Skip to main content Skip to course navigation

ß-BLOCKERS

  • Lipophilic: propranolol, carvedilol, metoprolol
  • Hydrophilic: sotalol, atenolol, nadolol
  • Lipophilic: better absorption, shorter half-life, greater diffusion cross blood-brain barrier, hepatic metabolism
  • Hydrophilic: not well absorbed, stay in bloodstream, excreted through kidneys
  • Pregnancy Category C

  • Oral

  • Adults
    • Flushing: propranolol 20-40mg 2-3 times a day;
    • nadolol 20-80 mg daily;
    • carvedilol 6,25 mg 2-3 times a day)
  • *Children
    • Infantile Hemangioma: propranolol 2-3 mg/kg/d divided twice a day or three times a day

  • Inhibits ß-adrenergic receptors
  • Anti-ß1-receptor, selective (metoprolol, atenolol): cardioselective (decrease heart rate / conduction / contraction)
  • Anti-ß2-receptor, non-selective (propranolol, nadolol): inhibition vasodilataion of bronchioles & blood vessels, decrease lipolysis

FDA approved

  • Proliferating infantile hemangioma (propranolol)

Off-label

  • Wound healing
  • Flushing (propranolol, nadolol)

  • Boxed Warning: Abrupt withdrawal in patients with coronary artery disease
  • Hypersensitivity
  • Bradycardia < 50 beats/min (unless pacemaker in place)
  • First degree heart block
  • Decompensated heart failure
  • Bronchial asthma / broncho-spasm
  • Systolic blood pressure < 100 mm Hg
  • Children:
    • Bradycardia < 80 beats/min
    • > 1st degree heart block
    • Blood pressure < 50/30 mm Hg

  • Bradycardia
  • – Hypotension
  • – Bronchospasm
  • – Fatigue
  • -Hyperkalemia 
  • Hypoglycemia (children & diabetics)
  • Depression (cause / exacerbate)
  • Sleep disturbance
  • Cold toes and fingers 
  • GI disturbance 
  • Cutaneous (lichenoid, eczematous, psoriasiform)
  • Psoriasis exacerbation
  • * Abrupt decompensation of ischemic heart disease if beta-blocker withdrawn quickly

  • Propranolol: substrate CYP1A2 & CYP2D6 (major)

  • For children receiving propranolol for infantile hemangioma:
  • Evaluate heart rate, blood pressure, (monitor heart rate & blood pressure for 2 hours after 1st dose, then monitor q4-8 weeks)
  • Always adjust dose according to weight
  • Starting dose 1mg/kg/day divided by 2-3 doses, increase by 1mg/kg/day weekly until goal reached
  • Goal: 2-3 mg/kg/day divided into 2-3 doses, continue for 6-12 months
  • Then, taper > 4 weeks to avoid rebound effect
  • Teaching to parents about risk of hypoglycemia.
    1. Signs: early = diaphoresis, increased heart rate, tremors, fuss; late = lethargy, hypothermia
    2. Give treatment during feedings or right after feedings (> 9 hours apart between 2 doses)