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Beta-blockers

Beta-blockers are medicines which make your heart beat more slowly and with less force. They’re used to treat a wide variety of conditions including angina, arrhythmia, high blood pressure, heart failure, heart attack, glaucoma and anxiety.

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  • When to take beta-blockers When to take beta-blockers

    Your doctor may offer you beta-blockers if you have a heart condition, such as:

    Your doctor may also suggest beta-blockers to:

    • help manage the symptoms of an overactive thyroid gland
    • treat glaucoma (an eye condition caused by a build-up of pressure in your eye)
    • lessen tremor (an uncontrollable trembling in part of your body) – especially for a condition known as essential tremor
    • reduce the number of attacks you have if you get migraine

    Beta-blockers are also used to relieve the physical symptoms of anxiety.

    There’s a lot of information about beta-blocker medicines in this topic but it’s not possible to cover every medical situation. If there are things you don’t understand, or if you still have questions about your medication, ask your doctor or your pharmacist. Sometimes it helps to prepare questions before you see your doctor, perhaps writing them down.

  • How they work How do beta-blockers work?

    Beta-blockers work by blocking the effects of hormones called noradrenaline and adrenaline. They affect the way your heart works by slowing it down and making it beat with less force. This means it doesn’t have to work so hard and is helpful if you have angina. Angina is when the blood supply to your heart isn’t enough to cope when your heart beats fast.

    Beta-blockers can also help to reduce your blood pressure, although doctors aren’t completely sure how they do this.

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  • Taking the medicine How to take beta-blockers

    Beta-blockers are only available on prescription from a doctor. The type of beta-blocker your doctor offers you will depend on why you need them. They come as:

    • tablets or capsules
    • syrup or solution
    • injections
    • eye drops (for glaucoma)

    The effects of some beta-blockers don’t last very long. So if you need beta-blocker tablets to help control a long-term condition, you may need to take them once or twice a day. Always follow the instructions your doctor or pharmacist gives you about when to take your medicines. If you’re not sure, your pharmacist will be happy to answer your questions.

    Depending on what your medical condition is, your doctor may prescribe beta-blockers in combination with other drugs such as calcium channel blockers.

    Don’t stop taking your beta-blocker medicine suddenly as this may make your symptoms worse. If you need to stop taking them, your doctor will tell you how to reduce your dose gradually.

    Make sure you read the patient information leaflet that comes with your medicine.

  • Special care Special care

    Beta-blockers may affect other parts of your body, such as your lungs and muscles.

    Your doctor may not prescribe you a beta-blocker, or will need to monitor you closely, if you have:

    Ask your doctor or pharmacist when you see them, if you’d like to know more.

  • Side-effects Side-effects of beta-blockers

    Like all medicines, beta-blockers can cause side-effects, but these aren’t usually serious. You may have some minor side-effects with beta-blockers but these tend to lessen over time as your body gets used to them.

    This section doesn’t include every possible side-effect of beta-blockers. Please read the patient information leaflet that comes with your medicine for more details. The following are some of the more common side-effects.

    • Tiredness. You may notice this most when you first start taking beta-blockers or if your dose is increased.
    • Cold hands and feet. You may need to wear gloves and thick socks in cold weather.
    • A slow heart rate and dizziness. One of the ways in which beta-blockers work is to slow down your heart rate. If it becomes too slow, you may feel dizzy. If you’re worried that your heart rate is too slow, see your doctor.

    Other side-effects can include:

    • sleep disturbance, including nightmares
    • problems for men in getting an erection (impotence)
    • visual disturbances

    If you have side-effects from your beta-blocker medicine, it’s important to talk to your doctor rather than just stop taking it. They may suggest changing the dosage or your medicine.

  • Interactions Interactions of beta-blockers with other medicines

    Beta-blockers can interact with certain other medicines, including some heart medicines, and this causes problems. These include hypotension – abnormally low blood pressure. Your doctor will make sure that the medicines they prescribe are suitable together.

    Always check with your doctor or pharmacist before you take any other medicines at the same time as a beta-blocker.

  • Common names Names of common beta-blockers

    All medicines have a generic name. Many medicines also have one or more brand name. Generic names are in lower case, whereas brand names start with a capital letter. The main types of beta-blocker are shown in the table.

    Generic names

    Examples of common brand names

    acebutolol Sectral
    atenolol Tenormin
    bisoprolol Cardicor
    carvedilol Eucardic
    celiprolol Celectol
    esmolol Brevibloc
    labetalol Trandate
    metoprolol Betaloc
    nadolol Corgard
    nebivolol Nebilet
    oxyprenolol Trasicor
    pindolol Visken
    propranolol Inderal-LA
    sotalol Beta-Cardone
    timolol Betim
  • FAQ: Alcohol and beta-blockers Can I drink alcohol when taking beta-blockers?

    If your doctor has prescribed beta-blockers, you should always check with them whether it’s safe for you to drink alcohol and how much.

    Explanation

    Beta-blockers slow down your heart rate and cause it to beat with less force. This lowers your blood pressure. If you drink while you’re taking beta-blockers your blood pressure can drop even further. This may make you feel dizzy and you might even faint. So it’s important to be careful about how much alcohol you’re drinking if you’re taking beta-blockers.

