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A modest chronotropic effect does not necessarily translate into adverse outcomes, but it should prompt careful monitoring in patients with symptomatic tachyarrhythmias, advanced autonomic neuropathy, inappropriate sinus tachycardia or poorly controlled AF

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The standard protocol begins with 0.25 mg once weekly for four weeks, increasing to 0.5 mg, with further increases to 1 mg or 2 mg only if needed and tolerated