Acronyms
- AHA - American Heart Association
- ARB - Angiotensin II receptor blockers
- BB - Beta blocker
- ER - Extended release
- HCTZ - Hydrochlorothiazide
- IR - Immediate release
- P - medications with approved pediatric dosing
Atenolol
Tenormin®
Tenormin®
Dosage forms
Tablet
- 25 mg
- 50 mg
- 100 mg
Dosing
Hypertension
- Starting: 50 mg once daily
- Maintenance: 50 - 100 mg once daily
- Max: 100 mg once daily
- Increase dose at intervals of 1 - 2 weeks
Angina
- Starting: 50 mg once daily
- Maintenance: 50 - 100 mg once daily
- Max: 200 mg once daily
- Increase dose at intervals of 1 - 2 weeks
- May take without regard to food
Migraine prevention (off-label)
- 50 - 100 mg/day
- May take without regard to food
Kidney disease
- CrCl 15 - 35 ml/min - maximum dose 50 mg once daily
- CrCl < 15 ml/min - maximum dose 25 mg once daily
Liver disease
- Manufacturer makes no specific dosage recommendations
- Atenolol undergoes little or no liver metabolism
Generic / Price
- YES/$
Other
- Atenolol is a selective beta blocker
- Full blood pressure effect seen in 1 - 2 weeks
Bisoprolol
Zebeta®
Zebeta®
Dosage forms
Tablet
- 5 mg
- 10 mg
Dosing
Hypertension
- Starting: 5 mg once daily
- Maintenance: 5 - 20 mg once daily
- Max: 20 mg once daily
- May take without regard to food
Heart failure (off-label)
- Starting: 1.25 mg once daily
- Target: 10 mg once daily
- In the CIBIS II trial, bisoprolol was started at 1.25 mg once daily, and the dose was increased by 1.25 mg/week for 3 weeks. 5 mg and 7.5 mg doses were given for 4 weeks each before reaching a target of 10 mg.
- While bisoprolol is not FDA-approved to treat heart failure, it is one of three beta blockers recommended by the AHA for heart failure because of the CIBIS II results.
- May take without regard to food
Kidney disease
- CrCl < 40 ml/min - the initial dose should be 2.5 mg once daily
- Dosage increases should be done with caution
Liver disease
- For patients with significant liver disease, the initial dose should be 2.5 mg once daily
- Dosage increases should be done with caution
Generic / Price
- YES/$
Other
- Bisoprolol is a selective beta blocker
- Starting dose of 2.5 mg once daily may be appropriate in patients with asthma or COPD
Carvedilol IR
Coreg®
Coreg®
Dosage forms
Tablet
- 3.125 mg
- 6.25 mg
- 12.5 mg
- 25 mg
Dosing
Hypertension
- Starting: 6.25 mg twice a day
- Maintenance: 6.25 - 25 mg twice a day
- Max: 25 mg twice a day
- Increase dose at intervals of 7 - 14 days
- Take with food to slow the rate of absorption and decrease the risk of orthostatic effects
Heart failure
- Starting: 3.125 mg twice a day for 2 weeks
- Maintenance: 6.25 - 25 mg twice a day
- Max: 25 mg twice a day
- Increase dose at intervals of 2 weeks
- Take with food to slow the rate of absorption and decrease the risk of orthostatic effects
Kidney disease
- Carvedilol levels are increased 40 - 50% in patients with moderate to severe kidney disease. Changes in mean peak plasma levels are less pronounced, approximately 12% to 26% higher. Manufacturer makes no specific recommendation.
