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Propranolol| IV Dose | 0.02 mg/kg every 5 min to 0.1 mg/kg total dose. | | Oral dose | 2 mg/kg/day divided q 6 hours to start. Increase routinely to 5 mg/kg/day. May in rare circumstances go to 14 mg/kg/day, watching levels.
Inderal LA should be given BID in children | | Levels | 25-150 nanograms/ml for beta blockade.
150-1000 ng/ml for control of VT. | | Kinetics | Large first-pass metabolism in liver.
Elimination half-life 4-6 hours. (T 1/2 of 4-hydroxy-P 5.2-7.5 hours, active).
Peak levels at 2-3 hours after oral dose. | | Cautions | Contraindicated in asthma, congestive heart failure.
Beware hypoglycemia in infants and diabetics | | Interactions | Levels increased by cimetidine.
Contraindicated with verapamil, due to synergistic negative inotropic effect and cardiovascular collapse
Increases hepatic lidocaine metabolism. | | Preparations | Inderal scored tabs: 10, 20, 40, 60, 80, 90 mg.
Inderal LA capsules: 60, 80, 120, 160 mg.
Inderal injection, 1 mg/1 ml ampules. | | FDA approval in children | yes |
Atenolol| IV Dose | No IV form | | Oral dose | 1 mg/kg/day, up to 2 mg/kg/day given QD. | | Levels | Not helpful | | Kinetics | Elimination half-life 5-9 hours in adults, 16 hours in neonates.
Peak levels 2-3 hours after oral dose. | | Cautions | Similar to propranolol. More cardioselective, less problems with asthma and hypoglycemia. | | Interactions | No effect on hepatic lidocaine metabolism. | | Preparations | Tenormin non-scored tablets: 25, 100 mg.
scored tablets, 50 mg.
| | FDA approval in children | no |
Nadolol| IV Dose | | | Oral dose | 1-2 mg/kg/day, given QD. Adjust up or down after 5 days based on side effects, sinus rate, and efficacy. | | Levels | Not yet clinically useful | | Kinetics | Elimination half-life 12-24 hours. Peak levels at 3-4 hours after oral dose. | | Cautions | Similar to propranolol. Not particularly cardioselective, but fewer CNS side effects. | | Interactions | | | Preparations | Corgard non-scored tabs: 20, 40, 80 mg scored tablets: 120, 160 mg | | FDA approval in children | no |
Metoprolol| IV Dose | 5 mg q 2 minutes to total 15 mg in adults post MI | | Oral dose | 100-450 mg/day in adults divided qd or bid | | Levels | unknown | | Kinetics | Plasma half-life 3-7 hours in adults | | Cautions | Similar to propranolol. Fairly cardioselective. | | Interactions | similar to propranolol | | Preparations | Lopressor scored tabs: 50, 100 mg
Lopressor injection, 1 mg/cc, 5 cc ampuls
| | FDA approval in children | no |
Pindolol| IV Dose | | | Oral dose | Drug of choice in vasodepressor syncope, because of intrinsic sympathomimetic activity. 10-60 mg/day in adults divided bid | | Levels | Unknown | | Kinetics | Plasma half-life 3-4 hours. Clearance reduced in uremia | | Cautions | Similar to other beta blockers. | | Interactions | ISA may be blocked by other beta blockers | | Preparations | Visken "heart-shaped" non-scored tabs: 5, 10 mg. | | FDA approval in children | no |
Esmolol| IV Dose | 500 ug/kg/min for 1 minute, then 50 ug/kg/min.
Repeat bolus in 5 minutes, increase infusion to 100 ug/kg/min if no effect. Further increases with boluses up to 200 ug/kg/min as necessary
| | Oral dose | | | Levels | Unknown | | Kinetics | Elimination half-life 9 minutes. | | Cautions | Hypotension occurs transiently in 44%. CNS side effects are common, esp. emesis (16%). | | Interactions | Increases digoxin levels by 10-19%. Levels increased by warfarin, morphine. | | Preparations | Breviblock injection, 2.5 grams/10 ml ampule | | FDA approval in children | no |
Propranolol| IV Dose | 0.02 mg/kg every 5 min to 0.1 mg/kg total dose. | | Oral dose | 2 mg/kg/day divided q 6 hours to start. Increase routinely to 5 mg/kg/day. May in rare circumstances go to 14 mg/kg/day, watching levels.
