BETA-ADRENERGIC BLOCKING AGENTS

Brand & Generic Names

ACEBUTOLOL	Normodyne
Apo-Atenolol	Novo-Atenol
Apo-Metoprolol	Novometoprol
Apo-Metoprolol (Type L)	Novo-Pindol
Apo-Propranolol	Novopranol
Apo-Timol	Novo-Timol
ATENOLOL	Nu-Atenol
Betaloc	NuMetop
Betaloc Durules	OXPRENOLOL
Betapace	PENBUTOLOL
BETAXOLOL	PINDOLOL
Blocadren	pms Propranolol
CARTEOLOL	PROPRANOLOL
Cartrol	Sectral
Corgard	Slow-Trasicor
Detensol	Sotacor
Inderal	SOTALOL
Inderal LA	Syn-Nadolol
Kerlone	Syn-Pindolol
LABETALOL	Tenormin
Levatol	TIMOLOL
Lopresor	Toprol XL
Lopressor	Trandate
Lopressor SR	Trasicor
METROPOLOL	Visken
Monitan	Zebeta
NADOLOL

Basic Information

• Habit forming? No
• Prescription needed? Yes
• Available as generic? Yes, for some.
• Drug class: Beta-adrenergic blocker

Uses

• Reduces angina attacks.
• Stabilizes irregular heartbeat.
• Lowers blood pressure.
• Reduces frequency of vascular headaches. (Does not relieve headache pain.)
• Other uses prescribed by your doctor.

Dosage & Usage Information

How to take:
Tablet, liquid or extended-release capsule--Swallow with liquid. If you can't swallow whole, crumble tablet or open capsule and take with liquid or food. Don't crush capsule or extended-release tablet.

When to take:
With meals or immediately after.

If you forget a dose:
Take as soon as you remember. Return to regular schedule, but allow 3 hours between doses.

What drug does:
Blocks certain actions of sympathetic nervous system.
Lowers heart's oxygen requirements.
Slows nerve impulses through heart.
Reduces blood vessel contraction in heart, scalp and other body parts.

Time lapse before drug works:
1 to 4 hours.

Don't take with:
Non-prescription drugs or drugs in Interaction Section without consulting doctor.

Overdose

SYMPTOMS:
Weakness, slow or weak pulse, blood pressure drop, fainting, difficulty breathing, convulsions, cold and sweaty skin.

WHAT TO DO:

• Dial 911 (emergency) or O (operator) for an ambulance or medical help. Then give first aid immediately.
• See EMERGENCY Information.

Possible Adverse Reactions or Side Effects

Life-threatening:

Congestive heart Discontinue. Seek failure (severe emergency treatment. shortness of breath, rapid heartbeat).

Common:

• Pulse slower than 50 beats per minute.
• Drowsiness, fatigue, numbness or tingling of fingers or toes, dizziness, diarrhea, nausea, weakness.
• Cold hands or feet; dry mouth, eyes and skin.

Infrequent:

• Hallucinations, nightmares, insomnia, headache, difficult breathing, joint pain, anxiety, chest pain.
• Confusion, reduced alertness, depression, impotence, abdominal pain.
• Constipation.

Rare:

• Rash, sore throat, fever.
• Unusual bleeding and bruising; dry, burning eyes.

Warnings & Precautions

Don't take if:

• You are allergic to any beta-adrenergic blocker.
• You have asthma.
• You have hay fever symptoms.
• You have taken MAO inhibitors in past 2 weeks.

Before you start, consult your doctor:

• If you have heart disease or poor circulation to the extremities.
• If you have hay fever, asthma, chronic bronchitis, emphysema.
• If you have overactive thyroid function.
• If you have impaired liver or kidney function.
• If you will have surgery within 2 months, including dental surgery, requiring general or spinal anesthesia.
• If you have diabetes or hypoglycemia.

Over age 60:
Adverse reactions and side effects may be more frequent and severe than in younger persons.