Liver disease
- Carvedilol is contraindicated in patients with severe hepatic impairment (Child-Pugh C)
Generic / Price
- YES/$
Other
- Carvedilol is a nonselective beta blockers with alpha-1 blocking activity
- Coreg® PI states that doses of 50 mg twice a day have been used in heart failure patients weighing > 187 pounds (85kg)
Carvedilol ER
Coreg CR®
Coreg CR®
Dosage forms
Capsule, extended release
- 10 mg
- 20 mg
- 40 mg
- 80 mg
Dosing
Hypertension
- Starting: 20 mg once daily
- Maintenance: 20 - 80 mg once daily
- Max: 80 mg once daily
- Increase dose at intervals of 7 - 14 days
- Take with food
- Capsule may be opened and sprinkled over applesauce
Heart failure
- Starting: 10 mg once daily for 2 weeks
- Maintenance: 20 - 80 mg once daily
- Max: 80 mg once daily
- Increase dose at intervals of 2 weeks
- Take with food
- Capsule may be opened and sprinkled over applesauce
Kidney disease
- Carvedilol levels are increased 40 - 50% in patients with moderate to severe kidney disease. Changes in mean peak plasma levels are less pronounced, approximately 12% to 26% higher. Manufacturer makes no specific recommendation.
Liver disease
- Carvedilol is contraindicated in patients with severe hepatic impairment (Child-Pugh C)
| Coreg® to Coreg CR® conversion | |
|---|---|
| Coreg® | Coreg CR® |
| 3.125 mg twice daily | 10 mg once daily |
| 6.25 mg twice daily | 20 mg once daily |
| 12.5 mg twice daily | 40 mg once daily |
| 25 mg twice daily | 80 mg once daily |
Generic / Price
- YES/$$
Other
- Carvedilol is a nonselective beta blockers with alpha-1 blocking activity
Labetalol
Trandate®
Trandate®
Dosage forms
Tablet
- 100 mg
- 200 mg
- 300 mg
Dosing
Hypertension
- Starting: 100 mg twice a day
- Maintenance: 200 - 400 mg twice a day
- Max: 1200 - 2400 mg/day
- Increase dose in increments of 100 mg/dose at intervals of 2 - 3 days
- May take without regard to food. Food increases absorption.
Kidney disease
- In patients with decreased renal function, the elimination half-life of labetalol is not altered
Liver disease
- In patients with decreased hepatic function, the elimination half-life of labetalol is not altered; however, the relative bioavailability in hepatically-impaired patients is increased due to decreased first-pass metabolism
Generic / Price
- YES/$
Other
- Labetalol is a nonselective beta blockers with alpha-1 blocking activity
- Full antihypertensive effect seen within 1 - 3 hours after initial dose
Metoprolol succinate ER
Toprol-XL®, Kaspargo Sprinkle®
Toprol-XL®, Kaspargo Sprinkle®
Dosage forms
Tablet, extended-release
- 25 mg
- 50 mg
- 100 mg
- 200 mg
Capsule, extended-release (Kapspargo®)
- 25 mg
- 50 mg
- 100 mg
- 200 mg
Dosing
Hypertension (adults)
- Starting: 25 - 100 mg once daily
- Maintenance: 100 - 400 mg once daily
- Max: 400 mg once daily
- Increase dose at intervals of 1 week
- Take with or immediately following a meal
Hypertension (children ≥ 6 years)
- Starting: 1 mg/kg once daily (maximum 50 mg/day)
- Maintenance: 1 - 2 mg/kg once daily
- Max: 2 mg/kg once daily (maximum 200 mg/day)
- Increase dose at intervals of 1 week
- Take with or immediately following a meal
Heart failure
- Starting: 25 once daily for 2 weeks
- Maintenance: 100 - 200 mg once daily
- Max: 200 mg once daily
- Increase dose at intervals of 2 weeks
- Patients with NYHA class III or IV heart failure should use a starting dose of 12.5 mg once daily
- Take with or immediately following a meal.
