Use caution with history of severe anaphylaxis to allergens (patients taking β-blockers may become more sensitive to repeated challenges). In general, β-blockers should not be used in bronchospastic disease. Consider pre-existing conditions such as sick sinus syndrome before initiating. Use with caution in diabetes mellitus (may potentiate hypoglycemia and/or mask signs and symptoms). Use with caution in compensated heart failure, in severe hepatic insufficiency or inflammatory diseases (risk of increased serum concentrations), in myasthenia gravis, and in peripheral vascular disease (including Raynaud’s). If pheochromocytoma (untreated), adequate α-blockade required prior to use of any β-blocker. Use with caution in history of psychiatric illness (may cause or exacerbate CNS depression). β-Blocker therapy should not be withdrawn abruptly (particularly in coronary artery disease).