Choice of a Beta-Adrenoceptor Antagonist Drug

CHOICE OF A BETA-ADRENOCEPTOR ANTAGONIST DRUG

Propranolol is the standard against which newer β antagonists developed for systemic use have been compared. In many years of very wide use, propranolol has been found to be a safe and effec-tive drug for many indications. Since it is possible that some actions of a β-receptor antagonist may relate to some other effect of the drug, these drugs should not be considered interchangeable for all applications. For example, only β antagonists known to be effective in stable heart failure or in prophylactic therapy after myocardial infarction should be used for those indications. It is possible that the beneficial effects of one drug in these settings might not be shared by another drug in the same class. The pos-sible advantages and disadvantages of β-receptor antagonists that are partial agonists have not been clearly defined in clinical set-tings, although current evidence suggests that they are probably less efficacious in secondary prevention after a myocardial infarc-tion compared with pure antagonists.