Greater Glasgow and Clyde Medicines
Key to symbols The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP The medicine should only be used and prescribed by a specialist Indicates the preferred choice within a class or group of medicines
The medicine should be initiated by, or on the advice of a specialist, but is suitable for continuation by a GP
The medicine should only be used and prescribed by a specialist
Indicates the preferred choice within a class or group of medicines
2. Cardiovascular system

2.4. Beta-adrenoceptor blocking drugs

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.
Preferred List
Preferred List First Line
BISOPROLOL

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.

Prescribing Notes:

First line beta-blocker for patients with heart failure.

BNF Link

CARVEDILOL

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.

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PROPRANOLOL

Prescribing Notes:

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.

BNF Link

ATENOLOL

Prescribing Notes:

Predominently used for angina and hypertension

BNF Link

Total Formulary
NEBIVOLOL

Restrictions: Restricted to initiation in patients over the age of 70 years with confirmed chronic cardiac failure who fail to tolerate bisoprolol and carvedilol.

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METOPROLOL
Specialist and GP
LABETALOL

Restrictions: Restricted to specialist initiation.

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Specialist and GP
ESMOLOL

Restrictions: Restricted to specialist use only.

BNF Link