Drug Info: B: Beta-adrenergic Blocking Agents (Systemic)

Some commonly used brand names are:

In the U.S.—

In Canada—

• Antiadrenergic --Acebutolol; Atenolol;Betaxolol; Carteolol; Labetalol ; Metoprolol; Nadolol;Oxprenolol; Penbutolol; Pindolol ; Propranolol; Sotalol;Timolol
• Antianginal --Acebutolol; Atenolol;Carteolol; Labetalol; Metoprolol ; Nadolol; Oxprenolol;Penbutolol; Pindolol; Propranolol ; Sotalol; Timolol
• Antianxiety therapy adjunct --Acebutolol;Metoprolol ; Oxprenolol; Propranolol; Sotalol; Timolol
• Antiarrhythmic --Acebutolol; Atenolol ;Metoprolol; Nadolol; Oxprenolol; Propranolol; Sotalol ;Timolol
• Antiglaucoma agent, systemic--Timolol
• Antihypertensive --Acebutolol ; Atenolol;Betaxolol; Bisoprolol; Carteolol; Labetalol ; Metoprolol;Nadolol; Oxprenolol; Penbutolol; Pindolol ; Propranolol;Sotalol; Timolol
• Antitremor agent --Acebutolol; Atenolol;Metoprolol ; Nadolol; Oxprenolol; Pindolol; Propranolol;Sotalol ; Timolol
• Hypertrophic cardiomyopathy therapyadjunct -- Acebutolol; Atenolol; Metoprolol;Nadolol; Oxprenolol; Pindolol ; Propranolol; Sotalol;Timolol
• Myocardial infarction prophylactic--Acebutolol ; Atenolol; Metoprolol; Nadolol; Oxprenolol;Propranolol ; Sotalol; Timolol
• Myocardial infarction therapy--Acebutolol; Atenolol ; Metoprolol; Nadolol; Oxprenolol;Propranolol; Sotalol ; Timolol
• Neuroleptic-induced akathisia therapy--Betaxolol ; Metoprolol; Nadolol; Propranolol
• Pheochromocytoma therapy adjunct --Acebutolol; Atenolol; Labetalol; Metoprolol ; Nadolol;Oxprenolol; Propranolol; Sotalol; Timolol
• Thyrotoxicosis therapy adjunct --Acebutolol; Atenolol; Metoprolol; Nadolol; Oxprenolol;Propranolol ; Sotalol; Timolol
• Vascular headache prophylactic --Atenolol;Metoprolol ; Nadolol; Propranolol; Timolol

This group of medicines is known as beta-adrenergicblocking agents, beta-blocking agents, or, more commonly,beta-blockers. Beta-blockers are used in the treatment ofhigh blood pressure (hypertension). Some beta-blockers arealso used to relieve angina (chest pain) and in heart attackpatients to help prevent additional heart attacks.Beta-blockers are also used to correct irregular heartbeat,prevent migraine headaches, and treat tremors. They may alsobe used for other conditions as determined by yourdoctor.

Beta-blockers work by affecting the response to some nerveimpulses in certain parts of the body. As a result, theydecrease the heart's need for blood and oxygen by reducingits workload. They also help the heart to beat moreregularly.

Beta-adrenergic blocking agents are available only withyour doctor's prescription, in the following dosageforms:

• Oral
• Acebutolol
  • Capsules (U.S.)
  • Tablets (Canada)
• Atenolol
  • Tablets (U.S. and Canada)
• Betaxolol
  • Tablets (U.S.)
• Bisoprolol
  • Tablets (U.S.)
• Carteolol
  • Tablets (U.S.)
• Labetalol
  • Tablets (U.S. and Canada)
• Metoprolol
  • Tablets (U.S. and Canada)
  • Extended-release tablets (U.S. and Canada)
• Nadolol
  • Tablets (U.S. and Canada)
• Oxprenolol
  • Tablets (Canada)
  • Extended-release tablets (Canada)
• Penbutolol
  • Tablets (U.S.)
• Pindolol
  • Tablets (U.S. and Canada)
• Propranolol
  • Extended-release capsules (U.S. and Canada)
  • Oral solution (U.S.)
  • Tablets (U.S. and Canada)
• Sotalol
  • Tablets (U.S. and Canada)
• Timolol
  • Tablets (U.S. and Canada)

• Parenteral
• Atenolol
  • Injection (U.S.)
• Labetalol
  • Injection (U.S. and Canada)
• Metoprolol
  • Injection (U.S. and Canada)
• Propranolol
  • Injection (U.S. and Canada)

In deciding to use a medicine, the risks of taking themedicine must be weighed against the good it will do. This isa decision you and your doctor will make. For thebeta-blockers, the following should be considered:

Allergies—Tell your doctor if you haveever had any unusual or allergic reaction to the beta-blockermedicine prescribed. Also tell your health care professionalif you are allergic to any other substances, such as foods,preservatives, or dyes.

