4 Beta-adrenoceptor blocking drugs

86 2.4 Beta-adrenoceptor blocking drugs

BNF 57

C ar

diov

ascular

sys

tem

BNF 57

2.4 Beta-adrenoceptor blocking drugs

Phaeochromocytoma (only with an alpha-blocker),

Dose

60 mg daily for 3 days before surgery or 30 mg daily in . Hypertension, initially 400 mg once daily or 200 mg patients unsuitable for surgery

twice daily, increased after 2 weeks to 400 mg twice Angina, initially 40 mg 2–3 times daily; maintenance

daily if necessary

120–240 mg daily . Angina, initially 400 mg once daily or 200 mg twice Arrhythmias, hypertrophic cardiomyopathy, anxiety

daily; 300 mg 3 times daily in severe angina; up to tachycardia, and thyrotoxicosis (adjunct), 10–40 mg

1.2 g daily has been used 3–4 times daily

. Arrhythmias, 0.4–1.2 g daily in 2–3 divided doses Anxiety with symptoms such as palpitation, sweating, tremor, 40 mg once daily, increased to 40 mg 3 times

Sectral c (Sanofi-Aventis) A daily if necessary

Capsules , acebutolol (as hydrochloride) 100 mg Prophylaxis after myocardial infarction, 40 mg 4 times

(buff/white), net price 84-cap pack = £14.97; 200 mg daily for 2–3 days, then 80 mg twice daily, beginning 5

(buff/pink), 56-cap pack = £19.18. Label: 8 to 21 days after infarction

Tablets , f/c, acebutolol 400 mg (as hydrochloride), Migraine prophylaxis and essential tremor, initially

net price 28-tab pack = £18.62. Label: 8

40 mg 2–3 times daily; maintenance 80–160 mg daily . By intravenous injection , arrhythmias and thyro- toxic crisis, 1 mg over 1 minute; if necessary repeat at 2-minute intervals; max. total dose 10 mg (5 mg

ATENOLOL

in anaesthesia) Indications see under Dose Note Excessive bradycardia can be countered with intra-

venous injection Cautions of atropine sulphate 0.6–2.4 mg in divided see under Propranolol Hydrochloride; renal doses of 600 micrograms; for overdosage see Emergency

impairment (Appendix 3) Treatment of Poisoning, p. 32

Contra-indications see under Propranolol Hydro-

chloride Propranolol (Non-proprietary) A Side-effects see under Propranolol Hydrochloride Tablets , propranolol hydrochloride 10 mg, net price

Dose

doses rarely necessary) ardiov Brands include C Angilol Oral solution , propranolol hydrochloride 5 mg/5 mL,

28 = 91p; 40 mg, 28 = 97p; 80 mg, 56 = £1.68; 160 mg,

56 = £3.29. Label: 8 By mouth , hypertension, 25–50 mg daily (higher

Angina, 100 mg daily in 1 or 2 doses net price 150 mL = £12.50; 10 mg/5 mL, 150 mL =

Arrhythmias, 50–100 mg daily . By intravenous injection , arrhythmias, 2.5 mg at a

ascular

£16.45; 50 mg/5 mL, 150 mL = £19.98. Label: 8 Brands include Syprol

rate of 1 mg/minute, repeated at 5-minute intervals to a max. of 10 mg Inderal c (AstraZeneca) A Note Excessive bradycardia can be countered with intra-

syst

Injection , propranolol hydrochloride 1 mg/mL, net venous injection of atropine sulphate 0.6–2.4 mg in divided doses of 600 micrograms; for overdosage see Emergency

em

price 1-mL amp = 21p

Treatment of Poisoning, p. 32 . By intravenous infusion , arrhythmias, 150 micr-

Modified release ograms/kg over 20 minutes, repeated every 12 Note Modified-release preparations can be used for once daily

hours if required

administration Early intervention within 12 hours of myocardial infarction (section 2.10.1),

c Half-Inderal LA by intravenous injection (AstraZeneca) A over 5 minutes, 5 mg, then by mouth , 50 mg after 15 Capsules , m/r, lavender/pink, propranolol hydro-

minutes, 50 mg after 12 hours, then 100 mg daily chloride 80 mg, net price 28-cap pack = £5.40. Label: 8, 25

