Beta-adrenergic Blocking Agents (Systemic)

Proper Use of This Medicine

For patients taking the extended-release capsule or tablet form of this medicine:

• Swallow the capsule or tablet whole.
• Do not crush, break (except metoprolol succinate extended-release tablets, which may be broken in half), or chew before swallowing.

For patients taking the concentrated oral solution form of propranolol :

• This medicine is to be taken by mouth even though it comes in a dropper bottle. The amount you should take is to be measured only with the specially marked dropper.
• Mix the medicine with some water, juice, or a carbonated drink. After drinking all the liquid containing the medicine, rinse the glass with a little more liquid and drink that also, to make sure you get all the medicine.
  If you prefer, you may mix this medicine with applesauce or pudding instead.
• Mix the medicine immediately before you are going to take it. Throw away any mixed medicine that you do not take immediately. Do not save medicine that has been mixed.

Ask your doctor about checking your pulse rate before and after taking beta-blocking agents. If your doctor tells you to check your pulse regularly while you are taking this medicine, and it is much slower than the rate your doctor has designated, check with your doctor. A pulse rate that is too slow may cause circulation problems.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking this medicine for high blood pressure :

• In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
• Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. However, if high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
• Remember that this medicine will not cure your high blood pressure but it does help control it. It is very important that you take your medicine exactly as directed , even if you feel well. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . Also, it is very important to keep your appointments with your doctor, even if you feel well.

Dosing - The dose of beta-blocker will be different for different patients. Follow your doctor's orders or the directions on the label . The following information includes only the average doses. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of solution that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the beta-blocker .

For acebutolol
• For oral dosage forms (capsules and tablets):
  • For angina (chest pain) or irregular heartbeat:
    • Adults - 200 milligrams (mg) two times a day. The dose may be increased up to a total of 1200 mg a day.
    • Children - Dose must be determined by your doctor.
  • For high blood pressure:
    • Adults - 200 to 800 mg a day as a single dose or divided into two daily doses.
    • Children - Dose must be determined by your doctor.

For atenolol
• For oral dosage form (tablets):
  • For angina (chest pain):
    • Adults - 50 to 100 mg once a day.
  • For high blood pressure:
    • Adults - 25 to 100 mg once a day.
    • Children - Dose must be determined by your doctor.
  • For treatment after a heart attack:
    • Adults - 50 mg ten minutes after the last intravenous dose, followed by another 50 mg twelve hours later. Then 100 mg once a day or 50 mg two times a day for six to nine days or until discharge from hospital.
• For injection dosage form:
  • For treatment of heart attacks:
    • Adults - 5 mg given over 5 minutes. The dose is repeated ten minutes later.

For betaxolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 10 mg once a day. Your doctor may double your dose after seven to fourteen days.
    • Children - Dose must be determined by your doctor.

For bisoprolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 5 to 10 mg once a day.
    • Children - Dose must be determined by your doctor.

For carteolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 2.5 to 10 mg once a day.
    • Children - Dose must be determined by your doctor.

For labetalol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 100 to 400 mg two times a day.
    • Children - Dose must be determined by your doctor.
• For injection dosage form:
  • For high blood pressure:
    • Adults - 20 mg injected slowly over two minutes with additional injections of 40 and 80 mg given every ten minutes if needed, up to a total of 300 mg; may be given instead as an infusion at a rate of 2 mg per minute to a total dose of 50 to 300 mg.
    • Children - Dose must be determined by your doctor.

For metoprolol
• For regular (short-acting) oral dosage form (tablets):
  • For high blood pressure or angina (chest pain):
    • Adults - 100 to 450 mg a day, taken as a single dose or in divided doses.
    • Children - Dose must be determined by your doctor.
  • For treatment after a heart attack:
    • Adults - 50 mg every six hours starting fifteen minutes after last intravenous dose. Then 100 mg two times a day for three months to 1 to 3 years .
• For long-acting oral dosage forms (extended-release tablets):
  • For high blood pressure or angina (chest pain):
    • Adults - Up to 400 mg once a day.
    • Children - Dose must be determined by your doctor.
• For injection dosage form:
  • For treatment of a heart attack:
    • Adults - 5 mg every two minutes for three doses.