Pregnancy—Use of some beta-blockersduring pregnancy has been associated with low blood sugar,breathing problems, a lower heart rate, and low bloodpressure in the newborn infant. Other reports have not shownunwanted effects on the newborn infant. Animal studies haveshown some beta-blockers to cause problems in pregnancy whenused in doses many times the usual human dose. Before takingany of these medicines, make sure your doctor knows if youare pregnant or if you may become pregnant.

Breast-feeding—It is not known whetherbisoprolol, carteolol, or penbutolol passes into breast milk.All other beta-blockers pass into breast milk. Problems suchas slow heartbeat, low blood pressure, and trouble inbreathing have been reported in nursing babies. Mothers whoare taking beta-blockers and who wish to breast-feed shoulddiscuss this with their doctor.

Children—Some of these medicines havebeen used in children and, in effective doses, have not beenshown to cause different side effects or problems in childrenthan they do in adults.

Older adults—Some side effects aremore likely to occur in the elderly, who are usually moresensitive to the effects of beta-blockers. Also,beta-blockers may reduce tolerance to cold temperatures inelderly patients.

Other medicines—Although certainmedicines should not be used together at all, in other casestwo different medicines may be used together even if aninteraction might occur. In these cases, your doctor may wantto change the dose, or other precautions may be necessary.When you are taking or receiving a beta-blocker it isespecially important that your health care professional knowif you are taking any of the following:

• Allergen immunotherapy (allergy shots) or
• Allergen extracts for skin testing—Beta-blockersmay increase the risk of serious allergic reaction to thesemedicines

• Aminophylline (e.g., Somophyllin) or
• Caffeine (e.g., NoDoz) or
• Dyphylline (e.g., Lufyllin) or
• Oxtriphylline (e.g., Choledyl) or
• Theophylline (e.g., Somophyllin-T)—The effects ofboth these medicines and beta-blockers may be blocked; inaddition, theophylline levels in the body may be increased,especially in patients who smoke

• Antidiabetics, oral (diabetes medicine you take bymouth) or
• Insulin—There is an increased risk ofhyperglycemia (high blood sugar); beta-blockers may coverup certain symptoms of hypoglycemia (low blood sugar) suchas increases in pulse rate and blood pressure, and may makethe hypoglycemia last longer

• Calcium channel blockers (bepridil [e.g., Bepadin],diltiazem [e.g., Cardizem], felodipine [e.g., Plendil],flunarizine [e.g., Sibelium], isradipine [e.g., DynaCirc],nicardipine [e.g., Cardene], nifedipine [e.g., Procardia],nimodipine [e.g., Nimotop], verapamil [e.g., Calan])or
• Clonidine (e.g., Catapres) or
• Guanabenz (e.g., Wytensin)—Effects on bloodpressure may be increased. In addition, unwanted effectsmay occur if clonidine, guanabenz, or a beta-blocker isstopped suddenly after use together. Unwanted effects onthe heart may occur when beta-blockers are used withcalcium channel blockers

• Cocaine—Cocaine may block the effects ofbeta-blockers; in addition, there is an increased risk ofhigh blood pressure, fast heartbeat, and possibly heartproblems if you use cocaine while taking abeta-blocker

• Monoamine oxidase (MAO) inhibitor activity(isocarboxazid [e.g., Marplan], isocarboxazid [e.g.,Marplan], phenelzine [e.g., Nardil], procarbazine [e.g.,Matulane], selegiline [e.g., Eldepryl], tranylcypromine[e.g., Parnate])—Taking beta-blockers while you aretaking or within 2 weeks of taking monoamine oxidase (MAO)inhibitors may cause severe high blood pressure

