Beta-adrenergic Blockers (β-blockers)
PREGNANCY CATEGORY C (MOST)
PREGNANCY CATEGORY D (ATENOLOL)
PREGNANCY CATEGORY B (ACEBUTOLOL, PINDOLOL, SOTALOL)
Therapeutic Actions
Beta-adrenergic blockers are antianginals, antiarrhythmics, and antihypertensives. These drugs competitively block beta-adrenergic receptors in the heart and juxtaglomerular apparatus. They decrease the influence of the sympathetic nervous system on these tissues, the excitability of the heart, cardiac workload, oxygen consumption, and the release of renin; they lower BP. They have membrane-stabilizing (local anesthetic) effects that contribute to their antiarrhythmic action. They also act in the CNS to reduce sympathetic outflow and vasoconstrictor tone.
Indications
Hypertension (alone or with other drugs, especially diuretics)
Angina pectoris caused by coronary atherosclerosis
Hypertrophic subaortic stenosis, to manage associated stress-induced angina, palpitations, and syncope; cardiac arrhythmias, especially supraventricular tachycardia, and ventricular tachycardias induced by digoxin or catecholamines; essential tremor, familial or hereditary
Prevention of reinfarction in clinically stable patients when started 1–4 wk after MI
Adjunctive therapy for pheochromocytoma after treatment with an alpha-adrenergic blocker, to manage tachycardia before or during surgery or if the pheochromocytoma is inoperable
Prophylaxis for migraine headache (propranolol)
Management of acute situational stress reaction (stage fright); essential tremor (propranolol)
Unlabeled uses: Treatment of recurrent GI bleeding in cirrhotic patients, schizophrenia, tardive dyskinesia, acute panic symptoms, vaginal contraceptive, acute alcohol withdrawal
Contraindications and Cautions
Contraindicated with allergy to beta-adrenergic blockers, sinus bradycardia, second- or third-degree heart block, cardiogenic shock, heart failure, bronchial asthma, bronchospasm, COPD, pregnancy (neonatal bradycardia, hypoglycemia, and apnea have occurred in infants whose mothers received propranolol; low birth weight occurs with chronic maternal use during pregnancy), or lactation.
Use cautiously with hypoglycemia and diabetes, thyrotoxicosis, hepatic impairment.
Adverse Effects
Allergic reactions: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm, respiratory distress
CV: Bradycardia, heart failure, cardiac arrhythmias, sinoatrial or AV nodal block, tachycardia, peripheral vascular insufficiency, claudication, stroke, pulmonary edema, hypotension
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