Indications

Hypertension, Angina pectoris, Adjunct in hyperthyroidism, Stable symptomatic heart failure, Prophylaxis or control of arrhythmias on induction of anaesthesia

Contraindication

2nd or 3rd degree AV block, sick sinus syndrome, hypotension, decompensated heart failure, sinus bradycardia, severe peripheral arterial circulatory disorders, cardiogenic shock, severe asthma and bronchospasm, untreated phaeochromocytoma, Prinzmetal's angina, metabolic acidosis.

Special Precautions

Patients w/ myasthenia gravis, well-compensated heart failure, bronchospastic disease, AV conduction disorders, substantial cardiomegaly. May mask signs and symptoms of hyperthyroidism and hypoglycaemia. Patients w/ history of cardiac failure or those w/ minimal cardiac reserve. Patients undergoing major surgery involving general anaesth. Avoid abrupt withdrawal as it may precipitate thyroid storm or MI, and may exacerbate angina and ventricular arrhythmias. Hepatic impairment. Pregnancy and lactation. Patient Counselling May affect ability to drive or operate machinery. Monitoring Parameters Monitor BP, ECG and heart rate.

Side Effects

Dizziness, insomnia, tiredness, headache, vertigo, confusion, bradycardia, shortness of breath, hypotension, Raynaud's phenomenon, CHF, peripheral oedema, cold extremities, syncope, chest pain, palpitations, gangrene, claudication, hallucinations, nightmares, visual disturbances; diarrhoea, constipation, flatulence, GI pain, heartburn, nausea, hiccups, xerostomia; bronchoconstriction, wheezing, dyspnoea; dry skin, maculopapular, psoriasiform, pruritus, worsening of psoriasis, urticarial rash. Rarely, Peyronie's disease, tinnitus, restless legs, musculoskeletal pain, a polymyalgia-like syndrome, decreased libido, blurred vision, dry mucous membranes, sweating; reversible alopecia, thrombocytopenia, agranulocytosis, retroperitoneal fibrosis, wt gain, arthritis, dry eyes.

Drug Interactions

Additive effect w/ catecholamine-depleting drugs (e.g. reserpine) and MAOIs. May antagonise β1-adrenergic stimulating effects of sympathomimetics. Additive negative effects on SA or AV nodal conduction w/ cardiac glycosides, nondihydropyridine Ca channel blockers. Paradoxical response to epinephrine may occur. Increased plasma concentrations w/ CYP2D6 inhibitors (e.g. bupropion, cimetidine). Increased risk of hypotension and heart failure w/ myocardial depressant general anaesth (e.g. diethyl ether). Risk of pulmonary HTN w/ vasodilators (e.g. hydralazine) in uraemic patients. Reduced plasma levels w/ rifampicin. May increase negative inotropic and negative dromotropic effect of antiarrhythmic drugs (e.g. quinidine, amiodarone). May reduce antihypertensive efficacy w/ indometacin. May increase effects of hypoglycaemics.

Route of Administration

Oral

Dosage

As directed by the physician