Inderal LA should be given BID in children | | Levels | 25-150 nanograms/ml for beta blockade.
150-1000 ng/ml for control of VT. | | Kinetics | Large first-pass metabolism in liver.
Elimination half-life 4-6 hours. (T 1/2 of 4-hydroxy-P 5.2-7.5 hours, active).
Peak levels at 2-3 hours after oral dose. | | Cautions | Contraindicated in asthma, congestive heart failure.
Beware hypoglycemia in infants and diabetics | | Interactions | Levels increased by cimetidine.
Contraindicated with verapamil, due to synergistic negative inotropic effect and cardiovascular collapse
Increases hepatic lidocaine metabolism. | | Preparations | Inderal scored tabs: 10, 20, 40, 60, 80, 90 mg.
Inderal LA capsules: 60, 80, 120, 160 mg.
Inderal injection, 1 mg/1 ml ampules. | | FDA approval in children | yes |
Atenolol| IV Dose | No IV form | | Oral dose | 1 mg/kg/day, up to 2 mg/kg/day given QD. | | Levels | Not helpful | | Kinetics | Elimination half-life 5-9 hours in adults, 16 hours in neonates.
Peak levels 2-3 hours after oral dose. | | Cautions | Similar to propranolol. More cardioselective, less problems with asthma and hypoglycemia. | | Interactions | No effect on hepatic lidocaine metabolism. | | Preparations | Tenormin non-scored tablets: 25, 100 mg.
scored tablets, 50 mg.
| | FDA approval in children | no |
Nadolol| IV Dose | | | Oral dose | 1-2 mg/kg/day, given QD. Adjust up or down after 5 days based on side effects, sinus rate, and efficacy. | | Levels | Not yet clinically useful | | Kinetics | Elimination half-life 12-24 hours. Peak levels at 3-4 hours after oral dose. | | Cautions | Similar to propranolol. Not particularly cardioselective, but fewer CNS side effects. | | Interactions | | | Preparations | Corgard non-scored tabs: 20, 40, 80 mg scored tablets: 120, 160 mg | | FDA approval in children | no |
Metoprolol| IV Dose | 5 mg q 2 minutes to total 15 mg in adults post MI | | Oral dose | 100-450 mg/day in adults divided qd or bid | | Levels | unknown | | Kinetics | Plasma half-life 3-7 hours in adults | | Cautions | Similar to propranolol. Fairly cardioselective. | | Interactions | similar to propranolol | | Preparations | Lopressor scored tabs: 50, 100 mg
Lopressor injection, 1 mg/cc, 5 cc ampuls
| | FDA approval in children | no |
Pindolol| IV Dose | | | Oral dose | Drug of choice in vasodepressor syncope, because of intrinsic sympathomimetic activity. 10-60 mg/day in adults divided bid | | Levels | Unknown | | Kinetics | Plasma half-life 3-4 hours. Clearance reduced in uremia | | Cautions | Similar to other beta blockers. | | Interactions | ISA may be blocked by other beta blockers | | Preparations | Visken "heart-shaped" non-scored tabs: 5, 10 mg. | | FDA approval in children | no |
Esmolol| IV Dose | 500 ug/kg/min for 1 minute, then 50 ug/kg/min.
Repeat bolus in 5 minutes, increase infusion to 100 ug/kg/min if no effect. Further increases with boluses up to 200 ug/kg/min as necessary
| | Oral dose | | | Levels | Unknown | | Kinetics | Elimination half-life 9 minutes. | | Cautions | Hypotension occurs transiently in 44%. CNS side effects are common, esp. emesis (16%). | | Interactions | Increases digoxin levels by 10-19%. Levels increased by warfarin, morphine. | | Preparations | Breviblock injection, 2.5 grams/10 ml ampule | | FDA approval in children | no |
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