Bisoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Bisoprolol is used to treat hypertension (high blood pressure).

Bisoprolol may also be used for purposes not listed in this medication guide.

Warnings

Do not skip doses or stop taking bisoprolol without first talking to your doctor. Stopping suddenly may make your condition worse or cause other serious heart problems.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using this medicine.

You should not use bisoprolol if you have a serious heart condition such as “AV block,” severe heart failure, or slow heartbeats that have caused you to faint.

Keep using bisoprolol as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Before taking this medicine

You should not use bisoprolol if you you are allergic to it, or if you have a serious heart condition such as:

• “AV block”;
• severe heart failure; or
• slow heartbeats that have caused you to faint.

To make sure bisoprolol is safe for you, tell your doctor if you have:

• congestive heart failure or other heart problems;
• coronary artery disease;
• circulation problems (such as Peripheral Vascular Disease or Raynaud’s syndrome);
• asthma, chronic obstructive pulmonary disease (COPD), or other breathing disorder;
• diabetes (taking bisoprolol can make it harder for you to tell when you have low blood sugar);
• liver or kidney disease;
• a thyroid disorder; or
• a history of allergies.

It is not known whether bisoprolol is harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether bisoprolol passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Bisoprolol is not approved for use by anyone younger than 18 years old.

How should I take bisoprolol?

Take bisoprolol exactly as it was prescribed for you. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Do not skip doses or stop taking bisoprolol without first talking to your doctor. Stopping suddenly may make your condition worse or cause other serious heart problems.

If you need surgery, tell the surgeon ahead of time that you are using bisoprolol.

Your blood pressure will need to be checked often.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

Store bisoprolol at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What to avoid

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Minimize drinking alcohol. It can increase some of the side effects of bisoprolol.

Bisoprolol side effects

Get emergency medical help if you have signs of an allergic reaction to bisoprolol: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• shortness of breath (even with mild exertion), swelling, rapid weight gain;
• slow heart rate;
• pounding heartbeats or fluttering in your chest;
• numbness, tingling, or cold feeling in your hands or feet;
• a light-headed feeling, like you might pass out;
• eye pain, vision problems; or
• bronchospasm (wheezing, chest tightness, trouble breathing).

Common bisoprolol side effects may include:

• headache;
• feeling tired;
• sleep problems (insomnia);
• joint pain;
• swelling; or
• cold symptoms such as stuffy nose, runny nose, cough, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

What other drugs will affect bisoprolol?

Tell your doctor about all your current medicines and any you start or stop using, especially:

• insulin or oral diabetes medicine;
• rifampin; or
• heart or blood pressure medicine–clonidine, digitalis, digoxin, diltiazem, reserpine, or verapamil.

What is atenolol?

Atenolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure).

Atenolol is also used to lower the risk of death after a heart attack.

Warnings

You should not use this atenolol if you have a serious heart condition such as “AV block,” very slow heartbeats, or heart failure.

Do not stop taking atenolol without first talking to your doctor. Stopping suddenly may make your condition worse.

If you are having any type of surgery, be sure the surgeon knows ahead of time that you are using this medicine.

Atenolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking this medicine.

Atenolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Before taking this medicine

You should not use atenolol if you are allergic to it, or if you have:

• a serious heart condition such as “AV block” (second or third degree);
• slow heartbeats;
• heart failure; or
• if your heart cannot pump blood properly.

To make sure atenolol is safe for you, tell your doctor if you have:

• congestive heart failure;
• coronary artery disease (hardened arteries);
• asthma, bronchitis, emphysema;
• diabetes;
• overactive thyroid;
• liver or kidney disease;
• pheochromocytoma (tumor of the adrenal gland);
• peripheral vascular disease such as Raynaud’s syndrome; or
• allergies (or if you are undergoing allergy treatments or skin-testing).

Atenolol may harm an unborn baby. Tell your doctor if you are pregnant or if you become pregnant while using this medicine.

Atenolol can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breastfeeding a baby.

Atenolol is not approved for use by anyone younger than 18 years old.

How should I take atenolol?

Take atenolol exactly as it was prescribed for you. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Your blood pressure will need to be checked often.

If you need surgery, tell the surgeon ahead of time that you are using atenolol. You may need to stop using the medicine for a short time.

Keep using the medication as directed and tell your doctor if your symptoms do not improve.

You should not stop taking atenolol suddenly. Stopping suddenly may make your condition worse.

If you are being treated for high blood pressure: Keep using this medicine even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

Your condition may need to be treated with a combination of drugs. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor’s advice.

Store at room temperature away from moisture, heat, and light. Keep the bottle tightly closed when not in use.

Atenolol dosing information

Usual Adult Dose of Atenolol for Hypertension:

Initial dose: 50 mg orally once a day
Maintenance dose: 50 to 100 mg orally once a day
Maximum dose: 100 mg per day

Comments:
-If desired response not achieved after 1 to 2 weeks, increase to 100 mg may be beneficial.
-Doses greater than 100 mg once a day did not result in significant additional antihypertensive effects.

