Beta blockers: types, uses and side effects (2023)


What are beta blockers?

Beta blockers are a class of drugs commonly used to treat a variety of problems affecting your heart and circulatory system. They are also sometimes used to treat disorders related to your brain and nervous system.

How do you work?

Your body uses a chemical signaling system to control certain processes and functions. It uses specific spots on the surface of your cells called receptors where certain chemicals called neurotransmitters can attach themselves.

Receptors work in a similar way to locks. When a chemical with the right structure binds to a receptor, it acts like a key, activating the cell to respond in a specific way. How the cell responds depends on where it is and what it is doing. When your body needs certain cells to act, it can produce more of the chemical, which can activate the cells' receptors.

Many drugs work by artificially altering this chemical signaling process. Drugs that work in this way fall into two categories:

  • These drugs bind to and activate receptor sites. In fact, they pretend to be the right kind of chemical compound, and the cell falls for the deception. This can stimulate cells that would otherwise not be active.
  • These drugs attach to the receptor sites but do nothing else. The effect is similar to breaking a key after inserting it into a lock. The broken part of the key stays in place, blocking the entry of another key. Antagonists reduce the number of receptors available for activation, which slows cell activity.

beta receptors

Adrenergic receptors (sometimes referred to as adrenoceptors) are a key type of receptor found throughout the body. They get their name from adrenaline (also called epinephrine), a neurotransmitter that your body naturally produces. Adrenaline can activate all adrenergic receptors, much like a building master key can open any lock within that structure.

Beta-blockers are beta-receptor antagonists, meaning they block beta-adrenergic receptors and slow down certain types of cellular activity.

(Video) Beta Blockers - Selective vs Non-Selective Beta Blockers | Uses | Beta Blocker Side Effects

What do beta receptors control?

Beta receptors come in three different subtypes and have different functions depending on their location.

Beta-1 (B1)

The beta-1 receptors are mainly located in the heart and kidneys. When enabled, they do the following:

  • Increase your heart rate.
  • Increase the pumping power of the heart.
  • Activate the release of renin, an enzyme found in your kidneys.

Beta-2 (B2)

The beta-2 receptors are mainly found in smooth muscle tissue. This tissue is found in your respiratory system (particularly the windpipe and bronchi), blood vessels, and your nervous system). When these receptors are activated, they affect various body systems in the following ways:

  • breathing: Relaxation of smooth muscles to allow people to breathe more easily.
  • blood vessels: Causes smooth muscle relaxation and lowers blood pressure.
  • Leber: Activate the conversion of glycogen in the liver into glucose (which your body uses for energy).
  • Herz: Increase pumping power and heart rate.
  • nervous system: Causes muscle tremors.

Beta-3 (B3)

Beta-3 receptors are mainly found in fat cells and in your bladder. When enabled, they do the following:

  • cause fat cells to break down.
  • Cause relaxation and increase bladder capacity
  • Causes tremors, limiting potential medical uses for B3 receptor-targeted drugs.

What conditions does this class of drugs treat?

Because beta-receptors are found in multiple places in the body, beta-blockers can treat a variety of problems and conditions.

Beta blockers are primarily used to treat heart and circulatory diseases, including the following:

  • aortic dissection.
  • Arrhythmias.
  • chest pain (angina).
  • Coronary heart disease.
  • Heart attack.
  • Heart failure (particularly chronic heart failure).
  • high blood pressure (hypertension).
  • Hypertrophic obstructive cardiomyopathy (enlarged heart).
  • Migraine (preventive).
  • Portal hypertension.

Outside of the cardiovascular system, they can treat several other conditions:

(Video) Beta Blockers | Types | Action | Uses | Side effects | Contraindication | Nursing Responsibilities

  • Essential tremors
  • Glaucoma
  • Hyperthyroidism (overactive thyroid)

Types of beta blockers

Some beta-blockers only work at certain beta-receptors, a property known as "selectivity." This is an important consideration when healthcare providers are deciding which beta-blocker to prescribe.

Beta blockers generally fall into two broad categories based on whether or not they are cardioselective, meaning they only block the B1 receptors, which are primarily found in the heart.

