrate; Sublingual tabs; Headache, flushing; Don't use with PDE5 inhibitors

Isosorbide mononitrate (Imdur)

Nitrate; ER tabs; Headache; Take in AM

Buspirone (Buspar)

Anxiolytic, 10-30 mg/day, takes weeks to work, may cause dizziness.

Clonazepam (Klonopin)

Benzo (CIV), 0.5-4 mg/day, may cause drowsiness, avoid alcohol.

Diazepam (Valium)

Benzo (CIV), 2-10 mg 2-4×/day, may cause sedation, has a long half-life.

Lorazepam (Ativan)

Benzo (CIV), 0.5-2 mg 2-3×/day, may cause sedation, don't stop suddenly.

Alprazolam (Xanax)

Benzo (CIV), 0.25-0.5 mg TID, may cause drowsiness, habit forming.

Warfarin (Coumadin)

Vitamin K antagonist; INR-based; Bleeding Pregnancy; Monitor INR, many interactions

Rivaroxaban (Xarelto)

Factor Xa inhibitor; 10-20 mg; Bleeding; Active bleeding; Take with food

Apixaban (Eliquis)

Factor Xa inhibitor; 2.5-5 mg BID; Bleeding; None major; No monitoring

Dabigatran (Pradaxa)

Direct thrombin inhibitor; 150 mg BID; GI upset; Mechanical heart valve; Keep in original bottle

Clopidogrel (Plavix)

P2Y12 inhibitor; 75 mg daily; Bleeding; Active bleed; Avoid omeprazole

Dipyridamole + Aspirin (Aggrenox)

Antiplatelet combo; BID; Headache, bleeding Ulcer, bleed risk; No

Cyanocobalamin (Nascobal)

B12 supplement; IM, nasal; Injection site pain; Leber disease; No

Sacubitril + Valsartan (Entresto)

ARNI; 24/26-97/103 mg BID; Hypotension; Pregnancy; Washout 36h from ACEI