Angina
- Starting: 100 mg once daily
- Maintenance: 100 - 400 mg once daily
- Max: 400 mg once daily
- Increase dose at intervals of 1 week
- Take with or immediately following a meal
Migraine prevention (off-label)
- 150 - 200 mg/day
- Titrate dose over several weeks
- Take with or immediately following a meal
Kidney disease
- No dosage adjustment is necessary in kidney disease
Liver disease
- Blood levels are likely to be increased. Start therapy at lower doses and increase gradually.
Generic / Price
- Tablet: YES/$
- Capsule: NO/$$-$$$
Other
- Metoprolol is a selective beta blocker
- Tablet may be cut in half but should not be crushed or chewed
- Capsule may be opened and sprinkled on soft food
Metoprolol tartrate IR
Lopressor®
Lopressor®
Dosage forms
Tablet
- 25 mg
- 50 mg
- 100 mg
Dosing
Hypertension
- Starting: 100 mg a day
- Maintenance: 100 - 450 mg a day
- Max: 450 mg a day
- May give in one or two divided doses
- Increase dose at intervals of 1 week
- Take with or immediately following a meal
Angina
- Starting: 50 mg twice a day
- Maintenance: 50 - 200 mg twice a day
- Max: 400 mg a day
- Increase dose at intervals of 1 week
- Take with or immediately following a meal
Migraine prevention (off-label)
- 150 - 200 mg/day
- Titrate dose over several weeks
- Take with or immediately following a meal
Kidney disease
- No dosage adjustment is necessary in kidney disease
Liver disease
- Blood levels are likely to be increased. Start therapy at lower doses and increase gradually.
Generic / Price
- YES/$
Other
- Metoprolol is a selective beta blocker
- Beta-1 selectivity decreases as dose increases
- At lower doses (100 mg a day), twice a day dosing may be necessary to maintain 24-hour effect
Nadolol
Corgard®
Corgard®
Dosage forms
Tablet
- 20 mg
- 40 mg
- 80 mg
Dosing
Hypertension
- Starting: 40 mg once daily
- Maintenance: 40 - 80 mg once daily
- Max: 320 mg once daily
- May take without regard to food
Angina
- Starting: 40 mg once daily
- Maintenance: 40 - 80 mg once daily
- Max: 240 mg once daily
- Increase dose at intervals of 3 - 7 days
- May take without regard to food
Migraine prevention (off-label)
- 40 - 80 mg/day
- May take without regard to food
Kidney disease
- CrCl > 50 ml/min: dosage interval is 24 hours
- CrCl 31 - 50 ml/min: dosage interval is 24 - 36 hours
- CrCl 10 - 30 ml/min: dosage interval is 24 - 48 hours
- CrCl < 10 ml/min: dosage interval is 40 - 60 hours
Liver disease
- Nadolol is not metabolized by the liver and is excreted unchanged by the kidneys. Liver disease by itself would not be expected to affect nadolol clearance.
Generic / Price
- YES/$
Other
- Nadolol is a nonselective beta blocker
Nebivolol
Bystolic®
Bystolic®
Dosage forms
Tablet
- 2.5 mg
- 5 mg
- 10 mg
- 20 mg
Dosing
Hypertension
- Starting: 5 mg once daily
- Maintenance: 5 - 40 mg once daily
- Max: 40 mg once daily
- Increase dose at intervals of 2 weeks
- May take without regard to food
Kidney disease
- CrCl < 30 ml/min: recommended starting dose is 2.5 mg once a day; titrate slowly as needed
Liver disease
- Child-Pugh B: recommended starting dose is 2.5 mg once a day; titrate slowly as needed
- Child-Pugh C: not recommended
Generic / Price
- YES/$
Other
- Nebivolol is a selective beta blocker
Pindolol
Visken®
Visken®
Dosage forms
Tablet
- 5 mg
- 10 mg
Dosing
Hypertension
- Starting: 5 mg twice a day
- Maintenance: 5 - 30 mg twice a day
- Max: 60 mg a day
- Increase dose in increments of 10 mg/day every 2 - 4 weeks
- May take without regard to food
Kidney disease
- Poor renal function has only minor effects on pindolol clearance
- CrCL < 20 ml/min: clearance is significantly reduced. Use caution.
