PO(Adults): Antianginal — 50 mg once daily; may be increased after 1 wk to 100 mg/day (up to 200 mg/
day). Antihypertensive — 25–50 mg once daily; may be increased after 2 wk to 50–100 mg once daily.
MI—50 mg (given 10 min after last IV dose), then 50 mg 12 hr later, then 100 mg/ day as a single dose or in 2
divided doses for 6–9 days or until hospital discharge. Renal Impairment
PO (Adults): CCr 15–35 ml/ min —dosage should not exceed 50 mg/day; CCr<15 ml/min —dosage should
not exceed 50 mg every other day.
IV (Adults): MI — 5 mg, followed by another 5 mg after 10 min; after 10 more min follow with oral dosing.
Hemodialysis: Give 25 to 50 mg after each dialysis session; marked falls in blood pressure can occur.
CHF. Pulmonary edema. Cardiogenic shock.
Bradycardia or heart block.
Use Cautiously In: Renal impairment (dosage reduction
recommended if CCr≤35 ml/min). Hepatic impairment.
Geriatric patients (increased sensitivity to beta blockers;
initial dosage reduction recommended). Pulmonary disease (including asthma; beta selectivity may be lost at higher doses).
Diabetes mellitus (may mask signs of hypoglycemia).
Thyrotoxicosis (may mask symptoms).
Patients with a history of severe allergic reactions
(intensity of reactions may be increased). OB: Crosses the placenta and may cause fetal/neonatal
bradycardia, hypointension, hypoglycemia, or respiratory depression. Lactation: Pedi: Safety not established.
•General anesthesia, IV phenytoin and verapamil
may cause additive myocardial depression.
• Additive bradycardia may occur with digoxin.
•Additive hypotension may occur with other antihypertensives,
acute ingestion of alcohol, or nitrates.
•Concurrent use with amphetamine, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or pseudoephedrine may result in unopposed alpha-adrenergic
stimulation(excessive hypertension, bradycardia).
Concurrent thyroid administration may ↓ effectiveness.
• May alter the effectiveness of insulins or oral hypoglycemic
agents (dosage adjustments may be necessary).
• May ↓ the effectiveness of theophylline.
•May ↓ the beneficial beta1- cardiovascular effects of dopamine or dobutamine.
•Use cautiously within 14 days of MAO inhibitor
therapy (may result in hypertension).
Absorption: Rapid and consistent but incomplete; approximately 50% is absorbed from the GI tract.
Tmax is 2 to 4 h.
Distribution: 6% to 16% bound to plasma proteins. Metabolism: Little or no metabolism by the liver. Excretion: Approximately 50% is excreted unchanged hypoin the feces. Approximately 50% is excreted in the urine within 24 h. Half-life is approximately 6 to 7 h. Special Populations: Renal Function
Impairment: Elimination is closely related to glomerular filtration rate. Significant accumulation occurs when CrCl falls
below 35 mL/min per 1.73 m2 . Elderly: Total Cl is about 50% lower than in younger subjects. Half-life is markedly longer in elderly