Cardioselective (B1 receptor)Not selective

*These drugs have distinctive or unique properties. Examples of these properties are:

  • Carvedilol und Labetalol: Both can also block some alpha receptors. This can help lower heart rate and blood pressure even further, making these drugs more effective.
  • Esmolol: This drug is only available in IV form, which limits its use to hospitals and similar medical facilities.
  • Nebivolol: This drug causes blood vessels to widen (the term for this is vasodilation), which may help lower blood pressure further.

Off-label prescription of beta-blockers

Beta blockers are sometimes used for "off-label" purposes. This means they are prescribed for conditions other than those they are specifically approved to treat.

  • An example of this is selecting a similar but unapproved drug to treat a medical condition over an approved one. This can happen when the approved drug has side effects that the patient should avoid and the alternative drug is safe and likely to help.

Off-label prescribing is a legal practice and is medically acceptable and justified when evidence shows a drug has a low risk of causing harmful side effects and is effective for off-label use.

Common off-label treatment uses of beta-blockers include:

  • Migraines (replacing one beta-blocker with another).
  • Angst(like stage fright or stage fright).
  • Reduction in tremors (beta-blockers are banned in certain sports because of their performance-enhancing properties).

Are beta blockers commonly prescribed?

Beta blockers are among the most commonly prescribed medications in the United States, with approximately 30 million adults using a beta blocker.

(Video) How do beta blockers work?

Risks / Benefits

What are the benefits of beta blockers?

Beta blockers are commonly used for several reasons:

  • They are effective for a variety of medical problems. Because so many heart and circulatory problems are linked, using a beta-blocker to treat one problem can often benefit several related problems.
  • They have been extensively studied. Beta blockers have been used for decades, with the first clinical trials taking place in the 1960s. Because of this, their effects are better understood and it is easier to use them safely and avoid negative effects.
  • Most (especially generics) are inexpensive. Beta blockers tend to be very affordable, making it easier to ensure patients don't have to go without medication because they can't afford the cost.

What are the possible side effects of these drugs?

Because beta-blockers affect your heart and circulatory system, they can cause a variety of side effects. As a result, healthcare providers often prescribe specific beta blockers to limit or avoid these side effects.

Common side effects of all beta blockers include:

  • Slow heartbeat (bradycardia).
  • Low blood pressure (hypotension).
  • Irregular heart rhythms (arrhythmias).
  • fatigue.
  • dizziness.
  • nausea.
  • insomnia, sleep changes and nightmares.
  • Dry mouthorEyes.

Rare side effects are:

  • SexualAnderectile dysfunction.

Why should I not take these medications?

Beta blockers can negatively affect various diseases, conditions, and health problems. These are known as contraindications and include:

  • Moderate to difficultAsthma. Non-selective beta-blockers may worsen or cause an asthma attack or difficulty breathing. Health care providers often prescribe B1-selective beta-blockers to minimize this for people with milder cases of respiratory problems, but avoid beta-blocker use entirely in those with moderate to severe cases.
  • Certain types of arrhythmias. Beta blockers can make some arrhythmias worse.
  • Slow heartbeat or low blood pressure. Most beta blockers make either of these conditions worse by further reducing heart rate and blood pressure.
  • Raynaud phenomenon. This condition causes decreased blood flow to your hands and feet (especially fingers and toes) and sometimes parts of your face. Beta blockers can make the condition worse. Raynaud's disease can occur alone (primary, also known as Raynaud's syndrome or Raynaud's disease) or due to another condition (secondary Raynaud's disease).
  • Hypoglycemia (low blood sugar). Beta blockers can delay most effects of low blood sugar. In people with conditions that lead to low blood sugar, such as diabetes (especially type 1), this may delay taking action to stabilize blood sugar levels. If levels drop too low, you may become confused, pass out, or have seizures. A key symptom of low blood sugar that beta-blockers don't mask is sweating. Recognizing sudden sweating can be an important warning sign for people taking beta blockers who are at risk of having low blood sugar.

Do beta blockers interact with other medications?

Beta blockers can interact with a variety of drugs, especially those related to the side effects or contraindications listed above. Your doctor is the best person to tell you about the side effects that worry you the most.

(Video) Beta blockers types and side effects - Dr. Ranjan Shetty

Recovery and Outlook

How long can I take beta blockers?

You can use beta blockers for a long time. In some cases, especially in adults over 65, it is possible to use them for years or indefinitely.

When to call the doctor

When should I see my doctor?

