Home Drug IndexClinical Monograph

Bevantolol: Uses, Dosage, Side Effects & Warnings | DrugsAtlas

Authoritative Clinical Reference

DRUG NAME: Bevantolol

Therapeutic Class: Antihypertensive

Subclass: β1-selective Beta-blocker with Intrinsic Sympathomimetic Activity (ISA)

Specialty: Cardiology

Schedule (India): Schedule H

Route(s): Oral

Formulations Available in India:
• Tablets: 100 mg

Note: Limited availability in India; not commonly stocked in hospitals or retail pharmacies

INDICATIONS + DOSING — FOR CLINICIAN USE ONLY

Primary Indications (Approved / Standard in India)

Indication	Starting Dose	Titration	Maintenance Dose	Maximum Dose	Clinical Notes
Essential Hypertension	100 mg once daily	Increase to 200 mg once daily after 1–2 weeks if blood pressure control inadequate	100–200 mg once daily	400 mg once daily (rarely required)	ISA property results in less resting bradycardia; may be preferred in patients with symptomatic bradycardia on other beta-blockers; taper gradually before discontinuation

Secondary Indications — Adults (Off-label, if any)

Indication	Dose	Duration	Notes	Evidence
Stable Angina Pectoris — OFF-LABEL	100–200 mg once daily	Chronic; reassess every 3 months	Specialist only; not preferred for post-MI beta-blockade	Limited international data; not standard in Indian guidelines; class effect of beta-blockers
Supraventricular Arrhythmias (selected) — OFF-LABEL	100 mg once daily	As clinically indicated	Specialist only	Based on beta-blocker class pharmacology; limited specific evidence

PAEDIATRIC DOSING (Specialist Only)

Primary Indications:
• NOT APPROVED for use in children in India
• No established paediatric indications
• Safety and efficacy data insufficient

Secondary Indications — Paediatrics (Off-label, if any):

Age	Indication	Dose	Notes
<18 years	Arrhythmias in congenital heart disease — OFF-LABEL	0.5–1 mg/kg/day in 1–2 divided doses	Specialist only; paediatric cardiologist supervision mandatory

Safety Monitoring in Paediatrics:
• Close ECG monitoring essential
• Heart rate and blood pressure monitoring at each visit
• Not recommended below 18 years except under specialist supervision in exceptional circumstances
• Limited Indian data available

RENAL ADJUSTMENT

Renal Function	Recommendation
Mild impairment (eGFR 60–89 mL/min)	No dose adjustment required
Moderate impairment (eGFR 30–59 mL/min)	No dose adjustment required
Severe impairment (eGFR <30 mL/min)	Use with caution; monitor heart rate and blood pressure closely
Haemodialysis	Limited data; no specific supplemental dose recommendation

HEPATIC ADJUSTMENT

Child-Pugh Class	Recommendation
Class A (Mild)	No dose adjustment required
Class B (Moderate)	Use with caution; hepatic metabolism may be affected; monitor for excessive beta-blockade
Class C (Severe)	Avoid use; limited safety data available

CONTRAINDICATIONS

• Sinus bradycardia (<50 beats per minute)
• Second-degree or third-degree atrioventricular block (without pacemaker)
• Sick sinus syndrome (without pacemaker)
• Cardiogenic shock
• Decompensated heart failure
• Severe bronchial asthma or COPD with active bronchospasm
• Hypersensitivity to bevantolol or other beta-blockers
• Untreated pheochromocytoma

CAUTIONS

• Controlled bronchospastic disease — cardioselectivity is dose-dependent and not absolute
• Diabetes mellitus — may mask hypoglycaemic symptoms (tachycardia, tremor); sweating preserved
• Peripheral arterial disease — may worsen claudication
• Thyrotoxicosis — may mask tachycardia; do not withdraw abruptly
• First-degree AV block — monitor for progression
• History of depression — monitor for mood changes
• Myasthenia gravis — potential worsening
• Psoriasis — potential exacerbation
• Abrupt discontinuation — taper over 1–2 weeks to prevent rebound hypertension, angina, or arrhythmia

PREGNANCY

Parameter	Details
Risk summary	Limited human data; use only if benefit clearly outweighs risk
Preferred alternatives	Labetalol, methyldopa (standard agents for antenatal hypertension in India)
When may be used	Only if preferred agents not tolerated or contraindicated; specialist supervision required
Monitoring	Fetal growth (risk of IUGR); fetal heart rate monitoring; neonatal bradycardia and hypoglycaemia if used near term

