Last Updated on August 19, 2026
Classification
• Selective vs non-selective Carvedilol https://www.myhouseman.my/carvedilol/ Therefore at high dose, all ß-blockerswill produce ß2-blockade effect; at low doses, can cause bronchospasm in asthma patients
• Vasodilating vs non-vasodilating
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• First generation (e.g. propranolol), Second generation (e.g. Acebutolol, Atenolol, Metoprolol, Bisoprolol, Esmolol), Third generation – vasodilating
• Third generation, ß1 selective (e.g. Nebivolol, Betaxolol)
• Third generation, non selective — ß1, ß2, α1 (e.g. Labetalol,
Carvedilol
• Selective — ß1 > ß2 (e.g. Atenolol, Metoprolol)
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No
Contraindications
Absolute contraindications
• Uncontrolled asthma
• Heart block 2nd degree & 3rd degree
• Severe peripheral vascular disease
Relative contraindications
• Controlled bronchial asthma / other forms of obstructive airways disease
Precaution
• Pregnancy
Adverse Effects
•
Dyslipidaemia
Non-selective ß-blockers cause increased triglycerides; reduced HDL
• Masking of hypoglycaemia
• Increased incidence of new onset DM
• Erectile dysfunction
• Cold peripheries
• Nightmares
Beta blockers in hypertension
• Can be used as single first line therapy especially in those who are post-MI / heart failure
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Benefits:
• Reduce cardiovascular mortality & morbidity in patients with stable angine / tachyarrhythmias / previous MI
• Certain beta-blockers beneficial in heart failure patients
Doses
ß-blocker | Starting dose | Recommended maximum daily dose | Remark |
Acebutolol | 200 mg BD | 1.2 g in divided dose | |
50 mg OD | 100 mg OD | ||
Betaxolol | 10 mg OD | 20 mg OD | |
5 mg OD | 20 mg OD | ||
Carvedilol
× Carvedilol Carvedilol https://www.myhouseman.my/carvedilol/ | 12.5 mg OD | 50 mg OD / in divided doses if necessary | • Different dosage for patients with heart failure / angina |
100 mg BD | 2400 mg per day in 2 - 4 divided doses | • α1, ß1, ß2 blocker | |
50 mg OD | 200 mg BD | ||
Nebivolol | 5 mg OD | 40 mg OD | |
40 mg BD | 320 mg BD |