BETA BLOCKER DOSING









Atenolol (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
  • May take without regard to food
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®)

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®)

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®)

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®)

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®)

Dosage forms

Tablet, extended-release
  • 25 mg
  • 50 mg
  • 100 mg
  • 200 mg

Dosing

Hypertension
  • 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
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

- YES/$

Other

  • Metoprolol is a selective beta blocker
  • Tablet may be cut in half
  • Tablet should not be crushed or chewed

Metoprolol tartrate IR (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®)

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®)

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®)

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®)

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)

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®)

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®)

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

Corzide® (nadolol + Bendroflumethiazide)

Dosage forms

Tablet
  • Nadolol - Bendroflumethiazide
    • 40 mg - 5 mg
    • 80 mg - 5 mg

Dosing

Hypertension
  • Starting: 40/5 mg once daily
  • Maintenance: 40/5 - 80/5 mg once daily
  • May take without regard to food

Generic / Price

- YES/$$

Dutoprol® (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)

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)

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)

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)

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/$

Byvalson® (nebivolol + valsartan)

Dosage forms

Tablet
  • Nebivolol - Valsartan
    • 5 mg - 80 mg

Dosing

Hypertension
  • Dosing: 5/80 mg once daily
  • Maximum effect occurs within 2 - 4 weeks
  • Increasing dose does not result in any meaningful further blood pressure reduction
  • May take without regard to food

Generic / Price

- NO/$$$







  • Reference: Manufacturer's PI
Beta blocker metabolism and clearance
Drug CYP1A2 CYP2C9 CYP2C19 CYP2D6 P-glycoprotein OCT2
Carvedilol - Substrate - Substrate Substrate and inhibitor -
Metoprolol - - - Substrate - -
Nebivolol - - - Substrate - -
Pindolol - - - - - Substrate
Propranolol Substrate - Substrate Substrate Substrate and inhibitor -
Timolol - - Minor substrate Major substrate - -
Atenolol Not well defined
Bisoprolol Not well defined
Labetalol Mainly metabolized through glucuronidation
Nadolol Not well defined



Pricing legend
  • $ = 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