LACTATION

Parameter	Details
Compatibility	Likely compatible; minimal data available
Preferred alternatives	Labetalol, propranolol (better studied in lactation)
Drug level in milk	Expected to be low (based on beta-blocker class)
Infant monitoring	Bradycardia, poor feeding, lethargy, inadequate weight gain

ELDERLY

• Starting dose: 100 mg once daily (consider 50 mg if significant frailty or comorbidities)
• Titration: Slower titration over 2–4 week intervals advised
• Special considerations:

Increased sensitivity to beta-blocker effects
Higher risk of symptomatic bradycardia and hypotension
Increased fall risk; assess balance and orthostatic blood pressure
Reduced hepatic clearance may prolong drug effects
Monitor for confusion or cognitive changes

MAJOR DRUG INTERACTIONS

Interacting Drug	Effect	Recommendation
Verapamil, Diltiazem	Severe bradycardia, AV block, myocardial depression	Avoid combination
Clonidine	Rebound hypertensive crisis on abrupt clonidine withdrawal	Discontinue bevantolol first; then taper clonidine gradually
Class I antiarrhythmics (disopyramide, flecainide)	Additive negative inotropy; proarrhythmic risk	Avoid concurrent use
CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine)	Increased bevantolol levels; enhanced beta-blockade	Avoid combination or use with caution; monitor heart rate
MAO inhibitors	Risk of severe hypertension	Avoid concurrent use

MODERATE DRUG INTERACTIONS

Interacting Drug	Effect	Recommendation
NSAIDs	Attenuation of antihypertensive efficacy	Monitor blood pressure; consider alternatives
Insulin, sulfonylureas	Masking of hypoglycaemic symptoms	Monitor blood glucose closely; counsel diabetic patients
Digoxin	Additive bradycardia and AV conduction delay	Monitor heart rate and ECG
Rifampicin	Reduced bevantolol efficacy via hepatic enzyme induction	Monitor blood pressure; may need dose adjustment
Other antihypertensives (ACEi, ARBs, diuretics)	Additive hypotension	Monitor blood pressure
Phenothiazines, TCAs	Additive hypotensive effects	Monitor blood pressure

COMMON ADVERSE EFFECTS

• Fatigue
• Dizziness
• Headache
• Mild bradycardia (less common due to ISA)
• Postural hypotension
• Cold extremities (less common due to ISA)
• Gastrointestinal disturbances
• Sleep disturbances

SERIOUS ADVERSE EFFECTS

• Symptomatic bradycardia or high-grade AV block — may require discontinuation or pacemaker support
• Exacerbation or precipitation of heart failure
• Severe bronchospasm — even with cardioselective agents; discontinue immediately
• Severe hypotension requiring hospitalisation
• Depression or significant mood changes
• Withdrawal syndrome (rebound hypertension, angina, arrhythmia) — if stopped abruptly

MONITORING REQUIREMENTS

Phase	Parameters
Baseline	Heart rate, blood pressure, ECG (especially if pre-existing conduction abnormalities), blood glucose (in diabetics)
After initiation/dose change	Heart rate and blood pressure at 1 week; recheck after each dose adjustment
Long-term	Periodic heart rate and blood pressure; ECG if symptoms of bradycardia or conduction delay; blood glucose in diabetics; clinical assessment for heart failure symptoms

BRANDS AVAILABLE IN INDIA

• Bevan (100 mg tablet)

Note: Limited manufacturers; regional availability may vary; confirm local pharmacy stocking before initiating long-term therapy

PRICE RANGE (INR)

Formulation	Approximate Price
Tablet 100 mg	₹7–12 per tablet

• Not included in NLEM; not under NPPA price control
• Not commonly available in government supply chains
• Private purchase only

CLINICAL PEARLS

• Intrinsic sympathomimetic activity (ISA) results in less resting bradycardia — useful in patients who develop symptomatic bradycardia with atenolol or metoprolol
• ISA property may result in fewer adverse metabolic effects (lipid profile, glucose tolerance) compared to non-ISA beta-blockers
• Not preferred for post-myocardial infarction secondary prevention — ISA attenuates mortality benefit demonstrated with non-ISA beta-blockers
• Limited availability in India; confirm pharmacy stocking before long-term prescription
• Other beta-blockers (metoprolol, atenolol, bisoprolol) preferred in routine practice due to wider availability and stronger evidence base
• Always taper gradually when discontinuing; never stop abruptly

Clinical Responsibility

This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.

Content Feedback

Is this information helpful?

Help us improve our clinical database for the medical community.

RxIndia

Loading clinical data...