Indications: hypertension, Prophylaxis of variceal bleeding in portal hypertension, Phaeochromocytoma, Angina, Arrhythmias, hypertrophic cardiomyopathy, anxiety tachycardia, and thyrotoxicosis (adjunct), Anxiety with symptoms such as palpitation, sweating, tremor, Prophylaxis after myocardial infarction, Essential tremor, Migraine prophylaxis, arrhythmias and thyrotoxic crisis.

Cautions: avoid abrupt withdrawal especially in ischaemic heart disease; first-degree AV block; portal hypertension (risk of deterioration in liver function); diabetes; history of obstructive airways disease (introduce cautiously and monitor lung function); myasthenia gravis; symptoms of hypoglycaemia and thyrotoxicosis may be masked, Psoriasis; history of hypersensitivity—may increase sensitivity to allergens and result in more serious hypersensitivity response, also may reduce response to adrenaline (epinephrine) ; verapamil.

Contra-indications: asthma, uncontrolled heart failure, Prinzmetal's angina, marked bradycardia, hypotension, sick sinus syndrome, second- or third- degree AV block, cardiogenic shock, metabolic acidosis, severe peripheral arterial disease; phaeochromocytoma, Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma or bronchospasm.

However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision.

Hepatic impairment: reduce oral dose.

Renal impairment: manufacturer advises caution—dose reduction may be required.

Side Effects: gastro-intestinal disturbances; bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction (including exacerbation of intermittent claudication and Raynaud's phenomenon); bronchospasm, dyspnea; headache, fatigue, sleep disturbances, paraesthesia, dizziness, vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia; visual disturbances; exacerbation of PSORIASIS, alopecia; rarely rashes and dry eyes (reversible on withdrawal).

Dose: By mouth, hypertension, initially 100 mg daily, increased if necessary to 200 mg daily in 1–2 divided doses; max. 400 mg daily (but high doses rarely necessary).

Angina, 50–100 mg 2–3 times daily Arrhythmias, usually 50 mg 2–3 times daily; up to 300 mg daily in divided doses if necessary.

Migraine prophylaxis, 100–200 mg daily in divided doses Hyperthyroidism (adjunct), 50 mg 4 times daily.

By intravenous injection, arrhythmias, up to 5 mg at rate 1–2 mg/minute, repeated after 5 minutes if necessary, total dose 10–15 mg.

Note : Excessive bradycardia can be countered with intravenous injection of atropine sulfate 0.6–2.4 mg in divided doses of 600 micrograms; for overdosage.

In surgery, by slow intravenous injection 2–4 mg at induction or to control arrhythmias developing during anaesthesia; 2-mg doses may be repeated to a max. of 10 mg.

Early intervention within 12 hours of infarction, by intravenous injection 5 mg every 2 minutes to a max. of 15 mg, followed after 15 minutes by 50 mg by mouth every 6 hours for 48 hours; maintenance 200 mg daily in divided doses.