Pregnancy:
Risk to unborn child outweighs drug benefits. Don't use.

Breast-feeding:
Drug passes into milk. Avoid drug or discontinue nursing until you finish medicine. Consult doctor for advice on maintaining milk supply.

Infants & children:
Not recommended.

Prolonged use:

• Weakens heart muscle contractions.
• Talk to your doctor about the need for follow-up medical examinations or laboratory studies to check blood pressure, ECG*, kidney function, blood sugar.

Skin & sunlight:
No problems expected.

Driving, piloting or hazardous work:
Don't drive or pilot aircraft until you learn how medicine affects you. Don't work around dangerous machinery. Don't climb ladders or work in high places. Danger increases if you drink alcohol or take medicine affecting alertness and reflexes.

Discontinuing:
Don't discontinue without consulting doctor. Dose may require gradual reduction if you have taken drug for a long time. Doses of other drugs may also require adjustment.

Others:

• May mask hypoglycemia.
• May affect results in some medical tests.
• Advise any doctor or dentist whom you consult that you take this medicine.

Possible Interaction with Other Drugs

GENERIC NAME	COMBINED EFFECT
------------------------	-----------------------
ACE inhibitors*:	Increased antihypertensive
captopril, enalapril,	effects of both drugs. Dosages
lisinopril	may require adjustment.
Antidiabetics*	Increased antidiabetic effect.
Antihistamines*	Decreased antihistamine effect.
Antihypertensives*	Increased antihypertensive effect.
Barbiturates*	Increased barbiturate effect.
	Dangerous sedation.
Beta-agonists*	Decreased beta-agonist effect.
Betaxolol eyedrops	Possible increased beta blocker
	effect.
Calcium channel blockers*	Additional blood pressure drop.
Clonidine	Additional blood pressure drop.
Diazoaxide	Additional blood pressure drop.
Dextrothyroxine	Possible decrease of beta blockers
	effect.
Digitalis	Can either increase or decrease
preparations*	heart rate. Improves irregular
	heartbeat.
Encainide	Increased effect of toxicity on
	heart muscle.
Guanabenz	Additional blood pressure drop.
Indomethacin	Decreased effect of beta blocker.
Insulin	Hypoglycemic effects may be
	prolonged.
Levobunolol	Possible increased
eyedrops	beta blocker effect.
MAO Inhibitors*	High blood pressure following MAO
	discontinuation.
Molindone	Increased tranquilizer effect.
Narcotics*	Increased narcotic effect.
	Dangerous sedation.
Nicardipine	Possible irregular heartbeat and
	congestive heart failure.
Nicotine	Increased beta blocker effect.
Nimodipine	Possible irregular heartbeat. May
	worsen congestive heart failure.
Nitrates*	Possible excessive blood pressure
	drop.
Non-steroidal	Decreased antihypertensive
anti-inflammatory	effect of beta blocker.
Phenytoin	Decreased beta blocker effect.
Propafenone	Increased effect of both drugs and
	increased risk of toxicity.
Quinidine	Slows heart excessively.
Reserpine	Increased reserpine effect.
	Excessive sedation and depression.
	Additional blood pressure drop.
Sympathomimetics*	Decreases effect of both drugs.
Timolol eyedrops	Possible increased beta blocker
	effect.
Tocainide	May worsen congestive heart
	failure.
Verapamil	Increased effects of both drugs.
Xanthines	Decreased effects of both drugs.

Possible Interaction with Other Substances

INTERACTS WITH	COMBINED EFFECT
---------------	---------------
Alcohol:	Excessive blood pressure drop.
	Avoid.
Beverages:	None expected.
Cocaine:	Irregular heartbeat; decreased
	beta-adrenergic effect. Avoid.
Foods:	None expected.
Marijuana:	Daily use--Impaired circulation
	to hands and feet.
Tobacco:	Possible irregular heartbeat.