page122
ESMOLOL HYDROCHLORIDE
Indications
short-term treatment of supraventricular
arrhythmias (including atrial fibrillation,
atrial flutter,
sinus tachycardia); tachycardia and hypertension in
peri-operative period
Cautions
see under Propranolol Hydrochloride
Contra-indications
see under Propranolol Hydro-
chloride
Renal impairment
manufacturer advises caution
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see under Propranolol Hydrochloride;
also on infusion venous irritation and thrombophleb-
itis
Dose
. By intravenous infusion,
usually within range 50–
200 micrograms/kg/minute (consult product litera-
ture for details of dose titration and doses during peri-
operative period)
Brevibloc
c
(Baxter) A
Injection
, esmolol hydrochloride 10 mg/mL, net price
10-mL vial = £7.79,
250-mL infusion bag = £89.69
LABETALOL HYDROCHLORIDE
Indications
hypertension (including hypertension in
pregnancy,
hypertension with angina,
and hyper-
tension following acute myocardial infarction);
hypertensive crises (see section 2.5);
controlled
hypotension in anaesthesia
Cautions
see under Propranolol Hydrochloride;
inter-
feres with laboratory tests for catecholamines;
liver
damage (see below)
Liver damage
Severe hepatocellular damage reported after
both short-term and long-term treatment.
Appropriate
laboratory testing needed at first symptom of liver dys-
function and if laboratory evidence of damage (or if jaundice)
labetalol should be stopped and not restarted
Contra-indications
see under Propranolol Hydro-
chloride
Hepatic impairment
avoid—severe hepatocellular
injury reported
Renal impairment
dose reduction may be required
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
postural hypotension (avoid upright
position during and for 3 hours after intravenous
administration),
tiredness,
weakness, headache,
rashes,
scalp tingling,
difficulty in micturition, epi-
gastric pain,
nausea,
vomiting; liver damage (see
above); rarely lichenoid rash
Dose
. By mouth,
initially 100 mg (50 mg in elderly) twice
daily with food, increased at intervals of 14 days to
usual dose of 200 mg twice daily; up to 800 mg daily in
2 divided doses (3–4 divided doses if higher); max.
2.4 g daily
.
By intravenous injection, 50 mg over at least 1 minute,
repeated after 5 minutes if necessary; max. total dose
200 mg
Note
Excessive bradycardia can be countered with intra-
venous injection of atropine sulphate 0.6–2.4 mg in divided
doses of 600 micrograms; for overdosage see Emergency
Treatment of Poisoning,
p.
37
. By intravenous infusion,
2 mg/minute until satisfac-
tory response then discontinue;
usual total dose 50–
200 mg, (not recommended for phaeochromocytoma,
see under Phaeochromocytoma,
section 2.5.4)
Hypertension of pregnancy,
20 mg/hour,
doubled
every 30 minutes;
usual max.
160 mg/hour
Hypertension following myocardial infarction, 15 mg/
hour,
gradually increased to max.
120 mg/hour
Labetalol Hydrochloride
(Non-proprietary) A
Tablets
,
f/c,
labetalol hydrochloride 100 mg,
net
price,
56 = £7.85;
200 mg,
56 = £11.49;
400 mg,
56 =
£20.60.
Label:
8,
21
Trandate
c
(UCB Pharma) A
Tablets
, all orange, f/c, labetalol hydrochloride 50 mg,
net price 56-tab pack = £3.64; 100 mg, 56-tab pack =
£4.01;
200 mg,
56-tab pack = £6.51;
400 mg,
56-tab
pack = £9.05.
Label:
8,
21
Injection
, labetalol hydrochloride 5 mg/mL, net price
20-mL amp = £2.04
METOPROLOL TARTRATE
Indications
see under Dose
Cautions
see under Propranolol Hydrochloride
Contra-indications
see under Propranolol Hydro-
chloride
Hepatic impairment
reduce dose in severe impair-
ment
Pregnancy
see notes above
Breast-feeding
see notes above
Side-effects
see under Propranolol Hydrochloride
Dose
. By mouth,
hypertension,
initially 100 mg daily,
increased if necessary to 200 mg daily in 1–2 divided
doses;
max.
400 mg daily (but high doses rarely
necessary)
Angina,
50–100 mg 2–3 times daily
Arrhythmias,
usually 50 mg 2–3 times daily; up to
300 mg daily in divided doses if necessary
Migraine prophylaxis,
100–200 mg daily in divided
doses
Hyperthyroidism (adjunct),
50 mg 4 times daily
. By intravenous injection,
arrhythmias,
up to 5 mg at
rate 1–2 mg/minute,
repeated after 5 minutes if
necessary,
total dose 10–15 mg
Note
Excessive bradycardia can be countered with intra-
venous injection
of atropine sulphate 0.6–2.4 mg in divided
doses of 600 micrograms; for overdosage see Emergency
Treatment of Poisoning,
p.
37
In surgery,
by slow intravenous injection 2–4 mg at
induction or to control arrhythmias developing during
anaesthesia; 2-mg doses may be repeated to a max. of
10 mg
Early intervention within 12 hours of infarction,
by
intravenous injection 5 mg every 2 minutes to a max.
of 15 mg,
followed after 15 minutes by 50 mg by
mouth every 6 hours for 48 hours;
maintenance
200 mg daily in divided doses
Metoprolol Tartrate
(Non-proprietary) A
Tablets
,
metoprolol tartrate 50 mg,
net price 28 =
£1.31,
56 = £1.74;
100 mg,
28 = £1.59,
56 = £2.51.
Label:
8
Betaloc
c
(AstraZeneca) A
Injection
,
metoprolol tartrate 1 mg/mL,
net price 5-
mL amp = 42p
Lopresor
c
(Novartis) A
Tablets
, f/c, scored, metoprolol tartrate 50 mg (pink),
net price 56-tab pack = £2.57;
100 mg (blue),
56-tab
pack = £6.68.
Label:
8
102
2.4 Beta-adrenoceptor blocking drugs
BNF 61
2
Cardiovascular system