Your doctor can advise you on when to call or make an appointment related to taking beta-blockers. In general, you should call or make an appointment if you have a sudden change in symptoms, especially if they involve your heart and circulatory system. These include:

  • shortness of breath.
  • chest pain.
  • palpitations(where you can feel your heartbeat racing, pounding, or skipping beats).
  • faintingunexpected or with multiple episodes where you feeldizziness or lightheadedness.

Other symptoms to watch out for and ask your doctor about include:

  • Slow heartbeat, low blood pressure, and confusion or changes in behavior, especially if they happen at the same time. This combination of symptoms may indicate a beta-blocker overdose.
  • Recurring episodes of low blood sugar. Left untreated, long-term low blood sugar can lead to brain damage.

A note from the Cleveland Clinic

Beta blockers are a widely used, commonly prescribed class of drugs. They can treat a variety of issues, from high blood pressure and heart problems to preventing migraines and anxiety attacks. Although they have been in use for decades, there are still cases where they are not the best choice. It's a good idea to talk to your doctor about any concerns or questions you may have. They can answer your questions and help you make the best use of these medications.

(Video) Side effects of beta blockers in easy way


What are the 4 types of beta blockers? ›

Metoprolol (Lopressor, Toprol XL) Nadolol (Corgard) Nebivolol (Bystolic) Propranolol (Inderal, InnoPran XL)

What are the uses and side effects of beta blockers? ›

Key takeaways:
  • Beta blockers are most commonly used to treat high blood pressure and other heart-related problems.
  • Some common side effects of beta blockers include a slow heart rate, low blood pressure, and dizziness. ...
  • Serious side effects of beta blockers, like heart block and difficulty breathing, are rare.
Sep 13, 2022

Which beta-blocker has the least amount of side effects? ›

There's not really one beta blocker that is least likely to cause side effects. Some experts believe that the cardioselective beta blockers may have a lower risk of certain side effects (e.g., fatigue, cold hands and feet), but there is no clear agreement amongst experts about this.

What type of patient would use beta blockers why are they used? ›

Beta-blockers may be used to treat: angina – chest pain caused by narrowing of the arteries supplying the heart. heart failure – failure of the heart to pump enough blood around the body. atrial fibrillation – irregular heartbeat.

What is the most popular beta-blocker? ›

Top 10 beta blockers by 2021 prescriptions
RankDrug nameNumber of prescriptions 2021
1Metoprolol succinate18,644,320
2Metoprolol tartrate11,287,317
6 more rows

What is the best beta-blocker on the market? ›

Propranolol and atenolol have been studied most intensely in hypertension. For secondary prevention of myocardial infarction, the evidence is best for timolol. Sotalol is probably the best antiarrhythmic among the beta-blockers.

What are serious side effects of beta-blockers? ›

It happens rarely, but some people have serious side effects when taking beta blockers. Tell a doctor straight away if you have: shortness of breath and a cough that gets worse when you exercise (like walking up stairs), swollen ankles or legs, or an irregular heartbeat – these can be signs of heart problems.

Do all beta-blockers have side effects? ›

Common side effects of all beta-blockers include: Slow heart rate (bradycardia). Low blood pressure (hypotension). Irregular heart rhythms (arrhythmias).

What are the dangers of taking metoprolol? ›

Metoprolol may worsen the symptoms of heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort, dilated neck veins, extreme fatigue, irregular breathing or heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, or weight gain.

What beta-blocker is better than metoprolol? ›

Coreg (carvedilol) is an agent with some alpha-blocker activity in addition to its non-selective beta-blockade and is an alternative beta-blocker for the management of HFrEF. Carvedilol is preferred over immediate-release metoprolol for this condition given its demonstration of a greater reduction in mortality.

Is there a beta-blocker that doesn't cause weight gain? ›

Weight gain is more likely with older beta blockers, such as atenolol (Tenormin) and metoprolol (Lopressor, Toprol-XL). Newer beta blockers, such as carvedilol (Coreg), don't usually cause weight gain as a side effect.

Why are beta blockers not recommended? ›

There are some conditions in which beta blockers are not recommended. This includes uncontrolled heart failure, hypotension (low blood pressure), certain problems with the rhythm of your heart, or bradycardia (a very slow heart beat).

What to avoid with beta blockers? ›

While on beta-blockers, you should also avoid eating or drinking products that have caffeine or taking over-the-counter cough and cold medicines, antihistamines, and antacids that contain aluminum. You should also avoid drinking alcohol, because it can decrease the effects of beta-blockers.

