Since there is not sufficient beta-1 selectivity of the available beta-blockers at the recommended doses, these drugs are generally contraindicated in patients with bronchospastic asthma. However, in patients with quiescent bronchospastic asthma in whom heart rate control is essential, or in patients with mild obstructive airway disease or symptomatic Raynaud’s phenomenon, a nonselective beta-blocker such as nadolol can be used cautiously,with careful monitoring of pulmonary status. Calcium channel blockers, both verapamil and diltiazem, when administered orally and not intravenously, have been shown to effect rate control in patients who do not tolerate or are not candidates for beta-adrenergic blocking agents.
3)