Beta-blocker duration of action and implications for therapy

Am J Cardiol. 1990 Nov 6;66(16):60G-62G. doi: 10.1016/0002-9149(90)90399-l.


Two studies were conducted to measure the effect of serum half-life on beta-blocker-related heart rate reduction throughout the 24-hour period. In the first study, nadolol, atenolol and pindolol were associated with significant (p less than 0.01) heart rate reduction even at 24 hours after dose. Nadolol, with a plasma half-life of 15.5 hours, had the most pronounced heart rate-lowering effect 24 hours after the daily dose compared to pindolol, which had a half-life of 5.5 hours. In a randomized, double-blind, crossover study, nadolol and atenolol had similar effects 3 to 4 hours after the daily dose. Nadolol, however, produced greater suppression of heart rate and double product (blood pressure x heart rate) than atenolol (compared to placebo) 24 hours after ingestion of the daily dose. On ambulatory electrocardiography 24 hours after medication administration, 80 to 100% of the heart rate-attenuating effect of nadolol was maintained versus only 20 to 45% of atenolol's effect. Statistically significant (p less than 0.05) reductions in heart rate were produced by nadolol, but not by atenolol, between 4 and 5 A.M., 6 and 7 A.M., 8 and 9 A.M. and 9 and 10 A.M. Furthermore, nadolol remained at 52% of peak blood level at 24 hours, whereas atenolol was at 20%. The data from these 2 studies indicate that significant differences in duration of action exist between beta blockers.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Antagonists / pharmacokinetics*
  • Adrenergic beta-Antagonists / pharmacology
  • Adult
  • Angina Pectoris / drug therapy
  • Angina Pectoris / physiopathology
  • Atenolol / pharmacokinetics*
  • Atenolol / therapeutic use
  • Circadian Rhythm
  • Double-Blind Method
  • Electrocardiography
  • Exercise Test
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Male
  • Nadolol / pharmacokinetics*
  • Nadolol / therapeutic use
  • Pindolol / pharmacokinetics*
  • Pindolol / therapeutic use


  • Adrenergic beta-Antagonists
  • Nadolol
  • Atenolol
  • Pindolol