Liver disease
- Poor hepatic function may cause blood levels of pindolol to increase substantially. Use caution.
Generic / Price
- YES/$
Other
- Pindolol is a beta blocker with intrinsic sympathomimetic activity (ISA)
Propranolol IR
Inderal®
Inderal®
Dosage forms
Tablet
- 10 mg
- 20 mg
- 40 mg
- 60 mg
- 80 mg
Dosing
Hypertension
- Starting: 40 mg twice a day
- Maintenance: 60 - 120 mg twice a day
- Max: 640 mg a day
- May take without regard to food
Angina
- Dosing: 80 - 320 mg a day given in 2 - 4 divided doses
- May take without regard to food
Atrial fibrillation
- Dosing: 10 - 30 mg three to four times a day before meals and at bedtime
- May take without regard to food
Migraine prevention
- Starting: 80 mg a day
- Maintenance: 160 - 240 mg a day
- Give in 2 - 3 divided doses
- May take without regard to food
Essential tremor
- Starting: 40 mg twice a day
- Maintenance: 60 mg twice a day
- Max: 320 mg a day
- May take without regard to food
Kidney disease
- Use caution. Clearance is decreased.
Liver disease
- Propranolol is extensively metabolized by the liver. Use caution. Clearance is decreased.
Generic / Price
- YES/$
Other
- Propranolol is a nonselective beta blocker
- In hypertension, lower doses may achieve better control with 3-times-a-day dosing
Propranolol ER
Inderal® LA
Inderal® LA
Dosage forms
Capsule, extended-release
- 60 mg
- 80 mg
- 120 mg
- 160 mg
Dosing
Hypertension
- Starting: 80 mg once daily
- Maintenance: 120 - 160 mg once daily
- Max: 640 mg once daily
- May take without regard to food
Angina
- Starting: 80 mg once daily
- Maintenance: 160 mg once daily
- Max: 320 mg once daily
- Increase dose at 3 - 7 day intervals
- May take without regard to food
Migraine prevention
- Starting: 80 mg once daily
- Maintenance: 160 - 240 mg once daily
- May take without regard to food
Kidney disease
- Use caution. Clearance is decreased.
Liver disease
- Propranolol is extensively metabolized by the liver. Use caution. Clearance is decreased.
Generic / Price
- YES/$
Other
- Propranolol is a nonselective beta blocker
Propranolol ER
Innopran XL®
Innopran XL®
Dosage forms
Capsule, extended-release
- 80 mg
- 120 mg
Dosing
Hypertension
- Starting: 80 mg once daily at bedtime
- Maintenance: 80 - 120 mg once daily at bedtime
- Max: 120 mg once daily
- Take consistently either on an empty stomach or with food
Kidney disease
- Exposure is increased. Start with 80 mg once daily and monitor for marked bradycardia and hypotension.
Liver disease
- Exposure is increased. Start with 80 mg once daily and monitor for marked bradycardia and hypotension.
Generic / Price
- NO/$$$$
Other
- Propranolol is a nonselective beta blocker
- Cannot be substituted for Inderal LA®
- Full antihypertensive effect achieved in 2 - 3 weeks
Timolol
Blocadren®
Blocadren®
Dosage forms
Tablet
- 5 mg
- 10 mg
- 20 mg
Dosing
Hypertension
- Starting: 10 mg twice a day
- Maintenance: 10 - 20 mg twice a day
- Maximum: 30 mg twice a day
- Increase dose at intervals of ≥ 7 days
- May take without regard to food
Myocardial infarction
- Dosing: 10 mg twice a day
- May take without regard to food
Migraine prevention
- Starting: 10 mg twice a day
- Maintenance: 10 - 30 mg a day
- Daily doses of 10 and 20 mg may be given once daily
- 30 mg dose should be given in divided doses
- May take without regard to food
Kidney disease
- Clearance is decreased. Use caution.