What is a natural beta blocker? ›

Fish, garlic, berries, and certain vitamins and amino acids are all natural sources of beta-blockers. Doctors usually prescribe beta-blockers to treat cardiovascular conditions such as angina and hypertension, which is also known as high blood pressure.

Are beta blockers a serious medication? ›

Beta blockers are generally safe to take. Side effects tend to be annoying, not life-threatening.

Which beta-blocker is prescribed for anxiety? ›

1. About propranolol. Propranolol belongs to a group of medicines called beta blockers. It's used to treat heart problems, help with anxiety and prevent migraines.

What is a better drug than metoprolol? ›

Carvedilol may lower blood pressure more than metoprolol. This is because carvedilol has vasodilating properties that help relax blood vessels and lower blood pressure.

Which beta-blockers don t cause fatigue? ›

Cardioselective beta-blockers, e.g. bisoprolol and metoprolol succinate, are less likely to cause fatigue and cold extremities than non-selective beta-blockers. However, peripheral vasoconstriction may still occur due to the reduction in cardiac output.

How long can you stay on beta-blockers? ›

Guidelines recommend beta blocker therapy for three years, but that may not be necessary. Beta blockers work by blocking the effects of the hormone epinephrine, also called adrenaline. Taking beta blockers reduces your heart rate and blood pressure. This eases the workload on your heart and improves blood flow.

Is anxiety a side effect of beta-blockers? ›

They are a common treatment for cardiovascular diseases, including heart failure, arrhythmias, chest pains and high blood pressure. Researchers have suspected beta-blockers of having negative psychological side effects, including depression, anxiety, drowsiness, insomnia, hallucinations and nightmares.

Can beta-blockers damage heart? ›

It turned out that users of beta-blockers or antiplatelet medications were likelier to have heart attacks during the hottest days compared to control days. Antiplatelet medication use was associated with a 63% increase in risk and beta-blockers with a 65% increase. People taking both drugs had a 75% higher risk.

What are the most common side effects of metoprolol? ›

Common side effects
  • Headaches. Make sure you rest and drink plenty of fluids. ...
  • Feeling tired, dizzy or weak. If metoprolol makes you feel dizzy or weak, stop what you're doing, and sit or lie down until you feel better. ...
  • Cold hands or feet. ...
  • Feeling sick (nausea) ...
  • Stomach pain.

Can you be on metoprolol for life? ›

Treatment with metoprolol is usually long term, possibly even for the rest of your life. Stopping metoprolol suddenly can make your condition worse, so talk to your doctor first. If you're bothered by any side effects, your doctor may be able to prescribe a different medicine for your heart problems.

What drugs should not be taken with metoprolol? ›

Conclusion: Metoprolol should not be used concomitantly with paroxetine, fluoxetine or bupropion due to extensive interactions and the risk of serious adverse effects.

Is memory loss a side effect of metoprolol? ›

Mental confusion and short-term memory loss have been reported. Headache, nightmares, and insomnia have also been reported.

What is the first drug of choice for atrial fibrillation? ›

Beta blockers and calcium channel blockers are the drugs of choice because they provide rapid rate control. These drugs are effective in reducing the heart rate at rest and during exercise in patients with atrial fibrillation.

Why is metoprolol preferred? ›

Metoprolol showed a more significant reduction in risk of cardiovascular mortality as compared to atenolol. Metoprolol also showed a decreased trend for all-cause mortality and coronary heart disease.

Which is safer carvedilol or metoprolol? ›

Carvedilol used to be the preferred treatment for heart failure, but now a long-acting metoprolol succinate is an equally good option. But if you have diabetes or prediabetes, carvedilol may be the best option. And if you have asthma, metoprolol is often the better choice.

Can you exercise when on beta-blockers? ›

Beta blockers slow the heart rate, which can prevent the increase in heart rate that typically occurs with exercise. This means that it might not be possible for you to reach your target heart rate — the number of heartbeats per minute you typically aim for to ensure you're exercising hard enough.

What are the newer beta-blockers? ›

Among newer agents, labetalol, carvedilol, and nebivolol have been approved for use in the United States. Nebivolol possesses both beta1-selectivity and nitric oxide-mediated vasodilatory effects, while carvedilol has attractive effects on insulin resistance and exhibits antioxidant effects.

