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-Adrenergic Blockers
Table 17-4 Adrenergic Blockers
| Generic (Brand) | Route and Dosage | Uses and Considerations |
|---|---|---|
| phentolamine mesylate (Regitine) (alpha1) | A: IM/IV: 2.5-5 mg, repeat q5min until controlled, then q2-3h PRNC: IM/IV: 0.05-0.1 mg/kg, repeat PRN | Management of peripheral vascular disorder and hypertensive emergency. Antidote for dopamine infiltration. Pregnancy category: C; PB: UK; t½: 20 min |
| doxazosin mesylate (Cardura) (alpha1) | A: PO: 1 mg/d, titrate dose up to max: 16 mg/d; maint: 4–8 mg/dElderly: PO: 0.5 mg/d initially; may increase dose | For mild to moderate hypertension and BPH. Check for orthostatic hypotension. Dizziness, headache, syncope may occur. Pregnancy category: C; PB: 98%; t½: 9–12 h |
| prazosin HCl (Minipress) (alpha1) | A: PO: 1 mg b.i.d./t.i.d.; maint: 3–15 mg/d; max: 20 mg/d in divided doses | Management of mild to moderate hypertension. May be used in combination with other antihypertensive drugs. Pregnancy category: C; PB: 95%; t½: 3 h |
| terazosin HCl (Hytrin) (alpha1) | A: PO: 1 mg at bedtime, maint: 1–5 mg in 1–2 divided doses; max: 20 mg/d | For hypertension. May be used in combination with diuretic or other antihypertensive drugs. May also be used for BPH. May cause dizziness, headache, edema, orthostatic hypotension. Pregnancy category: C; PB: UK; t½: 9–12 h |
| carvedilol (Coreg) (alpha1, beta1, and beta2) | A: PO: 6.25 mg b.i.d.; may increase to 12.5 mg b.i.d.; max: 50 mg/d | For treatment of hypertension. Can be used alone or with a thiazide diuretic. Used also for mild to moderate heart failure. Pregnancy category: C; PB: UK; t½: 7- 10 h |
| labetalol (Normodyne, Trandate) (alpha1, beta1, and beta2) | A: PO: 100 mg b.i.d.; dose may be increased; max: 2.4 g/d; IV: 20 mg OR 1- 2 mg/kg; repeat 20–80 mg at 10-min interval; max: 300 mg/d | To treat mild to severe hypertension; angina pectoris; used during surgery to manage blood pressure. Pregnancy category: C; PB: 50%; t½: 6–8 h |
| carteolol HCl (Cartrol) (beta1 and beta2) | A: PO: 2.5-5.0 mg/d | For hypertension and glaucoma. Primarily blocks beta1 adrenergic receptor; however, in large doses blocks beta2. Pregnancy category: C; PB: 23%-30%; t1/2: 4–6 h |
| penbutolol (Levatol) (beta1 and beta2) | A: PO: 10–20 mg/d; max: 80 mg/d | To treat mild to moderate hypertension. Clients with asthma should avoid taking the drug. Pregnancy category: C; PB: 80%-98%; t1/2: 5 h |
| propranolol HCl (Inderal) (beta1 and beta2) | A: PO: Initially: 10–20 mg t.i.d.-q.i.d.; maint: 20–60 mg t.i.d.-q.i.d.; max: 320 mg/day; SR: 80–160 mg/day | Management of angina pectoris, myocardial infarction, hypertension, dysrhythmias, thyrotoxicosis. Pregnancy category: C; PB: 93%; t1/2: 2–4 h |
| nadolol (Corgard) (beta1 and beta2) | A: PO: 40–80 mg/d; max: 320 mg/d | Management of hypertension and angina pectoris. Contraindicated in bronchial asthma and severe COPD because it blocks beta2. Pregnancy category: C; PB: 30%; t1/2: 10–24 h |
