Agent
Usual Daily Dose
{mg)*

Precautions and Special Considerations
Side Effects
Cardioselective, with ISA
  Should not be used in patients with asthma, chronic obstructive pulmonary disease (COPD) with bronchospasm, congestive heart.failufe, heart block (greater than first degree), sick sinus syndrome. Use with caution in insulin- dependent diabetics and patients with peripheral vascular disease. Should not be discontinued abruptly in patients with ischemic heart disease. Bronchospasm, peripheral arterial insufficiency, fatigue, insomnia, sexual dysfunction, exacerbation of congestive heart failure, may mask symptoms of hypoglycemia; hyperglycemia; hypertriglyceridemia, decreased high-density lipoprotein (HDL) cholesterol (except for drugs with ISA and labetalol)
Acebutolol (Sectral)** 200-1200***
Cardioselective, without ISA  
Atenolol (Tenormin)** 25-100
Betaxolol (Kerlone) 5-40
Metoprolol (Lopressor) 50-200
Metoprolol XL (Toprol XL) 50-200
Noncardioselective, with ISA  
Carteolol (Cartrol)** 2.5-10
Penbutolol (Levatol)** 20-80
Pindolol (Visken)** 10-60***
Noncardioselective, without ISA  
Labetalol^ (Normodyne, Trandate} 200-1200***
Nadolol (Corgard)** 40-320
Propranolol (Inderal} 40-240***
Propranolol LA (Inderal LA) 60-240
Timolol (Blocadren) 20-40***
Bisoprolol 5-20
ISA = intrinsic sympathomimetic activity
Special indications: Diuretics or beta blockers should be agents of choice for most patients with uncomplicated hypertension unless contraindicated, ineffective, unacceptable, or there are special indications for otber agents (see text); especially indicated for patients who have had myocardial infarction because of cardioprotective effect (non-ISA, non-alpha-blocking agents), white patients, hyperkinetic circulation, angina pectoris, migraine headache, senile tremor; severe hypertrophic cardiomyopathy of the elderly, severe asymmetric septal hypetrophy with outflow obstruction (idopathic hypertrophic subaortic stenosis), atrial fibrillation to control ventricular rate, paroxysmal supraventricular tachycardia (non-ISA, non-alpha-blocking agents preferred).
Contraindications: History of hypersensitivity reaction to beta-adrenergic blockers, more than first-degree heart block, sick sinus syndrome, left ventricular failure, asthma, chronic obstructive pulmonary disease with bronchospasm. Relative contraindications (see text): insulin-dependent diabetes, remote history of bronchial asthma, intermittent claudication, Raynaud's disease.
Advantages: Effective in reducing cardiovascular morbidity and mortality; cardioprotective after myocardial infarction, antianginal drug, relatively inexpensive, effective in -50% of mild hypertensives, reduce CO in hyperkinetic circulation, one dose daily (for most agents), no. pseudotolerance, migraine prophylaxis (propranolol), reduce senile tremor (propranolol).
Disadvantages: Many do not reduce total peripheral resistance; central nervous system side effects' metabolic side effects (HDL cholesterol decrease, triglycerides increase (except for ISA beta blockers, see text), glucose increase, insulin resistance increase. Multiple contraindications and precautions.
"The dosage range may differ slightly from recommended dosage in Physicians' Desk Reference or package insert. Given once daily unless otherwise indicated.
**Drug is excreted by kidney; may require dosage reduction in patients with renal insufficiency.
***This drug is usually given in divided doses twice daily.
^Combined alpha and beta blocker.