NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Prescribing
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2 Cardiovascular system

2.4 Beta-adrenoceptor blocking drugs

The CSM has advised that beta-blockers, including those considered to be cardioselective, should not be given to patients with a history of asthma or bronchospasm. However, in rare situations where there is no alternative a cardioselective beta-blocker may be used with extreme caution under specialist supervision. Combination preparations containing a beta-blocker are not recommended as they lack flexibility and may not be available in dose combinations appropriate for individual patients.

Preferred list
BISOPROLOL

Restrictions: The initiation and initial supervision of bisoprolol in confirmed cases of chronic cardiac failure is restricted to prescribers working with specialised heart failure teams in line with agreed protocols.

Prescribing Notes:

First line beta-blocker for patients with heart failure.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2481.htm

ATENOLOL

Prescribing Notes:

Predominently used for angina and hypertension

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2468.htm

CARVEDILOL

Restrictions: The initiation and initial supervision of carvedilol in confirmed cases of chronic cardiac failure is restricted to prescribers  working with specialised heart failure teams in line with agreed protocols. Not approved for hypertension or angina.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/27351.htm

PROPRANOLOL

Prescribing Notes:

Only beta-blocker licensed for anxiety with symptoms such as palpitation, sweating and tremor. It is not included in the Preferred List for hypertension, angina and heart failure.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2456.htm

Total Formulary
ESMOLOL

Restrictions: Restricted to specialist use only.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2486.htm

LABETALOL

Restrictions: Restricted to specialist initiation.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/2488.htm

NEBIVOLOL

Restrictions: Restricted to initiation in patients over the age of 70 years with confirmed chronic cardiac failure who fail to tolerate bisoprolol and carvedilol.

BNF Link: http://www.medicinescomplete.com/mc/bnf/current/77278.htm