Use: For the treatment of hypertension alone or in combination with other antihypertensive agents.

Usual Adult Dose of Atenolol for Angina Pectoris Prophylaxis:

Initial dose: 50 mg orally once a day
-Increase to 100 mg orally once a day after 1 week if optimal response not achieved
Maintenance dose: 50 to 200 mg orally once a day
Maximum dose: 200 mg per day

Comments:
-Some patients may require 200 mg per day to attain optimal effect.

Use: For the long-term management of angina pectoris due to coronary atherosclerosis.

Usual Adult Dose of Atenolol for Angina Pectoris:

Initial dose: 50 mg orally once a day
-Increase to 100 mg orally once a day after 1 week if optimal response not achieved
Maintenance dose: 50 to 200 mg orally once a day
Maximum dose: 200 mg per day

Comments:
-Some patients may require 200 mg per day to attain optimal effect.

Use: For the long-term management of angina pectoris due to coronary atherosclerosis.

Usual Adult Dose of Atenolol for Myocardial Infarction:

50 mg orally twice a day or 100 mg orally once a day

Comments:
-If IV beta blockers are contraindicated or inappropriate, oral therapy should continue for at least 7 days post-myocardial infarction (MI).
-Treatment with beta blockers post MI should generally continue for 1 to 3 years if there are no contraindications.

Use: For the management of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality.

Usual Geriatric Dose of Atenolol for Hypertension:

Initial dose: Consider reducing the starting dose to 25 mg orally once a day

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include extreme weakness or lack of energy, very slow heart rate, shortness of breath, or fainting.

What should I avoid while taking atenolol?

Follow your doctor’s instructions about any restrictions on food, beverages, or activity.

Atenolol side effects

Get emergency medical help if you have signs of an allergic reaction to atenolol: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

• new or worsening chest pain;
• slow or uneven heartbeats;
• a light-headed feeling, like you might pass out;
• shortness of breath (even with mild exertion), swelling, rapid weight gain; or
• a cold feeling in your hands and feet.

Common atenolol side effects may include include:

• cold hands or feet;
• dizziness;
• tiredness; or
• depressed mood.

What is metoprolol?

Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure).

Metoprolol is also used to lower your risk of death or needing to be hospitalized for heart failure.

Metoprolol injection is used during the early phase of a heart attack to lower the risk of death.

Warnings

You should not use metoprolol if you have a serious heart problem (heart block, sick sinus syndrome, slow heart rate), severe circulation problems, severe heart failure, or a history of slow heart beats that caused fainting.

Before taking this medicine

You should not use this medicine if you are allergic to metoprolol, or other beta-blockers (atenolol, carvedilol, labetalol, nadolol, nebivolol, propranolol, sotalol, and others), or if you have:

• a serious heart problem such as heart block, sick sinus syndrome, or slow heart rate;
• severe circulation problems;
• severe heart failure (that required you to be in the hospital); or
• a history of slow heart beats that have caused you to faint.

To make sure this medicine is safe for you, tell your doctor if you have:

• asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;
• diabetes (taking metoprolol may make it harder for you to tell when you have low blood sugar);
• liver disease;
• congestive heart failure;
• problems with circulation (such as Raynaud’s syndrome);
• a thyroid disorder; or
• pheochromocytoma (tumor of the adrenal gland).

Do not give this medicine to a child without medical advice.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether metoprolol will harm an unborn baby. However, having high blood pressure during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating hypertension may outweigh any risks to the baby.

Ask a doctor before using this medicine if you are breast-feeding. Metoprolol can pass into breast milk and may cause dry skin, dry mouth, diarrhea, constipation, or slow heartbeats in your baby.

How should I take metoprolol?

Take metoprolol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Metoprolol should be taken with a meal or just after a meal.

Take the medicine at the same time each day.

Swallow the capsule whole and do not crush, chew, break, or open it.

A Toprol XL tablet can be divided in half if your doctor has told you to do so. Swallow the half-tablet whole, without chewing or crushing.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

You will need frequent medical tests, and your blood pressure will need to be checked often.

If you need surgery, tell the surgeon ahead of time that you are using this medicine.

You should not stop using this medicine suddenly. Stopping suddenly may make your condition worse.

If you have high blood pressure, keep using metoprolol even if you feel well. High blood pressure often has no symptoms. You may need to use this medicine for the rest of your life.

Store at room temperature away from moisture and heat.

Metoprolol injection is given as an infusion into a vein. A healthcare provider will give you this injection in a medical setting where your heart and blood pressure can be monitored. The injections are given for only a short time before switching you to the oral form of this medicine.

Dosing information

Usual Adult Dose for Hypertension:

Metoprolol Tartrate Immediate Release Tablets:
Initial dose: 100 mg orally per day in single or divided doses

Maintenance dose: 100 to 450 mg orally per day.