Atenolol (Non-proprietary) A Note Modified-release capsules containing propranolol hydro-

Tablets , atenolol 25 mg, net price 28-tab pack = 81p; chloride 80 mg also available; brands include Bedranol SR , Half

50 mg, 28-tab pack = 85p; 100 mg, 28-tab pack = 86p. Beta Prograne

Label: 8 Brands include Atenix

Capsules , m/r, lavender/pink, propranolol hydro- Tenormin (AstraZeneca) A chloride 160 mg, net price 28-cap pack = £6.67.

Inderal-LA c (AstraZeneca) A c

‘25’ tablets , f/c, atenolol 25 mg, net price 28-tab pack Label: 8, 25

= £4.41. Label: 8

Note Modified-release capsules containing propranolol hydro- LS tablets , orange, f/c, scored, atenolol 50 mg, net chloride 160 mg also available; brands include Bedranol SR , Beta Prograne , Slo-Pro

price 28-tab pack = £5.11. Label: 8 Tablets , orange, f/c, scored, atenolol 100 mg, net

price 28-tab pack = £6.50. Label: 8 Syrup , sugar-free, atenolol 25 mg/5mL, net price

ACEBUTOLOL 300 mL = £8.55. Label: 8

, atenolol 500 micrograms/mL, net price 10- Indications

Injection

see under Dose mL amp = 96p (hosp. only) Cautions see under Propranolol Hydrochloride; renal

impairment (Appendix 3)

With diuretic

Contra-indications see under Propranolol Hydro- (Non-proprietary) chloride

A Tablets , co-tenidone 50/12.5 (atenolol 50 mg, chlor- Side-effects see under Propranolol Hydrochloride

Co-tenidone

talidone 12.5 mg), net price 28-tab pack = £1.15; co-

BNF 57 tenidone 100/25 (atenolol 100 mg, chlortalidone

88 2.4 Beta-adrenoceptor blocking drugs

Cardicor c (Merck) A

25 mg), 28-tab pack = £1.25. Label: 8 Tablets , f/c, bisoprolol fumarate 1.25 mg, net price Dose hypertension, 1 tablet daily (but see also under Dose

28-tab pack = £8.56; 2.5 mg (scored), 28-tab pack = above)

£4.90; 3.75 mg (scored, white-yellow), 28-tab pack = Kalten c (BPC 100) A £5.90; 5 mg (scored, light yellow), 28-tab pack = £5.90;

Capsules , red/ivory, atenolol 50 mg, co-amilozide

7.5 mg (scored, yellow), 28-tab pack = £5.90; 10 mg 2.5/25 (anhydrous amiloride hydrochloride 2.5 mg,

(scored, orange), 28-tab pack = £5.90. Label: 8 hydrochlorothiazide 25 mg), net price 28-cap pack =

£10.01. Label: 8 c Emcor (Merck) A Dose hypertension, 1 capsule daily

LS Tablets , yellow, f/c, scored, bisoprolol fumarate

5 mg, net price 28-tab pack = £11.30. Label: 8 Tenoret 50 c (AstraZeneca) A Tablets , orange, f/c, scored, bisoprolol fumarate

Tablets , brown, f/c, co-tenidone 50/12.5 (atenolol

10 mg, net price 28-tab pack = £12.68. Label: 8

50 mg, chlortalidone 12.5 mg), net price 28-tab pack = £5.70. Label: 8 Dose hypertension, 1 tablet daily

