Drug Facts

Type of Drug:

Beta-blockers; antihypertensives; drugs used to lower high blood pressure; antianginal drugs; antiarrhythmic drugs.

How the Drug Works:

Beta-adrenergic blocking agents interfere with the action of adrenalin and similar chemicals on heart muscle contraction (heart may beat with less force and pump out less blood) and nerve conduction in the heart (heart may beat more slowly and regularly). Beta-adrenergic blocking agents reduce the amount of work the heart has to do (reduces angina chest pain) and the amount of blood the heart pumps out (lowers elevated blood pressure) and stabilize heart rhythm in conditions in which the heart is beating too fast or irregularly (antiarrhythmic effects).

Precautions:

Discontinuing therapy: When discontinuing these medications, slowly reduce the dose over 1 to 2 weeks. Sudden discontinuation of these drugs has caused worsening of angina (chest pain), heart attacks, irregular heartbeats, and death. Other serious withdrawal symptoms include: sweating, palpitations (pounding in the chest), headache, tremulous­ness, discomfort, and allergy to catecholamines. If discontinued suddenly, beta-blockers may mask the signs of hyperthyroidism (overactive thyroid). If thyroid patients stop taking these medications too suddenly, symptoms of hyperthyroidism (eg, a rapid pulse) may occur.

Diabetes: These products can mask some of the signs of hypoglycemia (low blood sugar) such as rapid heart rate and tremors, and alter blood sugar levels. It may be necessary for your doctor to alter your dose of diabetic medications while taking beta-blockers.

Proarrhythmia: Betapace AF can cause or worsen ventricular arrhythmias, a different type of heartbeat that can be dangerous and even cause death. To minimize the risk of this heartbeat, patients should be placed in a medical facility that can provide cardiac resuscitation, continuous ECG monitoring, and calculations of creatinine clearance for a minimum of 3 days when starting or restarting therapy.

Allergic reaction: Patients with a history of allergic reactions to various allergens may be unresponsive to the usual doses of epinephrine used to treat the allergic reaction.

Pregnancy: There are no adequate or well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.

Atenolol acebutlolol and sotalol Acebutolol crosses the placenta; reduced birth weight and decreased blood pressure and heart rate have occurred.

Breastfeeding: Acebutolol, atenolol, betaxolol, metoprolol, nadolol, pindolol, propranolol, sotalol, and timolol appear in breast milk. It is not known if carteolol, bisoprolol, or penbutolol appear in breast milk. Discontinue nursing when taking any beta-blockers.

Children: Safety and effectiveness have not been established.

Drug Interactions:

Tell your doctor or pharmacist if you are taking or planning to take any over the-counter or prescription medications or dietary supplements with beta­blockers. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with beta-blockers:

Classes interact with beta-blockers:

• Alltacids (eg, aluminum carbonate)
• Antiarrhythmics (eg, quinidine)
• Antidiabetic drugs, oral (eg, glipizide)
• Calcium channel blockers (eg, verapamil)
• hydantoins (eg, phenytoin)
• hydralazine (eg, Apresoline)
• insulin lidocaine (eg, Xylocaine)
• NSAIDs (eg, ibuprofen)
• penicillins (eg, ampicillin)
• phenothiazines (eg, chlorpromazine)
• Cimetidine (eg, tagamet)
• Clonidine (eg, Catapres)
• Colestipol (eg, Colestid)
• Epinephine (eg, Adrenalin)
• Ergot alkaloids (eg, ergotamine)
• Prazosin (eg, Minipress)
• Propafenone (eg, Rythmol)
• Rifamycins (eg, rifampin)
• Selective serotonin reuptake inhibitors (eg, paroxetine)
• Theophyllines (eg, aminophylline)
• Thioamines (eg, methimazole)

Side Effects:

Every drug is capable of producing side effects. Many beta-blocker users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; stomach pain; gas; bloating; diarrhea; constipation; heartburn; indigestion; stomach cramping; appetite changes; dry mouth; colon or rectal problems.