• Allergy, history of (asthma, eczema, hay fever, hives),or
• Bronchitis or
• Emphysema—Severity and duration of allergicreactions to other substances may be increased; in addition,beta-blockers can increase trouble in breathing

• Bradycardia (unusually slow heartbeat) or
• Heart or blood vessel disease—There is a risk offurther decreased heart function; also, if treatment isstopped suddenly, unwanted effects may occur

• Diabetes mellitus (sugar diabetes)—Beta-blockersmay cause hyperglycemia (high blood sugar) and circulationproblems; in addition, if your diabetes medicine causes yourblood sugar to be too low, beta-blockers may cover up some ofthe symptoms (fast heartbeat), although they will not coverup other symptoms such as dizziness or sweating

• Kidney disease or
• Liver disease—Effects of beta-blockers may beincreased because of slower removal from the body

• Mental depression (or history of)—May be increasedby beta-blockers

• Myasthenia gravis or
• Psoriasis—Beta-blockers may make these conditionsworse

• Overactive thyroid—Stopping beta-blockers suddenlymay increase symptoms; beta-blockers may cover up fastheartbeat, which is a sign of overactive thyroid

For patients taking the extended-release capsule or tablet form of thismedicine:

• Swallow the capsule or tablet whole.
• Do not crush, break (except metoprolol succinateextended-release tablets, which may be broken in half), orchew before swallowing.

For patients taking the concentrated oral solution form of propranolol:

• This medicine is to be taken by mouth even though itcomes in a dropper bottle. The amount you should take is tobe measured only with the specially marked dropper.
• Mix the medicine with some water, juice, or acarbonated drink. After drinking all the liquid containingthe medicine, rinse the glass with a little more liquid anddrink that also, to make sure you get all the medicine.Ifyou prefer, you may mix this medicine with applesauce orpudding instead.
• Mix the medicine immediately before you are going totake it. Throw away any mixed medicine that you do not takeimmediately. Do not save medicine that has been mixed.

Ask your doctor about checking your pulse rate before andafter taking beta-blocking agents. If your doctor tells youto check your pulse regularly while you are taking thismedicine, and it is much slower than the rate your doctor hasdesignated, check with your doctor. A pulse rate that is tooslow may cause circulation problems.

To help you remember to take your medicine, try to getinto the habit of taking it at the same time each day.

For patients taking this medicine for high blood pressure :

• In addition to the use of the medicine your doctor hasprescribed, treatment for your high blood pressure mayinclude weight control and care in the types of foods youeat, especially foods high in sodium. Your doctor will tellyou which of these are most important for you. You shouldcheck with your doctor before changing your diet.
• Many patients who have high blood pressure will notnotice any signs of the problem. In fact, many may feelnormal. However, if high blood pressure is not treated, itcan cause serious problems such as heart failure, bloodvessel disease, stroke, or kidney disease.
• Remember that this medicine will not cure your highblood pressure but it does help control it. It is veryimportant that you take your medicine exactly as directed, even if youfeel well. You must continue to take it as directed if youexpect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine forthe rest of your life. Also, it is very important tokeep your appointments with your doctor, even if you feelwell.

Dosing—

The dose of beta-blocker will be different for differentpatients. Follow your doctor's orders or the directions on thelabel. The following information includes only theaverage doses. If your dose is different, do not change it unlessyour doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls ofsolution that you take depends on the strength of themedicine. Also, the number of doses you take each day, the time allowedbetween doses, and the length of time you take the medicinedepend on the medical problem for which you are taking thebeta-blocker.

• For acebutolol
• For oral dosage forms (capsules and tablets):
  • For angina (chest pain) or irregular heartbeat:
    • Adults—200 milligrams (mg) two times a day.The dose may be increased up to a total of 1200 mg aday.
    • Children—Dose must be determined by yourdoctor.
  • For high blood pressure:
    • Adults—200 to 800 mg a day as a single doseor divided into two daily doses.
    • Children—Dose must be determined by yourdoctor.

• For atenolol
• For oral dosage form (tablets):
  • For angina (chest pain):
    • Adults—50 to 100 mg once a day.
  • For high blood pressure:
    • Adults—25 to 100 mg once a day.
    • Children—Dose must be determined by yourdoctor.
  • For treatment after a heart attack:
    • Adults—50 mg ten minutes after the lastintravenous dose, followed by another 50 mg twelvehours later. Then 100 mg once a day or 50 mg two timesa day for six to nine days or until discharge fromhospital.
• For injection dosage form:
  • For treatment of heart attacks:
    • Adults—5 mg given over 5 minutes. The dose isrepeated ten minutes later.