| pindolol (Visken) Beta1 and beta2 | A: PO: 5 mg b.i.d./t.i.d.; maint: 10–30 mg in divided doses; max: 60 mg/d in divided doses | Management of hypertension and angina pectoris. Contraindicated in asthma, COPD, and second and thirddegree heart block. Pregnancy category: B; PB: 40%; t½: 3–4 h |
| sotalol (Betapace) Beta1 and beta2 | A: PO: 80 mg b.i.d.; may increase gradually. Average: 240–320 mg/d | To treat life-threatening ventricular arrhythmias and chronic angina pectoris. Pregnancy category: B; PB: 0; t½: 12 h |
| timolol maleate (Blocadren) Beta1 and beta2 | A: PO: Initially 10 mg b.i.d.; maint: 20–40 mg/d in 2 divided doses; max: 60 mg/d; Pregnancy category: C; PB: <10%; t½: 3–4 h | Management of mild to moderate hypertension, dysrhythmias, and postmyocardial infarction. Also may be used as prophylaxis of migraine headache. For ophthalmic use to treat IOP. Use with caution for clients with asthma or COPD. |
| metoprolol tartrate (Lopressor) Beta1 | Hypertension:A: PO: 50–100 mg/d in 1–2 divided doses; maint: 100–450 mg/d in divided doses; max: 450 mg/d in divided dosesMyocardial infarction:A: IV: 5 mg q2min 3 doses, then PO: 100 mg b.i.d | Management of hypertension, angina pectoris, postmyocardial infarction. Bradycardia, dizziness, and gastrointestinal distress may occur. Pregnancy category: C; PB: 12%; t½: 3–4 h |
| acebutolol HCl (Sectral) Beta1 | A: PO: Initially: 200–400 mg/dA: PO: maint; 200–800 mg/d in 1–2 divided doses; max: 1200 mg/d | Treatment for mild to moderate hypertension, anginapectoris, and supraventricular dysrhythmias. Check apical pulse; do not give if <60 bpm. Pregnancy category: B; PB: 26%; t½: 3–13 h |
| betaxolol (Kerlone) Beta1 | A: PO: 10–20 mg/d. Also for ophthalmic use: glaucoma | For hypertension and glaucoma. Ophthalmic preparation is used to decrease IOP. Pregnancy category: C; PB: UK; t½: 14–22 h |
| bisoprolol fumarate (Zebeta) Beta1 | A: PO: Initially: 5 mg/d; maint: 2.5-20 mg/d | For hypertension and angina pectoris. Long-acting beta blocker. Heart rate and blood pressure may be decreased. Pregnancy category: C; PB: <30%; t½: 9–12 h |
| esmolol HCl (Brevibloc) Beta1 | A: IV: Loading dose: 500 mcg/kg/min for 1 min; then 50 mcg/kg/min for 4 min | For treatment of supraventricular tachycardia, atrial fibrillation/flutter, and hypertension Contraindications: heart block, bradycardia, cardiogenic shock, uncompensated heart failure. Pregnancy category: C; PB: UK; t½: 9 min |
| atenolol (Tenormin) Beta1 | Hypertension:A: PO: 50–100 mg/dElderly: PO: 25–50 mg/dMyocardial infarction:A: IV: 5 mg q5min × 2: then 10 min after second dose 50 mg PO, then 50 mg PO 12 h later, then 50 mg bid for 6–9 d | To treat hypertension, angina pectoris, and myocardial infarction; Selectively blocks beta1-adrenergic receptor sites, decreases sympathetic outflow to the periphery, suppresses renin-angiotensin-aldosterone system |
| tolazoline (Priscoline HCl) (alpha1) | A: subQ/IM/IV: 10–50 mg q.i.d.Pulmonary hypertension: NB: IV: 1–2 mg/kg infused over 10 min, followed by 1–2 mg/kg/h for 24–48 h | For peripheral vascular disorder and persistent pulmonary hypertension in the newborn. Also for emergency hypertension. Pregnancy category: C; PB: UK; t½: 3–10 h |
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