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

Flecainide (Tambocor)

Class: Class IC antiarrhythmic; Dosage Form / Range: Tablets: common 50-150 mg twice daily (dose individualized); Common ADRs: Dizziness, blurred vision, headache; Can worsen arrhythmias (proarrhythmia); Contraindications: Structural heart disease (like prior MI with LV dysfunction), Cardiogenic shock; Counseling / Notes: Take at the same times every day. Report palpitations, fainting, or new/worse chest pain. Usually started and monitored by cardiology (often with EKGs).

Dofetilide (Tikosyn)

Class: Class III antiarrhythmic; Dosage Form / Range: Capsules: dose based on kidney function (CrCl); Common ADRs: QT prolongation, Risk of torsades de pointes (dangerous arrhythmia), Dizziness, headache; Contraindications: Baseline prolonged QT interval, Severe renal impairment, Use with certain interacting drugs (e.g., some diuretics, verapamil, cimetidine, etc.); Counseling / Notes: Must be started in the hospital with continuous EKG monitoring. Don't miss doses; call provider if you do.

Prazosin (Minipress)

Class: α1-blocker (for HTN; sometimes PTSD-related nightmares); Dosage Form / Range: Capsules: usually 1-5 mg BID-TID; Common ADRs: First-dose orthostatic hypotension, dizziness, drowsiness; Contraindications: Hypersensitivity; caution with other BP-lowering drugs; Counseling / Beers: Take first dose at bedtime; stand up slowly. Beers: Yes - high risk of fainting in older adults.

Terazosin (Hytrin)

Class: α1-blocker (HTN/BPH); Dosage Form / Range: Capsules: typically 1-20 mg daily; ADRs: Dizziness, orthostatic hypotension, fatigue; Counseling / Beers: Take at bedtime; avoid sudden position changes. Beers: Yes - orthostatic hypotension risk.

Doxazosin (Cardura)

Class: α1-blocker (BPH/HTN); Dosage Form / Range: IR tablets: once daily, XL tablets: typically taken with breakfast; Common ADRs: Dizziness, fatigue, edema; Counseling / Beers: For XL, tablet shell may appear whole in stool (normal). Take at bedtime (IR) to reduce dizziness. Beers: Yes - orthostatic hypotension.

Diltiazem (Cardizem, Cartia XT, Dilacor XR, Tiazac)

Class: Non-DHP CCB (for HTN, angina, rate control in AFib); Dosage Form / Range: IR tablets, ER capsules/tablets; Typical total daily dose: 120-360 mg/day; Common ADRs: Bradycardia, edema, headache, constipation; Contraindications: Severe LV dysfunction, 2nd/3rd-degree AV block, sick sinus syndrome (unless paced); Counseling: Don't crush ER products. Monitor heart rate and blood pressure. May interact with other rate-slowing drugs (like β-blockers).

Glipizide (Glucotrol)

Class: Sulfonylurea (Type 2 diabetes); Dosage Form / Range: IR tablets: 5-20 mg BID, XL once daily; Common ADRs: Hypoglycemia, weight gain; Contraindications: Type 1 diabetes, DKA, sulfa allergy (relative); Counseling: Take 30 min before breakfast (IR). Recognize low sugar: shakiness, sweating, confusion.

Glimepiride (Amaryl)

Class: Sulfonylurea; Forms / Dose: Tablets: 1-8 mg once daily; ADRs: Hypoglycemia, weight gain; Counseling: Usually taken with first main meal of the day.

Glyburide (Micronase, Diabeta)

Class: Sulfonylurea; Dosage Form / Range: Tablets: 1.25-20 mg/day in divided doses; Common ADRs: Higher risk of prolonged hypoglycemia, especially in elderly or renal impairment, weight gain; Beers List: Yes - avoid in older adults (high hypoglycemia risk); Counseling: Take with breakfast or first main meal. Very important to eat regularly; skip dose if skipping meals (per provider).

Irbesartan (Avapro)

Class: ARB (angiotensin receptor blocker); Dosage Form / Range: Tablets: 150-300 mg once daily; Common ADRs: Dizziness, fatigue, ↑K⁺ (hyperkalemia); Contraindications: Pregnancy, concomitant aliskiren in diabetes; Counseling: Avoid K⁺ salt substitutes; monitor BP and kidney function.

Telmisartan (Micardis)

Class: ARB; Dose: Tablets: 20-80 mg once daily; ADRs / Contra / Counseling: Same ARB pattern as irbesartan: dizziness, ↑K⁺, avoid in pregnancy.

Valsartan (Diovan)

Class: ARB; Dose: Tablets: 80-320 mg once daily (HTN range); ADRs / Contra / Counseling: Same as above (dizziness, ↑K⁺, avoid pregnancy, watch BP & labs).

Olmesartan (Benicar)

Class: ARB; Dose: Tablets: 20-40 mg once daily; Common ADRs: Dizziness; Rare: sprue-like enteropathy (chronic diarrhea, weight loss); Contraindications: Pregnancy; Counseling: Report persistent severe diarrhea and weight loss; may be drug-related.

Enalapril (Vasotec)

Class: ACE inhibitor (antihypertensive, HF); Dosage Form / Range: Tablets: 5-40 mg per day (once or divided); Common ADRs: Dry cough, dizziness, increased potassium (hyperkalemia); Rare: angioedema (swelling of face, lips, tongue); Contraindications: Pregnancy, history of ACEI-induced angioedema, bilateral renal artery stenosis; Counseling / Notes: Avoid potassium salt substitutes. Get labs checked (kidney function and K⁺). Rise slowly to avoid dizziness.

Ramipril (Altace)

Class: ACE inhibitor; Dosage Form / Range: Capsules: 2.5-20 mg per day (once or divided); Common ADRs / Contra / Counseling: Same ACEI pattern as enalapril: cough, ↑K⁺, angioedema risk, avoid in pregnancy, avoid K⁺ salt substitutes.

Benazepril (Lotensin)

Class: ACE inhibitor; Dosage Form / Range: Tablets: 10-40 mg per day; ADRs / Contra / Counseling: Same ACEI pattern: dry cough, dizziness, ↑K⁺, angioedema, avoid in pregnancy.

Fosinopril (Monopril)

Class: ACE inhibitor; Dosage Form / Range: Tablets: 10-40 mg per day; Common ADRs: Dry cough, dizziness, ↑K⁺; Special Note: Cleared by both liver and kidneys (unlike most ACEIs), but same pregnancy and angioedema issues; Counseling: Same as others: avoid in pregnancy, watch K⁺, report facial swelling.