• For betaxolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—10 mg once a day. Your doctor maydouble your dose after seven to fourteen days.
    • Children—Dose must be determined by yourdoctor.

• For bisoprolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—5 to 10 mg once a day.
    • Children—Dose must be determined by yourdoctor.

• For carteolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—2.5 to 10 mg once a day.
    • Children—Dose must be determined by yourdoctor.

• For labetalol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—100 to 400 mg two times a day.
    • Children—Dose must be determined by yourdoctor.
• For injection dosage form:
  • For high blood pressure:
    • Adults—20 mg injected slowly over two minuteswith additional injections of 40 and 80 mg given everyten minutes if needed, up to a total of 300 mg; may begiven instead as an infusion at a rate of 2 mg perminute to a total dose of 50 to 300 mg.
    • Children—Dose must be determined by yourdoctor.

• For metoprolol
• For regular (short-acting) oral dosage form (tablets):
  • For high blood pressure or angina (chest pain):
    • Adults—100 to 450 mg a day, taken as a singledose or in divided doses.
    • Children—Dose must be determined by yourdoctor.
  • For treatment after a heart attack:
    • Adults—50 mg every six hours starting fifteenminutes after last intravenous dose. Then 100 mg twotimes a day for three months to 1 to 3 years .
• For long-acting oral dosage forms (extended-releasetablets):
  • For high blood pressure or angina (chest pain):
    • Adults—Up to 400 mg once a day.
    • Children—Dose must be determined by yourdoctor.
• For injection dosage form:
  • For treatment of a heart attack:
    • Adults—5 mg every two minutes for threedoses.

• For nadolol
• For oral dosage form (tablets):
  • For angina (chest pain):
    • Adults—40 to 240 mg once a day.
  • For high blood pressure:
    • Adults—40 to 320 mg once a day.
    • Children—Dose must be determined by yourdoctor.

• For oxprenolol
• For regular (short-acting) oral dosage form (tablets):
  • For high blood pressure:
    • Adults—20 mg three times a day. Your doctormay increase your dose up to 480 mg a day.
    • Children—Dose must be determined by yourdoctor.
• For long-acting oral dosage form (extended-releasetablets):
  • For high blood pressure:
    • Adults—120 to 320 mg once a day.
    • Children—Dose must be determined by yourdoctor.

• For penbutolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—20 mg once a day.
    • Children—Dose must be determined by yourdoctor.

• For pindolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—5 mg two times a day. Your doctor mayincrease your dose up to 60 mg a day.
    • Children—Dose must be determined by yourdoctor.

• For propranolol
• For regular (short-acting) oral dosage forms (tabletsand oral solution):
  • For angina (chest pain):
    • Adults—80 to 320 mg a day taken in two,three, or four divided doses.
  • For irregular heartbeat:
    • Adults—10 to 30 mg three or four times aday.
    • Children—500 micrograms (0.5 mg) to 4 mg perkilogram of body weight a day taken in divideddoses.
  • For high blood pressure:
    • Adults—40 mg two times a day. Your doctor mayincrease your dose up to 640 mg a day.
    • Children—500 micrograms (0.5 mg) to 4 mg perkilogram of body weight a day taken in divideddoses.
  • For diseased heart muscle (cardiomyopathy):
    • Adults—20 to 40 mg three or four times aday.
  • For treatment after a heart attack:
    • Adults—180 to 240 mg a day taken in divideddoses.
  • For treating pheochromocytoma:
    • Adults—30 to 160 mg a day taken in divideddoses.
  • For preventing migraine headaches:
    • Adults—20 mg four times a day. Your doctormay increase your dose up to 240 mg a day.
  • For trembling:
    • Adults—40 mg two times a day. Your doctor mayincrease your dose up to 320 mg a day.
• For long-acting oral dosage form (extended-releasecapsules):
  • For high blood pressure:
    • Adults—80 to 160 mg once a day. Doses up to640 mg once a day may be needed in some patients.
  • For angina (chest pain):
    • Adults—80 to 320 mg once a day.
  • For preventing migraine headaches:
    • Adults—80 to 240 mg once a day.
• For injection dosage form:
  • For irregular heartbeat:
    • Adults—1 to 3 mg given at a rate not greaterthan 1 mg per minute. Dose may be repeated after twominutes and again after four hours if needed.
    • Children—10 to 100 micrograms (0.01 to 0.1mg) per kilogram of body weight given intravenouslyevery six to eight hours.