CARVEDILOL

tem c Tenoretic (AstraZeneca) A Indications hypertension; angina; adjunct to diuretics, Tablets , brown, f/c, co-tenidone 100/25 (atenolol

sys digoxin, or ACE inhibitors in symptomatic chronic

100 mg, chlortalidone 25 mg), net price 28-tab pack =

heart failure

£8.12. Label: 8 Cautions see under Propranolol Hydrochloride; Dose hypertension, 1 tablet daily (but see also under Dose

above) monitor renal function during dose titration in

ascular

patients with heart failure who also have renal

diov

With calcium-channel blocker impairment, low blood pressure, ischaemic heart Note Only indicated when calcium-channel blocker or beta-

C ar blocker alone proves inadequate. For cautions, contra-indica-

disease, or diffuse vascular disease; severe heart fail-

ure

Contra-indications 2 see under Propranolol Hydro-

tions, and side-effects of nifedipine see section 2.6.2

Beta-Adalat c (Bayer) A chloride; severe chronic heart failure; acute or Capsules , reddish-brown, atenolol 50 mg, nifedipine

decompensated heart failure requiring intravenous

20 mg (m/r), net price 28-cap pack = £10.41. Label: 8, inotropes; hepatic impairment

25 Side-effects postural hypotension, dizziness, head- Dose hypertension, 1 capsule daily, increased if necessary to

ache, fatigue, gastro-intestinal disturbances, brady- twice daily; elderly, 1 daily

cardia; occasionally diminished peripheral circulation, Angina, 1 capsule twice daily

peripheral oedema and painful extremities, dry mouth, Tenif c (AstraZeneca)

A dry eyes, eye irritation or disturbed vision, impotence, Capsules , reddish-brown, atenolol 50 mg, nifedipine

disturbances of micturition, influenza-like symptoms;

20 mg (m/r), net price 28-cap pack = £10.63. Label: 8, rarely angina, AV block, exacerbation of intermittent

25 claudication or Raynaud’s phenomenon; allergic skin Dose hypertension, 1 capsule daily, increased if necessary to

reactions, exacerbation of psoriasis, nasal stuffiness, twice daily; elderly, 1 daily

wheezing, depressed mood, sleep disturbances, Angina, 1 capsule twice daily

paraesthesia, heart failure, changes in liver enzymes, thrombocytopenia, leucopenia also reported

Dose

. Hypertension, initially 12.5 mg once daily, increased Indications see under Dose

BISOPROLOL FUMARATE

after 2 days to usual dose of 25 mg once daily; if Cautions see under Propranolol Hydrochloride;

necessary may be further increased at intervals of at ensure heart failure not worsening before increasing

least 2 weeks to max. 50 mg daily in single or divided dose; hepatic impairment (Appendix 2); renal

doses; ELDERLY initial dose of 12.5 mg daily may impairment (Appendix 3)

provide satisfactory control Contra-indications see under Propranolol Hydro-

. Angina, initially 12.5 mg twice daily, increased after 2 chloride; also acute or decompensated heart failure

days to 25 mg twice daily requiring intravenous inotropes; sino-atrial block

. Adjunct in heart failure (section 2.5.5) initially Side-effects see under Propranolol Hydrochloride

3.125 mg twice daily (with food), dose increased at Dose

intervals of at least 2 weeks to 6.25 mg twice daily, then to 12.5 mg twice daily, then to 25 mg twice daily;

. Hypertension and angina, usually 10 mg once daily increase to highest dose tolerated, max. 25 mg twice (5 mg may be adequate in some patients); max. 20 mg

daily in patients with severe heart failure or body- daily

weight less than 85 kg and 50 mg twice daily in . Adjunct in stable moderate to severe heart failure

patients over 85 kg (section 2.5.5), initially 1.25 mg once daily (in the morning) for 1 week then, if well tolerated, increased

Carvedilol (Non-proprietary) A to 2.5 mg once daily for 1 week, then 3.75 mg once

