Should beta blockers be taken with or without food?

There are many different types of beta blockers, and some should always be taken with food, some without food, and others with or without food.

Carvedilol,¹ labetalol,² and metoprolol^3-5 should always be taken with food. When taken orally, carvedilol is rapidly absorbed, reaching mean terminal elimination half-life in seven to ten hours following oral dose administration.⁶ Metoprolol absorption is also rapid and complete,^4,5  and elimination half-life is 7.5 hours for metoprolol tartrate and three to seven hours for metoprolol extended-release capsules. Labetalol elimination half-life is about six to eight hours.⁷ However, when carvedilol is taken with food, the rate of absorption is slowed.^6,8 Slowing down the rate of absorption can reduce the risk of orthostatic hypotension.

Atenolol is an example of a beta blocker that should be taken on an empty stomach.⁹ Nebivolol,^10,11 penbutolol,¹² and propranolol¹³ can be taken with or without food. Although nebivolol metabolite levels are slightly reduced under fed conditions, food not does significantly affect nebivolol pharmacokinetics.¹¹

^References

1. U.S. National Library of Medicine. Carvedilol (By mouth). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009479/?report=details. Accessed August 21, 2018.
2. U.S. National Library of Medicine. Labetalol (By mouth). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0010843/?report=details. Accessed October 11, 2018.
3. U.S. National Library of Medicine. Metoprolol (By mouth). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011186/?report=details. Accessed October 11, 2018.
4. Lopressor [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2008.
5. Metoprolol succinate extended-release tablets [package insert]. Sodertalje, Sweden: AstraZeneca AB; 2006.
6. Coreg [package insert]. Ciales, PR: GK Pharmaceuticals Contract Manufacturing Operations; 2008.
7. Trandate [package insert]. Oakville, ON: Prometheus Laboratories Inc.; 2010.
8. Coreg CR [package insert]. Ciales, PR: GK Pharmaceuticals Contract Manufacturing Operations; 2008.
9. U.S. National Library of Medicine. Atenolol (By mouth). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009135/?report=details. Accessed October 11, 2018.
10. U.S. National Library of Medicine. Nebivolol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a608029.html. Accessed October 11, 2018.
11. Bystolic [package insert]. St. Louis, MO: Forest Pharmaceuticals; 2011.
12. U.S. National Library of Medicine. Penbutolol (By mouth). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011634/?report=details. Accessed October 11, 2018.
13. Innopran XL [package insert]. Cranford, NJ: Akrimax Pharmaceuticals; 2003.