Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Severe bradycardia, heart block greater than first degree. cardiogenic shock, decompensated heart failure or sick sinus syndrome (without pacemaker)

• Severe hepatic impairment (Child-Pugh >B)

• Bronchospastic disease

• OB: Lactation

• Coronary artery disease (rapid cessation should be avoided)

• Compensated congestive heart failure.

• Major surgery (anesthesia may augment myocardial depression)

• Diabetes mellitus (may mask signs of hypoglycemia)

• Thyrotoxicosis (may mask symptoms)

• Moderate hepatic impairment ( metabolism)

• Severe renal impairment ( initial dose if CCr <30 ml/min)

• History of severe allergic reactions ( intensity of reactions)

• Pheochromocytoma (alpha blockers required prior to beta blockers)

• Geri: Consider increased sensitivity, concurrent chronic diseases, medications and presence of age-related decrease in clearance

• OB: Use in pregnancy only if maternal benefit outweighs fetal risk

• Pedi: Safe use in children <18 yr not established

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