Blocks β1, β2, and α1 receptors → ↓ heart rate/contractility plus vasodilation.
Black Box Warning
Ischemic heart disease — do NOT stop abruptly: abrupt cessation can cause severe exacerbation of angina, MI, and ventricular arrhythmias. Taper over 1–2 weeks.
Clinical Notes
One of three β-blockers with HFrEF mortality benefit (with metoprolol succinate, bisoprolol). Take with food to slow absorption and reduce orthostasis.