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Should not be given to patients with bronchospasm or asthma or to those with a history of obstructive airways disease. This contraindication applies even to those beta blockers considered to be cardioselective. However, some authorities consider that a cardioselective beta blocker might be used with extreme caution when there is no alternative treatment. Other contraindications include metabolic acidosis, cardiogenic shock, hypotension, severe peripheral arterial disease, sinus bradycardia, and second or third-degree atrioventricular block; caution should be observed in first-degree block.
Although beta blockers are used in the management of heart failure, they should not be given to patients with uncontrolled heart failure and treatment should be initiated with great care. Patients with pheochromocytoma should not receive beta blocker without concomitant alpha-adrenoceptor blocking therapy.
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