Classifications: autonomic nervous system agent; beta-adrenergic antagonist (sympatholytic, adrenergic blocking agent); antihypertensive
Prototype: Propranolol
Pregnancy Category: C


20 mg, 40 mg, 80 mg, 120 mg, 160 mg tablets


Nonselective beta-adrenergic blocking agent pharmacologically and chemically similar to propranolol. Inhibits response to adrenergic stimuli by competitively blocking beta-adrenergic receptors within heart.

Therapeutic Effects

Reduces heart rate and cardiac output at rest and during exercise, and also decreases conduction velocity through AV node and myocardial automaticity. Decreases both systolic and diastolic BP at rest and during exercise. Suppression of beta2-adrenergic receptors in bronchial and vascular smooth muscle can cause bronchospasm and a Raynaud's-like phenomenon.


Hypertension, either alone or in combination with a diuretic. Also long-term prophylactic management of angina pectoris.


Bronchial asthma, severe COPD, inadequate myocardial function, sinus bradycardia, greater than first-degree conduction block, overt cardiac failure, cardiogenic shock. Safety during pregnancy (category C), lactation, and in children <18 y is not established.

Cautious Use

CHF; diabetes mellitus; hyperthyroidism; renal impairment.

Route & Dosage

Hypertension, Angina
Adult: PO 40 mg once/d, may increase up to 240–320 mg/d in 1–2 divided doses


Note: Dose is usually titrated up in 40–80 mg increments until optimum dose is achieved.


Adverse Effects (1%)

Body as a Whole: Hypersensitivity (rash, pruritus, laryngospasm, respiratory disturbances). CV: Bradycardia, peripheral vascular insufficiency (Raynaud's type), palpitation, postural hypotension, conduction or rhythm disturbances, CHF. GI: Dry mouth. CNS: Dizziness, fatigue, sedation, headache, paresthesias, behavioral changes. Special Senses: Blurred vision, dry eyes. Skin: Dry skin. Urogenital: Impotence.


Drug: nsaids may decrease hypotensive effects; may mask symptoms of a hypoglycemic reaction to insulin, sulfonylureas; prazosin, terazosin may increase severe hypotensive response to first dose.


Absorption: 30–40% of PO dose absorbed. Peak: 2–4 h. Duration: 17–24 h. Distribution: Widely distributed; crosses placenta; distributed in breast milk. Metabolism: No hepatic metabolism. Elimination: 70% excreted in urine; also excreted in feces. Half-Life: 10–24 h.

Nursing Implications

Assessment & Drug Effects

Patient & Family Education

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug