Beta Blockers: medications in this class

Overview

Beta blockers block the effect of adrenaline on the heart, slowing the rate and reducing the force of contraction. For heart failure and after a heart attack they improve survival; for angina they reduce the heart’s oxygen demand; for atrial fibrillation they control the rate. Propranolol is also approved for migraine prevention and essential tremor, and it is sometimes prescribed for situational or performance anxiety, which is not an FDA-approved use, so the prescriber decides.

They are no longer a first choice for high blood pressure alone, but they remain essential where there is heart disease. Metoprolol, carvedilol and bisoprolol have the heart failure evidence; atenolol and propranolol are older options. The class should not be stopped suddenly after long use, because rebound can cause angina or a rhythm disturbance.

Fatigue, cold hands, slow pulse, dizziness and, in asthma, bronchospasm are the things to watch. They can mask the warning signs of low blood sugar in people with diabetes.

How the drugs in this class differ when you pay cash

The tablets are available as generics, but the forms are not interchangeable: metoprolol tartrate (twice daily) and metoprolol succinate extended-release (once daily) are different products, as are the extended-release carvedilol capsule and the twice-daily tablet, so a quote applies only to the form on the prescription.

Brand Toprol-XL and Coreg CR contain the same active ingredients as their generics. Whether the once-daily or twice-daily form suits you is a clinical decision for the prescriber; once the dose is stable, ask whether a ninety-day prescription is appropriate.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Metoprolol
  Tablets, tartrate (Lopressor and generics), Oral solution, tartrate (Lopressor), Extended-release tablets, succinate (Toprol-XL and generics)
  Generic: Yes · Twice a day, or once a day extended-release
• Carvedilol
  Tablets (Coreg and generics), Extended-release capsules, carvedilol phosphate (Coreg CR and generics)
  Generic: Yes · Twice a day
• Atenolol
  Tablets (Tenormin and generics)
  Generic: Yes · Once or twice a day
• Propranolol
  Tablets, Oral solution, Extended-release capsules (Inderal LA and generics, InnoPran XL, Inderal XL)
  Generic: Yes · Two to four times a day
• Bisoprolol
  Tablets, Tablets with hydrochlorothiazide (Ziac and generic)
  Generic: Yes · Once a day
• Labetalol
  Tablets, Injection (hospital use)
  Generic: Yes · Twice a day
• Nebivolol
  Tablets
  Generic: Yes · Once a day
• Nadolol
  Tablets
  Generic: Yes · Once a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Is this the twice-daily tablet or the once-daily extended-release form?
• Would the twice-daily tablet suit me as well as the once-daily form?
• What pulse rate is too slow, and what should I do about dizziness?
• Does this affect my asthma or my ability to notice low blood sugar?
• What happens if I run out or stop suddenly?