For nadolol
• For oral dosage form (tablets):
  • For angina (chest pain):
    • Adults - 40 to 240 mg once a day.
  • For high blood pressure:
    • Adults - 40 to 320 mg once a day.
    • Children - Dose must be determined by your doctor.

For oxprenolol
• For regular (short-acting) oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 20 mg three times a day. Your doctor may increase your dose up to 480 mg a day.
    • Children - Dose must be determined by your doctor.
• For long-acting oral dosage form (extended-release tablets):
  • For high blood pressure:
    • Adults - 120 to 320 mg once a day.
    • Children - Dose must be determined by your doctor.

For penbutolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 20 mg once a day.
    • Children - Dose must be determined by your doctor.

For pindolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 5 mg two times a day. Your doctor may increase your dose up to 60 mg a day.
    • Children - Dose must be determined by your doctor.

For propranolol
• For regular (short-acting) oral dosage forms (tablets and oral solution):
  • For angina (chest pain):
    • Adults - 80 to 320 mg a day taken in two, three, or four divided doses.
  • For irregular heartbeat:
    • Adults - 10 to 30 mg three or four times a day.
    • Children - 500 micrograms (0.5 mg) to 4 mg per kilogram of body weight a day taken in divided doses.
  • For high blood pressure:
    • Adults - 40 mg two times a day. Your doctor may increase your dose up to 640 mg a day.
    • Children - 500 micrograms (0.5 mg) to 4 mg per kilogram of body weight a day taken in divided doses.
  • For diseased heart muscle (cardiomyopathy):
    • Adults - 20 to 40 mg three or four times a day.
  • For treatment after a heart attack:
    • Adults - 180 to 240 mg a day taken in divided doses.
  • For treating pheochromocytoma:
    • Adults - 30 to 160 mg a day taken in divided doses.
  • For preventing migraine headaches:
    • Adults - 20 mg four times a day. Your doctor may increase your dose up to 240 mg a day.
  • For trembling:
    • Adults - 40 mg two times a day. Your doctor may increase your dose up to 320 mg a day.
• For long-acting oral dosage form (extended-release capsules):
  • For high blood pressure:
    • Adults - 80 to 160 mg once a day. Doses up to 640 mg once a day may be needed in some patients.
  • For angina (chest pain):
    • Adults - 80 to 320 mg once a day.
  • For preventing migraine headaches:
    • Adults - 80 to 240 mg once a day.
• For injection dosage form:
  • For irregular heartbeat:
    • Adults - 1 to 3 mg given at a rate not greater than 1 mg per minute. Dose may be repeated after two minutes and again after four hours if needed.
    • Children - 10 to 100 micrograms (0.01 to 0.1 mg) per kilogram of body weight given intravenously every six to eight hours.

For sotalol
• For oral dosage form (tablets):
  • For irregular heartbeat:
    • Adults - 80 mg two times a day. Your doctor may increase your dose up to 320 mg per day taken in two or three divided doses.
    • Children - Dose must be determined by your doctor.

For timolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults - 10 mg two times a day. Your doctor may increase your dose up 60 mg per day taken as a single dose or in divided doses.
    • Children - Dose must be determined by your doctor.
  • For treatment after a heart attack:
    • Adults - 10 mg two times a day.
  • For preventing migraine headaches:
    • Adults - 10 mg two times a day. Your doctor may increase your dose up to 30 mg once a day or in divided doses.

Missed dose - Do not miss any doses. This is especially important when you are taking only one dose per day. Some conditions may become worse if this medicine is not taken regularly.

If you do miss a dose of this medicine, take it as soon as possible. However, if it is within 4 hours of your next dose (8 hours when using atenolol, betaxolol, bisoprolol, carteolol, labetalol, nadolol, penbutolol, sotalol, or extended-release [long-acting] metoprolol, oxprenolol, or propranolol), skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage - To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.