Tablets , carvedilol 3.125 mg, net price 28-tab pack = daily for 1 week, then 5 mg once daily for 4 weeks,

£5.73; 6.25 mg, 28-tab pack = £6.09; 12.5 mg, 28-tab then 7.5 mg once daily for 4 weeks, then 10 mg once

pack = £1.54; 25 mg, 28-tab pack = £2.14. Label: 8 daily; max. 10 mg daily

Eucardic c (Roche) A Bisoprolol Fumarate (Non-proprietary) A Tablets , scored, carvedilol 3.125 mg (pink), net price Tablets , bisoprolol fumarate 5 mg, net price 28-tab

28-tab pack = £7.57; 6.25 mg (yellow), 28-tab pack = pack = £1.31; 10 mg, 28-tab pack = £1.62. Label: 8

£8.41; 12.5 mg (peach), 28-tab pack = £9.35; 25 mg, Brands include Vivacor

28-tab pack = £11.68. Label: 8

BNF 57

2.4 Beta-adrenoceptor blocking drugs

gastric pain, nausea, vomiting; liver damage (see Indications

CELIPROLOL HYDROCHLORIDE

above); rarely lichenoid rash mild to moderate hypertension

Dose

Cautions see under Propranolol Hydrochloride; renal . By mouth , initially 100 mg (50 mg in elderly) twice impairment (avoid if creatinine clearance less than

daily with food, increased at intervals of 14 days to

15 mL/minute; Appendix 3) Contra-indications

usual dose of 200 mg twice daily; up to 800 mg daily see under Propranolol Hydro-

in 2 divided doses (3–4 divided doses if higher); chloride

max. 2.4 g daily

Side-effects headache, dizziness, fatigue, nausea and . By intravenous injection , 50 mg over at least somnolence; also bradycardia, bronchospasm;

1 minute, repeated after 5 minutes if necessary; depression and pneumonitis reported rarely

max. total dose 200 mg Dose

Note Excessive bradycardia can be countered with intra- . 200 mg once daily in the morning, increased to

venous injection of atropine sulphate 0.6–2.4 mg in divided doses of 600 micrograms; for overdosage see Emergency

400 mg once daily if necessary Treatment of Poisoning, p. 32 Celiprolol (Non-proprietary)

A . By intravenous infusion , 2 mg/minute until satis- Tablets , celiprolol hydrochloride 200 mg, net price 28-

factory response then discontinue; usual total dose tab pack = £6.41; 400 mg, 28-tab pack = £37.89.

50–200 mg, (not recommended for phaeochromo- Label: 8, 22

cytoma, see under Phaeochromocytoma, section 2.5.4) Celectol c (Winthrop) A Hypertension of pregnancy, 20 mg/hour, doubled

Tablets , f/c, scored, celiprolol hydrochloride 200 mg every 30 minutes; usual max. 160 mg/hour (yellow), net price 28-tab pack = £20.63; 400 mg, 28-

Hypertension following myocardial infarction, 15 mg/ tab pack = £41.26. Label: 8, 22

hour, gradually increased to max. 120 mg/hour Labetalol Hydrochloride (Non-proprietary) A

Tablets , f/c, labetalol hydrochloride 100 mg, net Indications short-term treatment of supraventricular

ESMOLOL HYDROCHLORIDE

price, 56 = £7.80; 200 mg, 56 = £11.83; 400 mg, 56 =

arrhythmias (including atrial fibrillation, atrial flutter,

£17.73. Label: 8, 21

ardiov C

A Tablets , all orange, f/c, labetalol hydrochloride 50 mg, Cautions see under Propranolol Hydrochloride; renal

sinus tachycardia); tachycardia and hypertension in

Trandate c (UCB Pharma) peri-operative period

net price 56-tab pack = £3.79; 100 mg, 56-tab pack =

ascular

impairment £4.17; 200 mg, 56-tab pack = £6.77; 400 mg, 56-tab Contra-indications see under Propranolol Hydro-

pack = £9.42. Label: 8, 21 chloride

Injection , labetalol hydrochloride 5 mg/mL, net price Side-effects

syst

see under Propranolol Hydrochloride; 20-mL amp = £2.12 also on infusion venous irritation and thrombophleb-

em

itis Dose . By intravenous infusion , usually within range 50–

METOPROLOL TARTRATE

200 micrograms/kg/minute (consult product lit- Indications see under Dose erature for details of dose titration and doses during

