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.
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.
First line beta-blocker for patients with heart failure.
Predominently used for angina and hypertension
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.
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.
Restrictions: Restricted to specialist use only.
Restrictions: Restricted to specialist initiation.
Restrictions: Restricted to initiation in patients over the age of 70 years with confirmed chronic cardiac failure who fail to tolerate bisoprolol and carvedilol.