Do beta-blockers cause fatigue? ›

β-Blockers were associated with a small significant annual increase in risk of reported fatigue (18 per 1000 patients; 95% CI, 5-30), equivalent to 1 additional report of fatigue for every 57 patients treated per year with β-blockers.

Is it OK to take beta-blockers occasionally? ›

Yes. When used for performance anxiety and social anxiety, propranolol can be taken only when it's needed. Many people use propranolol as needed before public speaking events, meetings or other stressful, anxiety-inducing situations.

Why are beta-blockers not recommended for people over 60? ›

It is argued that the use of beta blockers in older adults may not be justified because of physiologic changes in people over 60 years of age. These include a low cardiac output, bradycardia, high total peripheral resistance, reduced renal blood flow and glomerular filtration rate, and low plasma renin activity [18].

What medications should not be taken with beta-blockers? ›

beta-Blockers may interact with a large number of commonly prescribed drugs, including antihypertensive and antianginal drugs, inotropic agents, anti-arrhythmics, NSAIDs, psychotropic drugs, anti-ulcer medications, anaesthetics, HMG-CoA reductase inhibitors, warfarin, oral hypoglycaemics and rifampicin (rifampin).

Is lisinopril considered a beta blocker? ›

No. Lisinopril is not a beta blocker. It's an ACE inhibitor. This medication class is described earlier in this article.

What to avoid with beta-blockers? ›

While on beta-blockers, you should also avoid eating or drinking products that have caffeine or taking over-the-counter cough and cold medicines, antihistamines, and antacids that contain aluminum. You should also avoid drinking alcohol, because it can decrease the effects of beta-blockers.

Why you shouldn't take beta-blockers? ›

There are some conditions in which beta blockers are not recommended. This includes uncontrolled heart failure, hypotension (low blood pressure), certain problems with the rhythm of your heart, or bradycardia (a very slow heart beat).

Is there an alternative to beta-blockers? ›

Other drug classes used to treat similar conditions as beta-blockers include angiontenin-converting enzyme inhibitors, (ACEIs), angiotensin II receptor blockers (ARBs), aldosterone antagonists, calcium channel blockers (CCBs), vasodilators, diuretics, and medications which control the heart rate or heart rhythm.

What are the long term side effects of beta-blockers? ›

Long-term side effects of beta-blockers may include disorientation, short-term memory loss, emotional lability (rapid, extreme changes in mood), inability to concentrate or think clearly, and decreased performance on neuropsychological tests used to measure a psychological function.

What are the dangers of taking lisinopril? ›

Side effects of lisinopril
  • A dry, tickly cough that does not get better. ...
  • Feeling dizzy or lightheaded, especially when you stand up or sit up quickly. ...
  • Headaches. ...
  • Being sick (vomiting) ...
  • Diarrhoea. ...
  • Itching or a mild skin rash. ...
  • Blurred vision.

Is lisinopril safer than metoprolol? ›

Thus both metoprolol and lisinopril were effective and safe in the treatment of mild to moderate essential hypertension with lisinopril being better tolerated.

What is the first drug of choice for hypertension? ›

Choice of initial therapy in most patients — The three primary options for antihypertensive drug therapy in most patients include an ACE inhibitor (or ARB), a calcium channel blocker, or a thiazide diuretic (preferably a thiazide-like diuretic) [3].

Do beta blockers weaken the heart? ›

Beta-blockers make your heart work less hard. This lowers your heart rate (pulse) and blood pressures. If your heart is weakened, certain beta-blockers can protect your heart and help it get stronger.

Is it OK to take beta blockers daily? ›

If you take beta-blockers regularly, you may have serious withdrawal symptoms if you suddenly stop. For some people, the side effects of beta-blockers may actually cause anxiety symptoms. You should follow up with your doctor as soon as possible if you feel like taking beta-blockers is increasing your anxiety.

Can you take vitamin D with beta-blockers? ›

No interactions were found between propranolol and Vitamin D3.

Can you have caffeine while on beta-blockers? ›

The Texas Heart Institute notes that you should avoid drinking or be eating caffeinated foods, drinks or prescriptions while on beta blockers.

Can I take Tylenol with a beta blocker? ›

Interactions between your drugs

No interactions were found between metoprolol and Tylenol.


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