Medications that cause sinus bradycardia

Class	Examples	Mechanism
Beta blockers	Metoprolol, atenolol, carvedilol	Slow sinus node automaticity
Calcium channel blockers (non-dihydropyridine)	Verapamil, diltiazem	Depress sinus node and atrioventricular node conduction
Antiarrhythmic drugs - Class I	Flecainide, propafenone	Depress sinus node and atrial tissue conduction
Antiarrhythmic drugs - Class III	Amiodarone, sotalol	Depress sinus node
Digoxin	Digoxin	Enhances vagal (parasympathetic) tone, slowing sinus node firing
Cholinergic agents	Donepezil, rivastigmine	Increase parasympathetic tone
Sedative-hypnotics	Benzodiazepines, propofol	Indirect bradycardia via sedation effects
Opioids	Morphine, fentanyl	Increase vagal tone, depress sinoatrial node
Certain antipsychotics	Haloperidol, risperidone	Autonomic effects leading to bradycardia
Certain antidepressants	Selective serotonin reuptake inhibitors (eg, fluoxetine), tricyclic antidepressants (eg, amitriptyline)	Variable (some increase vagal tone or direct cardiac effects)

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