Liver disease
- Clearance is decreased. Use caution.
Generic / Price
- YES/$-$$
Other
- Timolol is a nonselective beta blocker
Dutoprol®
Metoprolol succinate ER + HCTZ
Metoprolol succinate ER + HCTZ
Dosage forms
Tablet
- Metoprolol - HCTZ
- 25 mg - 12.5 mg
- 50 mg - 12.5 mg
- 100 mg - 12.5 mg
Dosing
Hypertension
- Starting: 25 mg/12.5 mg once daily
- Maintenance: 25 mg/12.5 mg - 200 mg/25 mg once daily
- Max: 200 mg/25 mg once daily
- Increase dose at intervals of 2 weeks
- May take without regard to food
Generic / Price
- NO/$$$$
Inderide®
Propranolol IR + HCTZ
Propranolol IR + HCTZ
Dosage forms
Tablet
- Propranolol - HCTZ
- 40 mg - 25 mg
- 80 mg - 25 mg
Dosing
Hypertension
- Starting: 40 mg/25 mg twice a day
- Maintenance: 40 mg/25 mg - 80 mg/25 mg twice a day
- Max: 80 mg/25 mg twice a day
- May take without regard to food
Generic / Price
- YES/$
Lopressor HCT®
Metoprolol tartrate IR + HCTZ
Metoprolol tartrate IR + HCTZ
Dosage forms
Tablet
- Metoprolol - HCTZ
- 50 mg - 25 mg
- 100 mg - 25 mg
- 100 mg - 50 mg
Dosing
Hypertension
- Dosing: Metoprolol may be dosed up to 200 mg/day. HCTZ may be dosed up to 50 mg/day. Daily dose may be given once daily or divided and given twice a day.
- Metoprolol doses of ≤ 100 mg/day may be more effective if given in divided doses
- Take with or immediately following a meal
Generic / Price
- YES/$
Tenoretic®
Atenolol + chlorthalidone
Atenolol + chlorthalidone
Dosage forms
Tablet
- Atenolol - Chlorthalidone
- 50 mg - 25 mg
- 100 mg - 25 mg
Dosing
Hypertension
- Starting: 50 mg/25 mg once daily
- Maintenance: 50 mg/25 mg - 100 mg/25 mg once daily
- May take without regard to food
Generic / Price
- YES/$
Ziac®
Bisoprolol + HCTZ
Bisoprolol + HCTZ
Dosage forms
Tablet
- Bisoprolol - HCTZ
- 2.5 mg - 6.25 mg
- 5 mg - 6.25 mg
- 10 mg - 6.25 mg
Dosing
Hypertension
- Starting: 2.5 mg/6.25 mg once daily
- Maintenance: 2.5 mg/6.25 mg - 20 mg/12.5 mg once daily
- Max: 20 mg/12.5 mg once daily
- Titrate dose at intervals of 14 days
- May take without regard to food
Generic / Price
- YES/$
- Kidney disease dosing
- Atenolol (Tenormin®)
- CrCl 15 - 35 ml/min - Maximum dose 50 mg a day
- CrCl < 15 ml/min - Maximum dose 25 mg a day
- Bisoprolol (Zebeta®)
- CrCl < 40 ml/min - the initial dose should be 2.5 mg a day
- Dosage increases should be done with caution
- Carvedilol (Coreg®, Coreg® CR)
- Carvedilol levels are increased 40 - 50% in patients with moderate to severe kidney disease. Changes in mean peak plasma levels are less pronounced, approximately 12% to 26% higher. Manufacturer makes no specific recommendation.