• For sotalol
• For oral dosage form (tablets):
  • For irregular heartbeat:
    • Adults—80 mg two times a day. Your doctor mayincrease your dose up to 320 mg per day taken in two orthree divided doses.
    • Children—Dose must be determined by yourdoctor.

• For timolol
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults—10 mg two times a day. Your doctor mayincrease your dose up 60 mg per day taken as a singledose or in divided doses.
    • Children—Dose must be determined by yourdoctor.
  • For treatment after a heart attack:
    • Adults—10 mg two times a day.
  • For preventing migraine headaches:
    • Adults—10 mg two times a day. Your doctor mayincrease your dose up to 30 mg once a day or in divideddoses.

Missed dose—

Do not miss any doses. This is especially important whenyou are taking only one dose per day. Some conditions maybecome worse if this medicine is not taken regularly.

If you do miss a dose of this medicine, take it as soon aspossible. However, if it is within 4 hours of your next dose(8 hours when using atenolol, betaxolol, bisoprolol,carteolol, labetalol, nadolol, penbutolol, sotalol, orextended-release [long-acting] metoprolol, oxprenolol, orpropranolol), skip the missed dose and go back to yourregular dosing schedule. Do not double doses.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, orin other damp places. Heat or moisture may cause themedicine to break down.
• Do not keep outdated medicine or medicine no longerneeded. Be sure that any discarded medicine is out of thereach of children.

It is important that your doctor check your progress atregular visits. This is to make sure the medicine is workingfor you and to allow the dosage to be changed if needed.

Do not stop taking this medicine without first checkingwith your doctor. Your doctor may want you to reducegradually the amount you are taking before stoppingcompletely. Some conditions may become worse when themedicine is stopped suddenly, and the danger of heart attackis increased in some patients.

Make sure that you have enough medicine on hand to lastthrough weekends, holidays, or vacations. You may want tocarry an extra written prescription in your billfold or pursein case of an emergency. You can then have it filled if yourun out of medicine while you are away from home.

Your doctor may want you to carry medical identificationstating that you are taking this medicine.

Before having any kind of surgery (including dentalsurgery) or emergency treatment, tell the medical doctor ordentist in charge that you are taking this medicine.

For diabetic patients:

• This medicine may cause your blood sugar levels torise. Also, this medicine may cover up signs of hypoglycemia (lowblood sugar), such as change in pulse rate.

This medicine may cause some people to become dizzy,drowsy, or lightheaded. Make sure you know how you react to this medicine beforeyou drive, use machines, or do anything else that could bedangerous if you are dizzy or are not alert. If theproblem continues or gets worse, check with your doctor.

Beta-blockers may make you more sensitive to coldtemperatures, especially if you have blood circulationproblems. Beta-blockers tend to decrease blood circulation inthe skin, fingers, and toes. Dress warmly during cold weatherand be careful during prolonged exposure to cold, such as inwinter sports.

Chest pain resulting from exercise or physical exertion isusually reduced or prevented by this medicine. This may tempta patient to be overly active. Make sure you discuss with your doctor a safe amount ofexercise for your medical problem.

Before you have any medical tests, tell the doctor incharge that you are taking this medicine. The results of sometests may be affected by this medicine.

Before you have any allergy shots, tell the doctor incharge that you are taking a beta-blocker. Beta-blockers maycause you to have a serious reaction to the allergy shot.

For patients with allergies to foods, medicines, or insect stings:

• There is a chance that this medicine will causeallergic reactions to be worse and harder to treat. If youhave a severe allergic reaction while you are being treatedwith this medicine, check with a doctor right away so thatit can be treated. Be sure to tell the doctor that you aretaking a beta-blocker.

For patients taking this medicine for high blood pressure :

• Do not take other medicines unless they have beendiscussed with your doctor. This especially includesover-the-counter (nonprescription) medicines for appetitecontrol, asthma, colds, cough, hay fever, or sinus problemssince they may tend to increase your blood pressure.