Nervous System: Depression; anxiety; nervousness; disorientation; confusion; fainting; weakness; dizziness; catatonia; vertigo (feeling of whirling motion); lightheadedness; fatigue; sleeplessness; drowsiness; lethargy; sleep disturbances; nightmares; abnormal, vivid dreams; hallucinations; short-term memory loss; decreased concentration; sedation; headache; emotional lability; mood changes; behavior changes; slurred speech.

Circulatory System: Changes in heart rate; decreased heart rate; irregular heart rate; heart rhythm abnormalities; chest pain; palpitations (pounding in the chest); cold extremities; changes in blood pressure; heart arrest; heart block; congestive heart failure; abnormal ECG; decreased blood platelets; decreased white blood cells; blood clot; vein inflammation; stroke.

Respiratory System: Shortness of breath or difficulty breathing; cough; nasal congestion; wheezing; upper respiratory infection; sinus infection; fluid in the lungs; bronchitis; asthma; bronchospasm; sore or inflamed throat; throat spasms.

Skin: Rash; swelling; flushing or paleness; abnormal skin sensations (eg, burning, prickling, tingling); increased or decreased skin sensitivity to stimulation; itching and irritation; hair loss; sweating; dry skin; numbness of the hands.

Muscular System: Aching or painful joints and muscles; back pain; limb pain; shoulder pain; muscle weakness; muscle cramps or twitching; tremor.

Urinary and Reproductive Tract: Painful urination; inability to urinate; frequent urination; urinary tract infection; excessive urination at night; sexual problems; decreased sex drive; impotence.

Other: Fever; weight changes; changes in blood sugar levels; infection; swelling of arms and legs; general body discomfort; decreased exercise tolerance; gout; cold - or flulike symptoms

Guidelines for Use:

• Dosage is individualized. Take exactly as prescribed.
• Do not stop taking or change the dose unless directed by your doctor. Abrupt withrawal has resulted in worsening of angina and ventricular arrhythmias and can cause myocardial infarction and death.
• If a dose is missed, take it as soon as possible. If several hours have passed or it is nearing time for the next dose, do not double the dose to catch up, unless advised to do so by your doctor. If more than one dose is missed or it is necessary to establish a new dosage schedule, contact your doctor or pharmacist.
• Do not chew or crush sustained-release or extended-release products.
• Diabetes - May mask some signs of low blood sugar (eg, rapid heart rate, tremors) or alter blood glucose levels.
• Glaucoma - May reduce intraocular pressure and interfere with the glaucoma screening test.
• Consult your pharmacist or doctor before using dietary supplements or other prescription or nonprescription products including nasal decongestants, diet aids, and nonprescription cold preparations.
• May cause drowsiness, dizziness, lightheadedness, or blurred vision. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
• Notify your doctor if you experience difficulty breathing (especially on exertion or when lying down), night cough, swelling of the extremities, slow pulse rate, dizziness, light-headedness, fainting, confusion, depression, rash, fever, sore throat, unusual bleeding or bruising, fatigue with exertion, cough, fast heartbeat, severe diarrhea, or unusual bleeding.
• Inform your doctor or dentist of therapy before any type of surgery.
• Inform your doctor if you are pregnant, become pregnant, plan on becoming pregnant, or are breastfeeding.
• Brand interchange - Do not change from one brand of this drug to another without consulting your pharmacist or doctor. For example, Betapace and Betapace AF are not interchangeable.
• Nadolol, pindolol, acebutolol, atenolol, carteolol, bisoprolol, betaxolol, and
• May be taken without regard to meals.
• Metoprolol and propranolol - Take consistently with or without food at the same time each day.
• Propranolollntensol- Mix prescribed dose with liquid or semi-solid food such as water, juices, soda or soda-like beverages, applesauce, or pudding. Use calibrated dropper to measure dose. Administer entire amount of mixture immediately after mixing. Do not store mixture after mixing.
• Sotalol- Food may reduce absorption. Take on an empty stomach.
• Sotalol - To reduce the risk of induced arrhythmias, patients should be placed in a medical facility that can provide cardiac resuscitation, continuous ECG monitoring, and calculations of creatine clearance for a minimum of 3 days when starting or restarting therapy.
• Store at room temperature (59° to 86°F). Avoid excessive heat. Protect from light, moisture, and freezing.

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