- Labetalol (Trandate®)
- Manufacturer makes no specific dosage recommendations
- Metoprolol (Toprol®, Lopressor®)
- No dosage adjustment is necessary in kidney disease
- Nadolol (Corgard®)
- CrCl > 50 ml/min: dosage interval is 24 hours
- CrCl 31 - 50 ml/min: dosage interval is 24 - 36 hours
- CrCl 10 - 30 ml/min: dosage interval is 24 - 48 hours
- CrCl < 10 ml/min: dosage interval is 40 - 60 hours
- Nebivolol (Bystolic®)
- CrCl < 30 ml/min: recommended starting dose is 2.5 mg once a day; titrate slowly as needed
- Pindolol (Visken®)
- Poor renal function has only minor effects on pindolol clearance
- CrCL < 20 ml/min: clearance is significantly reduced. Use caution.
- Propranolol (Inderal®)
- Use caution. Clearance is decreased.
- Propranolol (Inderal® LA)
- Use caution. Clearance is decreased.
- Propranolol (Innopran® XL)
- Exposure is increased. Start with 80 mg once daily and monitor for marked bradycardia and hypotension.
- Timolol (Blocadren®)
- Clearance is decreased. Use caution.
- Liver disease dosing
- Atenolol (Tenormin®)
- Manufacturer makes no specific dosage recommendations
- Atenolol undergoes little or no liver metabolism
- Bisoprolol (Zebeta®)
- For patients with significant liver disease, the initial dose should be 2.5 mg a day
- Dosage increases should be done with caution
- Carvedilol (Coreg®)
- Carvedilol is contraindicated in patients with severe hepatic impairment (Child-Pugh > B)
- Labetalol (Trandate®)
- Labetalol should be used with caution
- Manufacturer makes no specific dosage recommendations
- Metoprolol (Toprol®, Lopressor®)
- Blood levels are likely to be increased. Start therapy at lower doses and increase gradually.
- Nadolol (Corgard®)
- Nadolol is not metabolized by the liver and is excreted unchanged by the kidneys. Liver disease by itself would not be expected to affect nadolol clearance.
- Nebivolol (Bystolic®)
- Child-Pugh B: recommended starting dose is 2.5 mg once a day; titrate slowly as needed
- Child-Pugh C: not recommended
- Pindolol (Visken®)
- Poor hepatic function may cause blood levels of pindolol to increase substantially. Use caution.
- Propranolol (Inderal®)
- Propranolol is extensively metabolized by the liver. Use caution. Clearance is decreased.
- Propranolol (Inderal® LA)
- Propranolol is extensively metabolized by the liver. Use caution. Clearance is decreased.
- Propranolol (Innopran® XL)
- Exposure is increased. Start with 80 mg once daily and monitor for marked bradycardia and hypotension.
- Timolol (Blocadren®)
- Clearance is decreased. Use caution.
DRUG INTERACTIONS
- NOTE: The drug interactions presented here are NOT all-inclusive. Other interactions may exist. Drug interaction checkers provide the most efficient and practical way to check for interactions among multiple medications. A free interaction checker is available from Drugs.com (see Drugs.com interactions checker).
- All beta blockers
- Catecholamine depleting drugs - concomitant use of catecholamine-depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) may increase the risk of hypotension and bradycardia
- Clonidine (Catapres®) - abruptly stopping clonidine in patients taking beta blockers can lead to severe rebound hypertension. During coadministration, if clonidine is to be discontinued, stop the beta blocker several days before clonidine is withdrawn, and taper clonidine over 2 - 4 days.
- Medications that slow the heart rate - beta blockers slow the heart rate and use with other heart rate-slowing medications can increase the risk of bradycardia and syncope.
