Although metoprolol and atenolol, widely used β 1 ‐selective agents, are used as examples for switching in this article (Tables I and II), comparable steps can be determined for other β blockers. Beta blockers are widely utilized for both cardiovascular and noncardiovascular indications, such as hypertension, angina, and the treatment of migraine headache. In some cases slowing the rate of titration or reducing the dose may also be considered. Moreover, while some β blockers (carvedilol, bisoprolol, and metoprolol succinate [CR/XL]) reduce mortality and morbidity in HF, others do not (bucindolol, xamoterol).In clinical practice, the choice of β blockers for individual patients with HF is often based on practical issues such as the established use of a particular β‐blocking agent for a prior indication (hypertension, angina, arrhythmia, migraine) when HF is first diagnosed, a history of poor tolerance or limited efficacy of a particular β blocker in a given patient, the consideration of comorbid states (pulmonary disease, peripheral vascular disease, diabetes mellitus, disorders of cardiac impulse formation or conduction), physician preferences, and cost. By continuing to browse this site, you agree to its use of cookies as described in our I have read and accept the Wiley Online Library Terms and Conditions of UseCarvedilol produces dose‐related improvements in left ventricular function and survival in subjects with chronic heart failureThe Cardiac Insufficiency Bisoprolol Study II (CIBIS‐II): a randomised trialEffect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT‐HF)The effect of carvedilol on morbidity and mortality in patients with chronic heart failureDouble‐blind, placebo‐controlled study of the effects of carvedilol in patients with moderate to severe heart failure. In fact, there are only two β blockers that currently have regulatory approval in the United States for the treatment of patients with HF: carvedilol and the long‐acting form of metoprolol (metoprolol CR/XL).
Both the drugs, that is Metoprolol and Atenolol, belong to the same group called beta blockers and changing from one to another is not an issue and they do not react with one another.
Initiation or switching β blockers is not recommended in patients experiencing a severe decompensation of HF (e.g., requiring intravenous positive inotropic agents, vasodilators, or mechanical interventions).
and then up‐titrated at 1–2 week intervals (In switching patients from a first‐ or second‐generation β blocker to carvedilol:A direct switch is generally possible but must be tailored based on the β‐blocker dose the patient is receiving.Abrupt switches to high doses of carvedilol may be more likely to precipitate vasodilating side effects that could be avoided by a staggered approach.While switching is generally well tolerated, the application of general principles of HF management should be successful in ameliorating any issues that may arise during switching.Beta blockade has been clearly demonstrated to provide significant benefits in patients being treated for HF in combination with ACE inhibitors and diuretics.
Over the past decade, numerous large‐scale randomized controlled trials (RCTs) have demonstrated the significant mortality and morbidity benefits of β‐blocker therapy in the management of mild or moderate heart failure (HF).Based on this convincing evidence, both the Consensus Recommendations for the Management of Chronic Heart Failure and the Heart Failure Society of America Practice Guidelines mandate that all patients with New York Heart Association (NYHA) functional class II or III HF should be treated with a β blocker unless there is a contraindication to its use in a particular patient, or if the patient has been shown to be unable to tolerate treatment with the drug.However, not all β blockers produce similar benefits, and not all are indicated for the treatment of chronic HF.
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