For patients taking labetalol by mouth:

• Dizziness, lightheadedness, or fainting may occur,especially when you get up from a lying or sittingposition. This is more likely to occur when you firststart taking labetalol or when the dose is increased. Getting up slowly may help. When you get up fromlying down, sit on the edge of the bed with your feetdangling for 1 to 2 minutes. Then stand up slowly. If theproblem continues or gets worse, check with yourdoctor.
• The dizziness, lightheadedness, or fainting is alsomore likely to occur if you drink alcohol, stand for longperiods of time, or exercise, or if the weather is hot. While you are taking this medicine, be careful to limitthe amount of alcohol you drink. Also, use extra careduring exercise or hot weather or if you must stand forlong periods of time .

For patients receiving labetalol by injection:

• It is very important that you lie down flat whilereceiving labetalol and for up to 3 hours afterward. If youtry to get up too soon, you may become dizzy or faint. Do not try to sit or stand until your doctor or nursetells you to do so.

Along with its needed effects, a medicine may cause someunwanted effects. Although not all of these side effects mayoccur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of thefollowing side effects occur:

• Less common
  • Breathing difficulty and/or wheezing; cold hands andfeet; mental depression; shortness of breath; slowheartbeat (especially less than 50 beats per minute);swelling of ankles, feet, and/or lower legs
  
  

• Rare
  • Back pain or joint pain; chest pain ; confusion(especially in elderly patients); dark urine—foracebutolol, bisoprolol, or labetalol; dizziness orlightheadedness when getting up from a lying or sittingposition; fever and sore throat; hallucinations (seeing,hearing, or feeling things that are not there); irregularheartbeat; red, scaling, or crusted skin; skin rash;unusual bleeding and bruising; yellow eyes orskin—for acebutolol, bisoprolol, or labetalol
  
  

• Signs and symptoms of overdose (in the order in whichthey may occur)
  • Slow heartbeat; dizziness (severe) or fainting; fastor irregular heartbeat; difficulty in breathing;bluish-colored fingernails or palms of hands; convulsions(seizures)
  
  

Other side effects may occur that usually do not needmedical attention. These side effects may go away duringtreatment as your body adjusts to the medicine. However, checkwith your doctor if any of the following side effects continueor are bothersome:

• More common
  • Decreased sexual ability; dizziness orlightheadedness; drowsiness (slight); trouble insleeping; unusual tiredness or weakness
  
  

• Less common or rare
  • Anxiety and/or nervousness; changes intaste—for labetalol only; constipation; diarrhea;dry, sore eyes; frequent urination—for acebutololand carteolol only; itching of skin; nausea or vomiting ;nightmares and vivid dreams; numbness and/or tingling offingers and/or toes; numbness and/or tingling of skin,especially on scalp—for labetalol only; stomachdiscomfort; stuffy nose
  
  

Although not all of the side effects listed above have beenreported for all of these medicines, they have been reportedfor at least one of them. Since all of the beta-adrenergicblocking agents are very similar, any of the above side effectsmay occur with any of these medicines. However, they may bemore or less common with some agents than with others.

After you have been taking a beta-blocker for a while, itmay cause unpleasant or even harmful effects if you stop takingit too suddenly. After you stop taking this medicine or whileyou are gradually reducing the amount you are taking, checkwith your doctor right away if any of the following occur:

• Chest pain; fast or irregular heartbeat ; general feelingof discomfort or illness or weakness ; headache; shortness ofbreath (sudden); sweating; trembling

• You may notice a tingling feeling on your scalp when youfirst begin to take labetalol. This is to be expected andusually goes away after you have been taking labetalol for awhile.

Other side effects not listed above may also occur in somepatients. If you notice any other effects, check with yourdoctor.

Once a medicine has been approved for marketing for acertain use, experience may show that it is also useful forother medical problems. Although these uses are not includedin product labeling, some beta-blockers are used in certainpatients with the following medical conditions:

• Glaucoma
• Neuroleptic-induced akathisia (restlessness or the needto keep moving caused by some medicines used to treatnervousness or mental and emotional disorders)

Other than the above information, there is no additionalinformation relating to proper use, precautions, or sideeffects for these uses.