Classifications: beta-adrenergic antagonist; antihypertensive; Therapeutic: antihypertensive
Pregnancy Category: C
20 mg tablets
Synthetic beta1- and beta2-adrenergic blocking agent which competes with epinephrine and norepinephrine for available beta receptor sites. Lowers
both supine and standing BP in hypertensive patients. Hypotensive effect is associated with decreased cardiac output, suppressed
renin activity as well as beta blockage.
Effective in lowering mild to moderate blood pressure.
Mild to moderate hypertension alone or with other antihypertensive agents.
Clients with cardiogenic shock, acute CHF, sinus bradycardia, second and third degree AV block; bronchial asthma, COPD;
hypersensitivity to the drug; pregnancy (category C).
Cardiac failure; chronic bronchitis; diabetes; mental depression; myasthenia gravis; renal disease; lactation. Safety and
effectiveness in children is not established.
Route & Dosage
Adult: PO 1020 mg daily, may increase to 4080 mg/d
- Discontinue by reducing the dose gradually over 1 to 2 wk.
Adverse Effects (≥1%)CNS:
, headache, insomnia
AV block, bradycardia. GI:
, dyspepsia. Respiratory:
and other hypotensive agents
increase hypotensive effect; effects of albuterol, metaproterenol, terbutaline, pirbuterol,
are antagonized; nsaid
s blunt hypotensive effect; decreases hypoglycemic effect of glyburide; amiodarone
increases risk of bradycardia and sinus arrest.
Readily from GI tract. Peak:
23 h. Duration:
20 h. Metabolism:
In liver. Elimination:
In urine. Half-Life:
Assessment & Drug Effects
- Take apical pulse before administering drug. If pulse is below 60, or other established parameter, hold the drug and contact
- Take a BP reading before giving drug, if BP is not stabilized. If systolic pressure is ≤90
mm Hg, hold drug and contact physician.
- Check BP near end of dosage interval or before administration of next dose to evaluate effectiveness.
- Monitor therapeutic effectiveness. Full effectiveness of the drug may not be seen for 46 wk.
- Watch for S&S of bronchial constriction. Report promptly and withhold drug.
- Monitor diabetics for loss of glycemic control. Drug suppresses clinical signs of hypoglycemia (e.g., BP changes, increased
pulse rate) and may prolong hypoglycemic state.
- Monitor carefully for exacerbation of angina during drug withdrawal.
Patient & Family Education
- Do not discontinue the drug without physician's advice because of the possible exacerbation of ischemic heart disease.
- If diabetic, report persistent S&S of hypoglycemia (see Appendix F) to physician (diabetics).
- Avoid driving or other potentially hazardous activities until response to drug is known.
- Make position changes slowly and avoid prolonged standing. Notify physician if dizziness and light-headedness persist.
- Comply with and do not alter established regimen (i.e., do not omit, increase, or decrease dosage or change dosage interval).
- Avoid prolonged exposure of extremities to cold.
- Avoid excesses of alcohol. Heavy alcohol consumption [i.e., >60 mL (2 oz)/d] may elevate arterial pressure; therefore, to
maintain treatment effectiveness, either avoid alcohol or drink moderately (<60 mL/d). Consult physician.