Metoprolol Succinate Extended Release Tablets:
Initial dose: 25 to 100 mg orally once a day

Maintenance dose: 100 to 400 mg orally once a day.

Usual Adult Dose for Angina Pectoris:

Initial dose:
-Metoprolol tartrate immediate release tablets: 50 mg orally twice a day
-Metoprolol succinate extended release tablets: 100 mg orally once a day

Maintenance dose: 100 to 400 mg per day.

Usual Adult Dose for Myocardial Infarction:

Metoprolol Tartrate :
Early Treatment:
Initial dose: 5 mg IV every 2 minutes as tolerated for 3 doses
-Patients tolerant of full IV dose (15 mg): 50 mg orally every 6 hours starting 15 minutes after the last IV dose and continued for 48 hours
-Patients intolerant of full IV dose (15 mg): 25 or 50 mg orally every 6 hours depending on the degree of intolerance starting 15 minutes after the last IV dose or as soon as their clinical condition allows

Late Treatment:
Maintenance dose: 100 mg orally twice a day.

Usual Adult Dose for Congestive Heart Failure:

Metoprolol Succinate Extended Release Tablets:
25 mg orally once a day (12.5 mg orally once a day in patients with more severe heart failure); double dose every 2 weeks to highest tolerated dose or up to 200 mg orally once a day.

Usual Pediatric Dose for Hypertension:

Metoprolol Succinate Extended Release Tablets:
6 Years or Older:
Initial dose: 1 mg/kg orally once a day (not to exceed 50 mg orally once a day)

Maximum dose: 2 mg/kg (or 200 mg) orally once a day.

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What to avoid

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Drinking alcohol can increase certain side effects of this medicine.

Metoprolol side effects

Get emergency medical help if you have signs of an allergic reaction to metoprolol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Metoprolol may cause serious side effects. Call your doctor at once if you have:

• very slow heartbeats;
• a light-headed feeling, like you might pass out;
• shortness of breath (even with mild exertion), swelling, rapid weight gain; or
• cold feeling in your hands and feet.

Common side effects of metoprolol may include:

• dizziness;
• tired feeling;
• depression;
• confusion;
• memory problems;
• nightmares;
• trouble sleeping;
• diarrhea;
• mild itching or rash.

What is nebivolol?

Nebivolol is a beta-blocker that is used to treat hypertension (high blood pressure). Lowering blood pressure may lower your risk of a stroke or heart attack.

Nebivolol may also be used for purposes not listed in this medication guide.

Nebivolol side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Nebivolol may cause serious side effects. Call your doctor at once if you have:

• a light-headed feeling, like you might pass out;
• rapid weight gain;
• shortness of breath;
• slow or uneven heartbeats; or
• numbness or cold feeling in your hands and feet.

Common side effects of nebivolol may include:

• dizziness;
• swelling in your legs;
• slow heartbeats;
• tiredness; or
• headache.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA .

Warnings

Do not skip doses or stop taking nebivolol without first talking to your doctor.

Before taking this medicine

You should not take nebivolol if you are allergic to it, or if you have:

• a serious heart condition such as heart failure, “AV block” (2nd or 3rd degree), or sick sinus syndrome (unless you have a pacemaker);
• very slow heartbeats;
• severe liver disease; or
• if your heart cannot pump blood properly.

Tell your doctor if you have ever had:

• asthma, bronchitis, emphysema;
• a heart attack;
• problems with circulation (especially in your feet and legs);
• diabetes (taking nebivolol can make it harder for you to tell when you have low blood sugar);
• a thyroid disorder;
• liver or kidney disease;
• allergies; or
• pheochromocytoma (tumor of the adrenal gland).

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether nebivolol will harm an unborn baby. However, having high blood pressure during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating hypertension may outweigh any risks to the baby.

You should not breastfeed while using nebivolol.

How should I take nebivolol?

Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed.

You may take nebivolol with or without food.

Your blood pressure will need to be checked often.

If you need surgery, tell the surgeon ahead of time that you are using nebivolol.

You should not skip doses or stop using nebivolol suddenly. Stopping suddenly may make your condition worse or cause serious heart problems, including heart attack. Follow your doctor’s instructions about tapering your dose.

Keep using nebivolol as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

Store at room temperature away from moisture and heat.

Nebivolol dosing information

Usual Adult Dose for Hypertension:

Initial dose: 5 mg orally once a day
Dose adjustment: Titrate dose at 2-week intervals up to 40 mg once a day as needed.
Maximum dose: 40 mg per day

Comments:
-Titrating doses more frequently than every 2 weeks is unlikely to be beneficial.
-The dose should be individualized to patient requirements.

Use: For the management of hypertension, alone or with another antihypertensive agent.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line

Overdose symptoms may include slow heart rate, dizziness, vomiting, trouble breathing, or feeling like you might pass out.

What should I avoid while taking nebivolol?

Avoid driving or hazardous activity until you know how nebivolol will affect you. Your reactions could be impaired.