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
• 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
• 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
• 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
• 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
• 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:
• 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
• 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
• 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
• 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
• 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
TAGS
bevantolol; hypertension; beta-blocker; cardioselective beta-blocker; ISA; intrinsic sympathomimetic activity; Schedule H; limited availability; pregnancy-caution; elderly-caution; non-NLEM
VERSION
RxIndia v1.0 — 28 Feb 2026
REFERENCES
• CDSCO product database
• Indian Pharmacopoeia / National Formulary of India
• API Textbook of Medicine
• AIIMS Hypertension Treatment Protocol
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics
• Indian specialist clinical practice (cardiology)
• International data (for off-label indications — clearly marked)
• Indian Pharmacopoeia / National Formulary of India
• API Textbook of Medicine
• AIIMS Hypertension Treatment Protocol
• Goodman & Gilman’s The Pharmacological Basis of Therapeutics
• Indian specialist clinical practice (cardiology)
• International data (for off-label indications — clearly marked)
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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.
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