Switching beta-blockers equivalent dosing


-When switching between oral and intravenous dosage forms, equivalent beta-blocking effect is achieved when doses in a 2.5:1 (Oral:I.V.) ratio is used. For example, if the patient is receiving an oral dose of 25 mg twice daily (50 mg/day), this would translate to 5 mg I.V. every 6 hours; consider

Table 3 Equivalent dose of carvedilol with other beta-blockers
Carvedilol IR 3.125 mg bid 6.25 mg bid
Carvedilol SR 8 mg qd 16 mg bid
Bisoprolol 1.25 mg qd 2.5 mg qd
Nebivolol 1.25 mg qd 2.5 mg qd

1 more row


Is metoprolol better than propranolol?

Metoprolol is less popular for anxiety and is typically used more for high blood pressure. And the side effects can be more frequent than Propranolol, although overall, still quite insignificant and rare.

Can Viagra be used with beta blockers?

Yes it can be taken but it definately has risks and both are vasodilators.But the viagra should not have been taken atleast 24 hrs on taking of a beta blocker… In short better not to take it as it is risky if you are using chronic beta blockers.It wouldnt be advised in this case. 4.8K views View upvotes Promoted by Lifecell

How quickly do beta blockers work to lower blood pressure?

Treatment. Beta blockers start lowering your blood pressure within 30 minutes to 4 hours of the first dose. When you start a beta blocker, it takes anywhere from 1 to 2 weeks to see the most effect. Sometimes your doctor will raise your dose if you are not meeting your blood pressure goals.

Is propranolol and metoprolol the same?

With Propranolol and Metoprolol, the same basic side effects are going to be present when taking them. As they are both beta blockers, there is not a whole lot of difference between the two, making them react in the same sort of manner as the other would.


Can you switch between beta blockers?

β-Blockers are a cornerstone of therapy for cardiovascular disease, but their clinical benefits are not consistent across the class and specific agents are preferred for certain indications. Further, when prescribed, a patient’s clinical status might change, requiring the cardiologist to switch to an alternate agent.

How do you convert beta blockers?

For this non-overlapping or abrupt switching, the current β blocker should be discontinued approximately 12 hours before the first dose of carvedilol. As mentioned, most patients can be initially switched to 6.25 mg or 12.5 mg b.i.d. and then up-titrated at 1–2 week intervals (Table I).

What medication can be substituted for metoprolol?

Other alternatives to metoprololInderal LA (propranolol, extended release)Blocadren (timolol)Betaxolol.Bisoprolol.Labetalol.Acebutolol.Captopril.Accupril (quinapril)More items…•

Can I switch from metoprolol to carvedilol?

Carvedilol may be an option if metoprolol succinate is poorly tolerated. There is no advantage in changing to carvedilol for people who are already taking metoprolol succinate at effective doses. However, carvedilol may be an option if metoprolol succinate is poorly tolerated.

Can you switch from a beta blocker to an ACE inhibitor?

Switching from beta blockers to ACE inhibitors Other BP medications are better suited for those patients.” Some studies suggest that switching from beta blockers to ACE inhibitors can help reduce symptoms of drowsiness and improve cognition.

Can I switch from metoprolol to nebivolol?

Conclusions: This real-world study suggests that switching from metoprolol to nebivolol is associated with an increase in medication costs and significant reductions in hospitalizations and outpatient visits upon switching, resulting in an overall neutral effect on healthcare costs.

Why is metoprolol preferred over carvedilol?

Two hours after oral administration of the drugs heart rate and blood pressure were measured at rest, after 10 min of exercise, and after 15 min of recovery. Results: Metoprolol tended to decrease heart rate during exercise (-21%, -25% and -24%) to a greater extent than carvedilol (-16%, -16% and -18%).

Why is atenolol preferred over metoprolol?

by Drugs.com Atenolol is water soluble. Metoprolol is lipid soluble so is more likely to produce sleep disturbances and nightmares because it can cross the blood brain barrier. 2. Atenolol has a longer half life and can be taken once a day while Metoprolol needs to be taken twice daily.

Is 50 mg of metoprolol succinate too much?

The dose is usually 1 milligram (mg) per kilogram (kg) of body weight once a day. The first dose should not be more than 50 mg once a day.

Which is safer carvedilol or metoprolol?

According to studies, carvedilol and metoprolol are just as good at improving the chances of survival after a heart attack. Both medications significantly reduce the risk of another heart attack from occurring, and there are no obvious differences between the 2 on this front. Winner = both.

Is 12.5 mg of metoprolol effective?

For people with more severe heart failure, it’s 12.5 mg once daily. Typical maintenance dosage: Your doctor can double the dosage every 2 weeks to the highest dosage level your body will tolerate, or up to 200 mg per day.

