… ed in uncontrolled heart failure (see section 4.3), may be used in patients whose signs of heart failure have been controlled. Similarly, care must be taken with patients with poor cardiac reserve.
Ischaemic Heart disease: especially in patients with ischaemic heart disease, treatment should not be discontinued suddenly. The dosage should be gradually reduced, i.e. over 1-2 weeks, if necessary at the same time initiating replacement therapy, to prevent exacerbation of angina pectoris. In addition, hypertension and arrhythmias may develop. Furthermore, there is a risk of myocardial infarction and sudden death. Patients should be followed during withdrawal, especially those with ischaemic heart disease.
Untreated Congestive Heart disease: beta-blockers should not be used in such patients. The condition should be stabilised first.
First Degree Heart Block: due to its negative effect on conduction …