Cautions see under Propranolol Hydrochloride; peri-operative period)

hepatic impairment (Appendix 2) Brevibloc c (Baxter) A Contra-indications see under Propranolol Hydro-

Injection , esmolol hydrochloride 10 mg/mL, net price

chloride

10-mL vial = £7.79, 250-mL infusion bag = £89.69 Side-effects see under Propranolol Hydrochloride Dose . By mouth , hypertension, initially 100 mg daily,

increased if necessary to 200 mg daily in 1–2 Indications hypertension (including hypertension in

LABETALOL HYDROCHLORIDE

divided doses; max. 400 mg daily (but high doses pregnancy, hypertension with angina, and hyper-

rarely necessary)

tension following acute myocardial infarction); Angina, 50–100 mg 2–3 times daily hypertensive crisis (but see section 2.5); controlled

Arrhythmias, usually 50 mg 2–3 times daily; up to hypotension in anaesthesia

300 mg daily in divided doses if necessary Cautions see under Propranolol Hydrochloride; inter-

Migraine prophylaxis, 100–200 mg daily in divided feres with laboratory tests for catecholamines; liver

doses

damage (see below); renal impairment (Appendix 3) Hyperthyroidism (adjunct), 50 mg 4 times daily Liver damage Severe hepatocellular damage reported after

. By intravenous injection , arrhythmias, up to 5 mg at both short-term and long-term treatment. Appropriate laboratory testing needed at first symptom of liver dys-

rate 1–2 mg/minute, repeated after 5 minutes if function and if laboratory evidence of damage (or if jaundice)

necessary, total dose 10–15 mg labetalol should be stopped and not restarted

Note Excessive bradycardia can be countered with intra- Contra-indications see under Propranolol Hydro-

venous injection of atropine sulphate 0.6–2.4 mg in divided doses of 600 micrograms; for overdosage see Emergency

chloride Treatment of Poisoning, p. 32 Side-effects postural hypotension (avoid upright

In surgery, by slow intravenous injection 2–4 mg at position during and for 3 hours after intravenous

induction or to control arrhythmias developing administration), tiredness, weakness, headache,

during anaesthesia; 2-mg doses may be repeated to rashes, scalp tingling, difficulty in micturition, epi-

a max. of 10 mg

BNF 57 Early intervention within 12 hours of infarction, by

90 2.4 Beta-adrenoceptor blocking drugs

Cautions see under Propranolol Hydrochloride; intravenous injection

5 mg every 2 minutes to a reduce dose in renal impairment (Appendix 3) max. of 15 mg, followed after 15 minutes by 50 mg

Contra-indications see under Propranolol Hydro- by mouth every 6 hours for 48 hours; maintenance

chloride; also acute or decompensated heart failure 200 mg daily in divided doses

requiring intravenous inotropes; hepatic impairment Metoprolol Tartrate (Non-proprietary) A (Appendix 2)

Tablets , metoprolol tartrate 50 mg, net price 28 = Side-effects see under Propranolol Hydrochloride; £1.39, 56 = £1.54; 100 mg, 28 = £1.88, 56 = £2.24.

