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Propranolol may be contraindicated in people with: [35] Reversible airway diseases, particularly asthma or chronic obstructive pulmonary disease (COPD) Slow heart rate (bradycardia) (<60 beats/minute) Sick sinus syndrome; Atrioventricular block (second-or third-degree) Shock; Severe low blood pressure
Alpha 1 blockers should not be used in those with a history of orthostatic hypotension, and those using calcium channel blockers or phosphodiesterase inhibitors, as they may intensify the hypotensive effect. [1] They are also contraindicated in people with heart failure as they increase blood volume and put more stress on the heart. [1]
Like other non-selective beta blockers, levobunolol is contraindicated in patients with airway diseases such as asthma and severe chronic obstructive pulmonary disease (COPD), as well as heart problems such as sinus bradycardia, second- or third-degree atrioventricular block, sick sinus syndrome, and cardiogenic shock.
Beta blockers vary in their lipophilicity (fat solubility) and in turn in their ability to cross the blood–brain barrier and exert effects in the central nervous system. [76] Beta blockers with greater blood–brain barrier permeability can have both neuropsychiatric therapeutic benefits and side effects, as well as adverse cognitive effects ...
When combined with inhaled steroids, β adrenoceptor agonists can improve symptoms. [1] [2] In children this benefit is uncertain and they may be potentially harmful. [2]They should not be used without an accompanying steroid due to an increased risk of severe symptoms, including exacerbation in both children and adults. [3]
Beta blockers are not contraindicated for those with COPD and should only be used where there is concomitant cardiovascular disease. [62] Recent studies show that metformin plays a role in reducing systemic inflammation by reducing biomarker levels that are increased during COPD exacerbations. [177]