All beta blockers should be taken at the same time(s) every day, and with or without food depending on the medication. This article includes only a select number of the most commonly used beta blockers.
Atenolol pills are usually taken once or twice a day on an empty stomach,1-3 with an elimination half-life of six to seven hours.1
It is recommended that carvedilol,6-12 labetalol,13,14 and metoprolol15 should be taken at the same time every day, always with food. Carvedilol immediate-release tablet is usually taken twice per day, with each pill’s effect lasting approximately seven to ten hours.16 Carvedilol extended-release capsule is usually taken once a day, with its effect lasting about 24 hours.17 Labetalol is usually taken two or three times a day,18 with a dose-dependent duration of effect – lasting eight hours for the 100 mg dose and more than 12 hours for the 300 mg dose.19 Metoprolol tartrate is usually taken twice per day, while metoprolol (succinate) extended-release tablet is usually taken once per day.21 Elimination half-life of metoprolol tartrate and succinate ranges from three to seven hours.22,23
Nebivolol is usually taken once a day, with or without food.25 Elimination half-life of nebivolol ranges approximately from 12 hours in CYP2D6 extensive metabolizers to 19 hours in poor metabolizers.26
The Hygia Chronotherapy Trial compared clinical results for patients taking their antihypertensive medication upon awakening with those taking their medication at bedtime (n=19.084).27 Ambulatory blood pressure (BP) readings, sleep time BP, and cardiovascular outcomes were all improved in those taking medication at bedtime. A 45% relative reduction in cardiovascular disease (CVD) events was achieved by those consuming their blood pressure medications at bedtime compared to those taking medications upon awakening. The absolute reduction in risk was 5.4%.28
Patients in the Hygia study continued on the medications they were taking at the time of enlistment into the study.27 Of those taking medication upon awakening, 22% were taking beta-blockers; 17% of patients taking bedtime medication were taking beta-blockers. The authors of the Hygia study point out that there may be medications which do not result in better CVD outcomes when given at bedtime.
References
- Tenormin [package insert]. Conovanas, PR: AstraZeneca Pharmaceuticals LP; 2011.
- U.S. Department of Health & Human Services. Medicines: Common Questions Answered. NIH National Institute on Aging. https://www.nia.nih.gov/health/medicines-common-questions-answered. Accessed October 12, 2018.
- 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.
- Tenormin Injection [package insert]. Conovanas, PR: AstraZeneca Pharmaceuticals LP; 2016.
- U.S. National Library of Medicine. Atenolol (By injection). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009136/?report=details. Accessed October 16, 2018.
- APO-Carvedilol [package insert]. Toronto, Canada: Apotex Pharmaceutical Holdings Inc.; 2015.
- Auro-Carvedilol [package insert]. Ontario, CA: Aurobindo Pharma Inc.; 2013.
- Coreg [package insert]. Ciales, PR: GK Pharmaceuticals Contract Manufacturing Operations; 2008.
- Coreg CR [package insert]. Ciales, PR: GK Pharmaceuticals Contract Manufacturing Operations; 2008.
- 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.
- U.S. National Library of Medicine. Carvedilol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a697042.html. Accessed August 21, 2018.
- U.S. National Library of Medicine. CARVEDILOL-carvedilol tablet, coated. DailyMed. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7d485d38-5d43-4a54-bc63-82734035c66a. Accessed August 27, 2018.
- 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.
- Trandate Injection [package insert]. San Diego, CA: Prometheus Laboratories Inc.; 2010.
- 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.
- Morgan T. Clinical pharmacokinetics and pharmacodynamics of carvedilol. Clin Pharmacokinet. 1994;26(5):335-346. 1994.
- Tenero DM, Henderson LS, Baidoo CA, et al. Pharmacokinetic properties of a new controlled-release formulation of carvedilol. Am J Cardiol. 2006;98(7, Supplement 1):5-16.
- U.S. National Library of Medicine. Labetalol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a685034.html. Accessed October 11, 2018.
- Trandate [package insert]. Oakville, ON: Prometheus Laboratories Inc.; 2010.
- U.S. National Library of Medicine. Labetalol (By injection). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0010844/?report=details. Accessed October 16, 2018.
- U.S. National Library of Medicine. Metoprolol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a682864.html. Accessed October 11, 2018.
- Lopressor [package insert]. East Hanover, NJ: Novartis Pharmaceuticals Corporation; 2008.
- Metoprolol succinate extended-release tablets [package insert]. Sodertalje, Sweden:AstraZeneca AB; 2006.
- U.S. National Library of Medicine. Metoprolol (By injection). PubMed Health. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011187/?report=details. Accessed October 16, 2018.
- U.S. National Library of Medicine. Nebivolol. MedlinePlus. https://medlineplus.gov/druginfo/meds/a608029.html. Accessed October 11, 2018.
- Bystolic [package insert]. St. Louis, MO: Forest Pharmaceuticals; 2011.
- Hermida RC, Crespo JJ, Domínguez-Sardiña M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J. October 2019. doi:10.1093/eurheartj/ehz754
- NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals. https://www.jwatch.org/na50538/2019/12/26/antihypertension-medications-might-best-be-taken-night. Accessed January 24, 2020.