oedema, headache, dizziness, depression, visual dis- Label: 8

turbances, paraesthesia, impotence Dose

. Hypertension, 5 mg daily; ELDERLY Injection initially 2.5 mg mL amp = 42p

Betaloc c (AstraZeneca) A , metoprolol tartrate 1 mg/mL, net price 5-

daily, increased if necessary to 5 mg daily . Adjunct in heart failure (section 2.5.5), initially Lopresor c (Novartis) A 1.25 mg once daily, then if tolerated increased at Tablets , f/c, scored, metoprolol tartrate 50 mg (pink),

intervals of 1–2 weeks to 2.5 mg once daily, then to tem 5 mg once daily, then to max. 10 mg once daily net price 56-tab pack = £2.57; 100 mg (blue), 56-tab

sys pack = £6.68. Label: 8

Nebilet c (Menarini) A Modified release

Tablets , scored, nebivolol (as hydrochloride) 5 mg, net

c Betaloc-SA price 28-tab pack = £9.23. Label: 8

c (AstraZeneca) ascular A Durules (= tablets, m/r), metoprolol tartrate

diov 200 mg, net price 28-tab pack = £4.56. Label: 8, 25

C ar

Dose hypertension, angina, 200 mg daily in the morning,

OXPRENOLOL HYDROCHLORIDE

increased to 400 mg daily if necessary; migraine prophylaxis,

Indications 2 see under Dose

200 mg daily

Lopresor SR c (Novartis) A Cautions see under Propranolol Hydrochloride; Tablets , m/r, yellow, f/c, metoprolol tartrate 200 mg,

reduce dose in hepatic impairment net price 28-tab pack = £9.80. Label: 8, 25

Contra-indications see under Propranolol Hydro- Dose hypertension, 200 mg daily; angina, 200-400 mg daily;

chloride Side-effects see under Propranolol Hydrochloride

migraine prophylaxis, 200 mg daily

Dose

. Hypertension, 80–160 mg daily in 2–3 divided doses, increased as required; max. 320 mg daily Indications see under Dose

NADOLOL

. Angina, 80–160 mg daily in 2–3 divided doses; max. Cautions see under Propranolol Hydrochloride;

320 mg daily

hepatic impairment; renal impairment (Appendix 3) . Arrhythmias, 40–240 mg daily in 2–3 divided doses; Contra-indications see under Propranolol Hydro-

max. 240 mg daily chloride

. Anxiety symptoms (short-term use), 40–80 mg daily Side-effects see under Propranolol Hydrochloride

in 1–2 divided doses Dose . Hypertension, initially 80 mg once daily, increased in

Oxprenolol (Non-proprietary) A increments of up to 80 mg at weekly intervals if

Tablets , coated, oxprenolol hydrochloride 20 mg, net required; max. 240 mg daily (higher doses rarely

price 56 = £1.86; 40 mg, 56 = £3.73; 80 mg, 56 = £6.20; necessary)

160 mg, 20 = £2.36. Label: 8 . Angina, initially 40 mg once daily, increased at weekly

Trasicor c (Amdipharm) A intervals if required; usual max. 160 mg daily (rarely

Tablets , f/c, oxprenolol hydrochloride 20 mg (contain up to 240 mg may be required)

gluten), net price 56-tab pack = £1.86; 40 mg (contain . Arrhythmias, initially 40 mg once daily, increased at

gluten), 56-tab pack = £3.73; 80 mg (yellow), 56-tab weekly intervals up to 160 mg if required; reduce to

pack = £6.20. Label: 8

40 mg if bradycardia occurs . Migraine prophylaxis, initially 40 mg once daily, increased in 40 mg increments at weekly intervals

Modified release according to response; usual maintenance dose 80–

Slow-Trasicor c (Amdipharm) A 160 mg once daily

Tablets , m/r, f/c, oxprenolol hydrochloride 160 mg, . Thyrotoxicosis (adjunct), 80–160 mg once daily

net price 28-tab pack = £6.63. Label: 8, 25 Dose hypertension, angina, initially 160 mg once daily; if