Does carvedilol lower blood pressure more than metoprolol?

Conclusions: Both metoprolol and carvedilol were equally effective in improving symptoms, quality of life, exercise capacity and LV ejection fraction, although carvedilol lowers blood pressure more than metoprolol.

Can you switch from atenolol to metoprolol?

Both metoprolol and atenolol can lower blood pressure, but they aren’t interchangeable.

What is the most commonly prescribed beta blocker?

Bisoprolol or metoprolol succinate are usually prescribed as they are the most cardioselective beta-blockers, but there is evidence of benefit for a number of other beta-blockers and international guidelines do not specify which beta-blocker to prescribe.

What’s the difference between metoprolol and propranolol?

Inderal (Propranolol) Lowers blood pressure and controls heart rate. Lopressor (metoprolol tartrate) lowers high blood pressure, controls chest pain, and helps treat heart failure and heart attack.

Which is better metoprolol or bisoprolol?

To demonstrate that bisoprolol is superior in mean ambulatory heart rate and/or non-inferior in mean ambulatory DBP as compared with metoprolol SR in the last 4 hours after 12-week active treatment in subjects with mild to moderate essential hypertension (EH).

What are beta blockers used for?

Beta blockers are widely utilized for both cardiovascular and noncardiovascular indications, such as hypertension, angina, and the treatment of migraine headache. Over the past decade, numerous large-scale randomized controlled trials (RCTs) have demonstrated the significant mortality and morbidity benefits of β-blocker therapy in the management of mild or moderate heart failure (HF). 1 – 6 In fact, approximately 6000 patients evaluated in more than 20 trials have shown a variety of benefits including reduction in death, hospitalizations, and progression of HF, as well as improved left ventricular (LV) function when β blockers are combined with angiotensin-converting enzyme (ACE) inhibitors and diuretics. 7, 8 Indeed, the majority of β-blocker mortality trials have consistently shown a favorable effect on mortality, with a relative decrease at least as great as that produced with ACE inhibitors alone. 9, 10

What is a third generation blocker?

Third-generation β-blocking agents are nonselective β blockers with ancillary vasodilating properties . 48, 49 Vasodilation mediates a reduction in ventricular after-load, physiologically counterbalancing the negative inotropic effects of acute cardiac β-sympathetic withdrawal. 50 When tested in HF, carvedilol, which inhibits α 1 as well as β 1 and β 2 adrenergic receptors, was found in double-blind, randomized placebo-controlled studies to reduce heart rate and pulmonary capillary wedge pressure while increasing stroke volume, LV stroke work, and EF 51 and was found to be superior in improving ventricular function compared with the β 1 -selective agent metoprolol. 52 – 54 These effects have been explained by carvedilol’s more complete degree of adrenergic blockade.

What class of blocker is used for HF?

Based on this convincing evidence, both the Consensus Recommendations for the Management of Chronic Heart Failure and the Heart Failure Society of America Practice Guidelines mandate that all patients with New York Heart Association (NYHA) functional class II or III HF should be treated with a β blocker unless there is a contraindication to its use in a particular patient, or if the patient has been shown to be unable to tolerate treatment with the drug. 11, 12 Two recent studies of carvedilol extend this recommendation to different classes of patients. The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial showed that the benefits of carvedilol with respect to mortality as well as morbidity could be extended to patients with severe HF, those with symptoms at rest or on minimal exertion, and with an ejection fraction (EF) less than 25%. 13 Meanwhile, the Carvedilol Post Infarction Survival Control in Left Ventricular Dysfunction (CAPRICORN) trial showed that carvedilol improved outcomes in patients with LV dysfunction (LV ejection fraction <40%) following acute myocardial infarction (MI) with or without symptoms of HF. 14 In fact, recent relabeling of carvedilol extends its indication to all patients from NYHA class I (post-MI patients with LV dysfunction) through stable patients with NYHA class IV HF.

Can you switch between blockers?

Patients were switched if they were stable on a minimum dose of 25 mg b.i.d. carvedilol or 100 mg metoprolol. The crossover was performed within 1 day during monitoring of blood pressure and heart rate in the outpatient clinic. Switching initially was done between patients receiving doses of 25 mg carvedilol and 100 mg metoprolol. The authors reported that the change from metoprolol to carvedilol was well tolerated; however, the first patients switched from carvedilol to metoprolol frequently experienced hypotension or bradycardia. The switch dose was reduced to 50 mg metoprolol. Despite this lower initial dose, 25% of patients still experienced hypotension or bradycardia. The authors postulated that this was probably related to greater inverse agonist activity and more pronounced negative inotropic effects of metoprolol.

Can you switch patients from a metoprolol to a carvedilol?

