Is There a Better Beta Blocker?
With the recent national shortage of atenolol, the Dispensary of Hope is looking for therapeutic alternatives from other sources. Although the use of atenolol is widespread, newer studies have raised questions about its place in therapy within the beta blocker class.1 The Eighth Joint National Committee (JNC 8) Guidelines place higher importance on beta blocker selection based on evidence, which would include metoprolol and carvedilol.2 Atenolol has not demonstrated improved outcomes in hypertension, heart failure, or post heart attack.3
Metoprolol succinate is recommended when possible over the tartrate and is currently in inventory. Metoprolol tartrate and carvedilol are still available consistently to order from the Dispensary of Hope for patients with hypertension or other cardiovascular diseases. Some of the other beta blockers such as propranolol and labetalol are used in specific situations such as performance anxiety and pregnancy, respectively. There are not direct dose equivalents among the beta blockers thus titrating and careful dose adjustments may be needed. 3
Additional guidance from Pharmacist's Letter regarding the atenolol shortage is available on their website. Of note: Each Dispensary of Hope Access Site will need to determine based on their clinical judgement and available information which medications will work best for their specific patients.