Corgard c (Sanofi-Synthelabo) A necessary may be increased to max. 320 mg daily Tablets , blue, scored, nadolol 80 mg, net price 28-tab

pack = £5.20. Label: 8

With diuretic

Trasidrex c (Goldshield) A Tablets , red, s/c, co-prenozide 160/0.25 (oxprenolol

hydrochloride 160 mg (m/r), cyclopenthiazide Indications

NEBIVOLOL

250 micrograms), net price 28-tab pack = £10.66. essential hypertension; adjunct in stable

Label: 8, 25

mild to moderate heart failure in patients over 70 Dose hypertension, 1 tablet daily, increased if necessary to 2 years

daily as a single dose

BNF 57

2.4 Beta-adrenoceptor blocking drugs

320 mg daily in 2 divided doses; higher doses of Indications

PINDOLOL

480–640 mg daily for life-threatening ventricular see under Dose Cautions

arrhythmias under specialist supervision see under Propranolol Hydrochloride

. By intravenous injection over 10 minutes, acute Contra-indications see under Propranolol Hydro-

arrhythmias, 20–120 mg with ECG monitoring, chloride; severe renal impairment (Appendix 3)

repeated if necessary with 6-hour intervals between Side-effects see under Propranolol Hydrochloride

injections

Dose Diagnostic use, see product literature . Hypertension, initially 5 mg 2–3 times daily or 15 mg

Note Excessive bradycardia can be countered with intra- once daily, increased as required at weekly intervals;

venous injection of atropine sulphate 0.6–2.4 mg in divided doses of 600 micrograms; for overdosage see Emergency

usual maintenance 15–30 mg daily; max. 45 mg daily Treatment of Poisoning, p. 32 . Angina, 2.5–5 mg up to 3 times daily Pindolol (Non-proprietary) A Sotalol (Non-proprietary) A Tablets , pindolol 5 mg, net price 100-tab pack = £7.81.

Tablets , sotalol hydrochloride 40 mg, net price 56 = Label: 8

£1.34; 80 mg, 56 = £1.99; 160 mg, 28 = £2.21. Label: 8

Beta-Cardone (UCB Pharma) A = £5.85; 15 mg, 28-tab pack = £8.79. Label: 8

Visken c (Amdipharm) A c

Tablets , scored, pindolol 5 mg, net price 56-tab pack

Tablets , scored, sotalol hydrochloride 40 mg (green), net price 56-tab pack = £1.34; 80 mg (pink), 56-tab

With diuretic pack = £1.99; 200 mg, 28-tab pack = £2.50. Label: 8

Tablets , scored, pindolol 10 mg, clopamide 5 mg, net Sotacor (Bristol-Myers Squibb) A price 28-tab pack = £6.70. Label: 8

Viskaldix c (Amdipharm) A c

Tablets , scored, sotalol hydrochloride 80 mg, net Dose hypertension, 1 tablet daily in the morning, increased if

price 28-tab pack = £3.25; 160 mg, 28-tab pack = necessary to 2 daily; max. 3 daily

£6.41. Label: 8 Injection , sotalol hydrochloride 10 mg/mL, net price

ardiov C SOTALOL HYDROCHLORIDE

4-mL amp = £1.76

ascular

Indications Tablets and injection: life-threatening

arrhythmias including ventricular tachyarrhythmias, symptomatic non-sustained ventricular tachyar-

TIMOLOL MALEATE

rhythmias Tablets only: prophylaxis of paroxysmal atrial tachy-

syst

Indications see under Dose; glaucoma (section 11.6)

cardia or fibrillation, paroxysmal AV re-entrant Cautions see under Propranolol Hydrochloride;

em

tachycardias (both nodal and involving accessory hepatic impairment (Appendix 2); renal impairment pathways), paroxysmal supraventricular tachycardia

(Appendix 3)

after cardiac surgery, maintenance of sinus rhythm Contra-indications see under Propranolol Hydro- following cardioversion of atrial fibrillation or flutter

chloride

Injection only: electrophysiological study of inducible Side-effects see under Propranolol Hydrochloride ventricular and supraventricular arrhythmias; tem-