There are no data from the large RCTs on changing patients from such commonly used cardioselective β blockers as metoprolol or atenolol to carvedilol because clinical study protocols have generally excluded patients receiving prior β-blocker therapy. The recommendations presented here are primarily from the observational experience of HF physicians familiar with the use of carvedilol and in switching such patients. For completeness, the regimens used in two publications in which switching was performed are also reviewed. 53, 70

Does Carvedilol increase HF?

Carvedilol’s use in HF does not increase β 1 -receptor density and is associated with a selective decrease, rather than increase in coronary sinus norepinephrine levels. As previously noted, carvedilol has a number of other biologically distinguishing ancillary properties in addition to α 1 inhibition.

Do beta blockers work for HF?

However, not all β blockers produce similar benefits, and not all are indicated for the treatment of chronic HF. In fact, there are only two β blockers that currently have regulatory approval in the United States for the treatment of patients with HF: carvedilol and the long-acting form of metoprolol (metoprolol CR/XL). Moreover, while some β blockers (carvedilol, bisoprolol, and metoprolol succinate [CR/XL]) reduce mortality and morbidity in HF, others do not (bucindolol, xamoterol). 15, 16 Beta blockers are a heterogeneous group of agents that differ with respect to pharmacology (particularly receptor biology and important ancillary properties), hemodynamic effects, and tolerability. 17, 18 These differences provide a basis for the varying results obtained during clinical trials with different agents in patients with both ischemic and nonischemic HF. 19, 20

How much should the opioid dose be reduced?

It is recommended that the new dose should be reduced by 30-50% to allow for incomplete cross-tolerance.

Why switch IV to PO?

Switching from intravenous (IV) to oral (PO) therapy as soon as patients are clinically stable can reduce the length of hospitalization and lower associated costs. While intravenous medications may be more bioavailable and have greater effects, some oral drugs produce serum levels comparable to those of the parenteral form. Medications involved in switch therapy include antibiotics, analgesics, antipsychotics, and antivirals.

What is the most commonly used anxiolytic?

Benzodiazepines are the most commonly used anxiolytics and hypnotics. There are major differences in potency between different benzodiazepines and this difference in potency is important when switching from one benzodiazepine to another.

Why do we provide an opioid conversion table?

We provide an opioid conversion table for commonly used opioid preparations to help clinicians better understand the relationship between these agents and methadone. Conversion must take into consideration clinical issues that affect translation of equivalents to and from methadone.

What is the class of corticosteroids?

Topical corticosteroids range in potency from mild (class VII) to superpotent (class I— Relative Potency of Selected Topical Corticosteroids). Intrinsic differences in potency are attributable to fluorination or chlorination (halogenation) of the compound.

Can you switch from one antipsychotic to another?

In the case of antipsychotic medications, this issue must be carefully addressed. There are a number of reasons for switching patients from one antipsychotic compound to another .

Is prednisolone 5 mg the same as hydrocortisone 20 mg?

What is the equivalent dose of oral prednisolone to intravenous (IV) hydrocortisone? From the literature, prednisolone 5mg is approximately equivalent to hydrocortisone 20mg in terms of equivalent anti-inflammatory dose.

Is beta blocker a homogeneous group?

In fact, beta-blockers are not a singular, homogeneous group, but rather a class made up of a number of agents with individual differences in pharmacology, receptor biology, hemodynamic effects, and tolerability.

Is beta blocker used for hypertension?

The use of beta-blocker therapy has proven extremely useful in a variety of clinical settings, including the management of hypertension , acute- and post-myocardial infarction, and in congestive heart failure (HF). However, there are noticeable differences among individual beta-blockers in regard to efficacy of treatment and clinical outcomes in many of these conditions. These differences are particularly apparent in the treatment of HF, where effects on reverse remodeling and interactions on the periphery are potential factors that can differentiate between the efficacy of one drug versus another. In fact, beta-blockers are not a singular, homogeneous group, but rather a class made up of a number of agents with individual differences in pharmacology, receptor biology, hemodynamic effects, and tolerability. In the event of ongoing disease progression, the onus of choosing the most appropriate beta-blocker falls on the clinician’s shoulders. Given the baseline differences among medications of this class, the rationale and manner for transitioning to a different beta-blocker should take into account the specific receptor-blockade subtype of any given agent, as well as any other intrinsic effects attributed to a specific drug. This article includes 2 protocols for switching between carvedilol, a third generation non-selective agent with vasodilatory properties through a1-blockade, and a beta1-selective agent (e.g., metoprolol, atenolol). The aim is to simplify and maximize the safety and tolerability of performing this exchange. With the increasing amount of clinical evidence supporting the use of one beta-blocker over another in the treatment of HF, it behooves physicians treating this patient population to utilize the adrenergic blocking agent that provides optimal therapy with minimal side effects and intolerability.


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