- Common medications that slow the heart rate
- Amiodarone (Cordarone®)
- Calcium channel blockers (diltiazem and verapamil)
- Clonidine (Catapres®)
- Digoxin (Lanoxin®)
- Fingolimod (Gilenya®)
- Ivabradine (Corlanor®)
- Siponimod (Mayzent®)
- Sulfonylureas (glimepiride, glipizide, Glucotrol®, etc.) - beta blockers may potentiate the effect of sulfonylureas. Monitor blood sugars when adding a beta blocker to a sulfonylurea. [95]
- Carvedilol (Coreg®)
- Cyclosporine (Neoral®) - carvedilol may increase cyclosporine exposure [13]
- CYP2D6 inhibitors - carvedilol is a CYP2D6 sensitive substrate, and CYP2D6 inhibitors may increase its exposure
- CYP2D6 poor metabolizers - carvedilol is a CYP2D6 sensitive substrate, and CYP2D6 poor metabolizers may have increased carvedilol exposure
- Labetalol (Trandate®)
- Cimetidine (Tagamet®) - cimetidine may increase labetalol exposure [86]
- Metoprolol (Toprol®, Lopressor®)
- CYP2D6 inhibitors - metoprolol is a CYP2D6 sensitive substrate, and CYP2D6 strong inhibitors have been shown to double its exposure. The effects of moderate and weak inhibitors have not been studied, but they also likely increase its exposure. Use caution during coadministration and be aware that high metoprolol concentrations decrease its cardioselectivity.
- CYP2D6 poor metabolizers - metoprolol is a CYP2D6 sensitive substrate, and poor CYP2D6 metabolizers may have increased exposure.
- Nebivolol (Bystolic®)
- CYP2D6 inhibitors - nebivolol is a CYP2D6 substrate, and CYP2D6 inhibitors may increase increase its exposure
- Pindolol (Visken®)
- Thioridazine (Mellaril®) - thioridazine may increase pindolol exposure and vice versa [85]
- Propranolol (Inderal®)
- Bile Acid Sequestrants (Questran®, etc.) - bile acid sequestrants may decrease propranolol absorption. Take propranolol at least one hour before or four hours after bile acid sequestrants. [87]
- CYP2D6 substrates and inhibitors - propranolol is a CYP2D6 substrate, and CYP2D6 inhibitors and substrates may increase its exposure
- CYP1A2 substrates, inducers, and inhibitors - propranolol is a CYP1A2 substrate, and CYP1A2 substrates, inducers, and inhibitors may alter its exposure
- CYP2C19 substrates and inhibitors - propranolol is a CYP2C19 substrate, and CYP2C19 inhibitors and substrates may increase its exposure
- Rizatriptan (Maxalt®) - propranolol increases rizatriptan exposure. See rizatriptan for dosing recommendations.
- Warfarin (Coumadin®) - propranolol may increase warfarin exposure. Monitor INR levels when adding propranolol to warfarin.
- Zileuton (Zyflo®) - zileuton may increase propranolol exposure
- Timolol (Blocadren®)
- CYP2D6 strong inhibitors - timolol is a CYP2D6 sensitive substrate, and CYP2D6 inhibitors may increase its exposure
- Metabolism and clearance
- Atenolol
- Not well defined
- Bisoprolol
- Not well defined
- Carvedilol
- CYP2D6 - Major substrate
- CYP2C9 - Minor substrate
- P-glycoprotein - Substrate and inhibitor
- Labetalol
- Mainly metabolized through glucuronidation
- Metoprolol
- CYP2D6 - Major substrate
- Nadolol
- Not well defined
- Nebivolol
- CYP2D6 - Substrate
- Pindolol
- OCT2 - Substrate
- Propranolol
- CYP1A2 - Substrate
- CYP2C19 - Substrate
- CYP2D6 - Substrate
- P-glycoprotein - Substrate and inhibitor
- Timolol
PRICE ($) INFO
- $ = 0 - $50
- $$ = $51 - $100
- $$$ = $101 - $150
- $$$$ = > $151
- Pricing based on one month of therapy at standard dosing in an adult
- Pricing based on information from GoodRX.com®
- Pricing may vary by region and availability
BIBLIOGRAPHY
- Manufacturer's PI