Dose

porary substitution for tablets CSM advice. The use of sotalol should be limited to the

. Hypertension, initially 10 mg daily in 1–2 divided treatment of ventricular arrhythmias or prophylaxis of

doses; gradually increased if necessary to max. 60 mg supraventricular arrhythmias (see above). It should no longer

daily, usual maintenance dose 10–30 mg daily (doses be used for angina, hypertension, thyrotoxicosis or for sec-

above 30 mg daily given in divided doses) ondary prevention after myocardial infarction; when stop- ping sotalol for these indications, the dose should be reduced

. Angina, initially 5 mg twice daily increased if neces- gradually

sary by 10 mg daily every 3–4 days; max. 30 mg twice Cautions see under Propranolol Hydrochloride;

daily

reduce dose in renal impairment (avoid if creatinine . Prophylaxis after myocardial infarction, initially 5 mg clearance less than 10 ml/minute; Appendix 3); cor-

twice daily, increased after 2 days to 10 mg twice daily rect hypokalaemia, hypomagnesaemia, or other

if tolerated

electrolyte disturbances; severe or prolonged diarr- . Migraine prophylaxis, 10–20 mg daily in 1–2 divided hoea; interactions: Appendix 1 (beta-blockers),

doses

important: verapamil interaction see also p. 118 Contra-indications see under Propranolol Hydro-

Betim c (Valeant) A

chloride; congenital or acquired long QT syndrome; Tablets , scored, timolol maleate 10 mg, net price 30- torsade de pointes; renal failure

tab pack = £2.08. Label: 8 Side-effects see under Propranolol Hydrochloride; arrhythmogenic (pro-arrhythmic) effect (torsade de pointes—increased risk in women)

With diuretic

Dose Prestim c (Valeant) A . By mouth with ECG monitoring and measurement

Tablets , scored, timolol maleate 10 mg, bendroflu- of corrected QT interval, arrhythmias, initially

methiazide 2.5 mg, net price 30-tab pack = £3.49.

80 mg daily in 1–2 divided doses increased gradu-

Label: 8

ally at intervals of 2–3 days to usual dose of 160– Dose hypertension, 1–2 tablets daily; max. 4 daily

92 2.5 Hypertension and heart failure

BNF 57

2.5 organ damage or diabetes, confirm within 12 Hypertension and heart

weeks and treat if these values are sustained;

failure

Where the initial blood pressure is systolic 140– 159 mmHg or diastolic 90–99 mmHg and no cardi-

2.5.1 Vasodilator antihypertensive drugs

ovascular complications, no target-organ damage,

2.5.2 Centrally acting antihypertensive

or no diabetes, advise lifestyle changes and reas-

drugs

sess monthly; treat persistent mild hypertension if the 10-year cardiovascular disease risk is 20% or

2.5.3 Adrenergic neurone blocking drugs

more. 2

2.5.4 Alpha-adrenoceptor blocking drugs

A target systolic blood pressure < 140 mmHg and dia-

2.5.5 Drugs affecting the renin-angiotensin

stolic blood pressure < 90 mmHg is suggested. A lower

system

target systolic blood pressure < 130 mmHg and diasto- lic blood pressure < 80 mmHg should be considered for

Lowering raised blood pressure decreases the risk of those with established atherosclerotic cardiovascular stroke, coronary events, heart failure, and renal impair-

disease, diabetes, or chronic renal failure. In some individuals it may not be possible to reduce blood

tem ment. Advice on antihypertensive therapy in this section takes into account the recommendations of the Joint pressure below the suggested targets despite the use sys British Societies (JBS2: British Societies’ guidelines on of appropriate therapy.

prevention of cardiovascular disease in clinical practice. Heart 2005; 91 (Suppl V): v1–v52).