II. Indications

III. Contraindications

  1. Severe Liver Impairment

IV. Mechanism

  1. Third generation Beta Blocker (Beta-1 Selective) with vasodilatory properties (nitric oxide release)
  2. Unique vasodilator mechanism with nitric oxide release via Beta-3 Agonist activity
    1. Relaxes vascular Smooth Muscle resulting in vasodilation
    2. Contrast with Labetalol and Carvedilol which exert vasodilation via alpha-1 activity

V. Dosing

  1. Start: 5 mg orally daily
    1. Start at 2.5 mg in hepatic Impairment or CrCl <30 ml/min
  2. Maximum: 40 mg/day

VI. Adverse Effects

VII. Safety

  1. Pregnancy Category C
  2. Avoid in Lactation

IX. References

  1. (2019) Presc Lett, Resource #350503, Comparison of Oral Beta Blockers
  2. (2020) Med Lett Drugs Ther 62(1598): 73-80
  3. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 66-7
  4. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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