  • FAQ: Beta-blockers and high blood pressure If beta-blockers reduce blood pressure, why aren’t they generally used to treat high blood pressure?

    Although they do reduce blood pressure, beta-blockers are not used as the first choice to treat high blood pressure (hypertension). This is because there are other medicines that work better at reducing the complications of high blood pressure including stroke and heart attack.

    More information

    Your doctor will probably offer you medicines such as diuretics, angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers if you have high blood pressure. They work better than beta-blockers at preventing heart attack and stroke.

    Your doctor will usually only suggest beta-blockers as a treatment for your high blood pressure if:

    • you’re under 55
    • you find you can’t tolerate other types of blood pressure medication
    • you’re a woman trying to get pregnant
    • you have other heart problems such as angina, or have had a previous heart attack or arrhythmia
  • FAQ: Stopping beta-blockers Why should beta-blockers be stopped gradually?

    Beta-blockers affect the way your heart works by slowing it down and causing it to beat with less force. Your body gets used to this, so it can be harmful if you stop taking beta-blockers suddenly. Always ask your doctor or pharmacist for information and advice before you stop taking any regular medicines.

    More information

    If you stop beta-blockers abruptly, your blood pressure may go up suddenly and you may get irregular heart rhythms (palpitations). If you take beta-blockers to treat angina (chest pain), stopping your medicine abruptly could make your chest pain worse.

    If you want to stop taking your beta-blockers, for example, because they cause unpleasant side-effects, talk to your doctor for advice. They may be able to give you a different medicine to try while you slowly stop the beta-blocker. You will probably need to take smaller doses of your beta-blocker over a few weeks until you stop completely.
  • FAQ: Beta-blockers and exercise Will taking a beta-blocker affect my ability to exercise?

    Beta-blockers work by reducing your heart rate and the force with which your heart beats. When you exercise on beta-blockers your heart rate will go up, but not as much as it would without them. If you’re training this means that you’ll probably have to aim for a lower target heart rate. Or you might need to use other ways of monitoring how hard you’re working. If you’re taking beta-blockers for angina you’ll usually find that you can tolerate more exercise before you get chest pains. Check with your doctor before starting, or changing an exercise regime while on beta-blockers.

    More information

    Taking regular exercise is good for you – it helps keep your body healthy and your mind well. If you’re taking beta-blockers you may find that these affect the way your body responds to exercise but it’s still important to stay active.

    Beta-blockers work by reducing the speed at which your heart beats, and also lessening the force of each heart beat. Since your body responds to exercise by increasing your heart rate, it’s to be expected that taking a beta-blocker will affect this response.

    When you first start taking a beta-blocker you might find that you feel very tired and less like taking exercise. This should pass as your body gets used to the medicine.

    You’ll probably notice a difference in your body’s response to exercise, especially if you’re training or exercising to become fitter. You may be used to aiming for a target heart rate to show that your body is working hard enough. When you take a beta-blocker your heart rate won’t go as high as before, so you won’t reach this target any more. It’s important to know this so that you don’t push yourself too hard trying to reach it.

    Instead, you could monitor the intensity of your exercise by checking to see how tired you’re getting. Aim to exercise to the point of being tired, but still be able to carry out a conversation.

    If you’re taking beta-blockers for angina (chest pain on exertion) you’ll probably notice that you can actually do more exercise before you get symptoms.

    If you’re concerned about the effects of your medicines on how well you can exercise, talk to your doctor. They may be able to make changes to your medication that might help.

  • FAQ: Beta-blockers and weight gain Will taking beta-blockers make me put on weight?

    Some people do put on weight when they take beta-blockers. This is most likely to happen in the first few months after you start them. Weight gain may be linked to changes in how active you are and the way the medicine affects your metabolism. If you’re worried about putting on weight while on beta-blockers, speak with your doctor.

    More information

    One of the side effects you may get with beta-blockers is to gain a little weight. The average weight gain is around 1.2kg (just over two and a half pounds) and it tends to be gained in the first few months.

    It’s not clear exactly why people who take some beta-blockers put on weight. It’s probably due to a number of different factors acting together. Beta-blockers affect the way your metabolism works, including the way your tissues deal with sugar and fat. Taking beta-blockers can also make you tired, which may lead to you resting more and being less active.

    Not all beta-blockers are linked to weight gain. For instance, one research study showed that people who take the beta-blocker carvedilol didn’t put on extra weight while the people who took metoprolol did.

    If you’re worried about gaining weight while you’re taking a beta-blocking medicine, speak with your doctor. They’ll be able to give you advice on losing excess weight safely. They might also be able to change your medication. It’s important that you don’t just stop taking your beta-blocker as that could be harmful (see our FAQ above).

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 5 August 2015 (online version)
    • Drugs for the heart. Oxford handbook of cardiology (online). Oxford Medicine Online. www.oxfordmedicine.com, published May 2012 (online version)
    • Medicines for your heart. British Heart Foundation. www.bhf.org.uk, published 8 January 2014
    • Heart matters: Beta blockers. British Heart Foundation. www.bhf.org.uk, accessed 5 August 2015
    • Beta-blockers. Blood pressure UK. www.bloodpressureuk.org, published May 2009
    • Heart and stroke encyclopedia. American Heart Association. www.heart.org, accessed 5 August 2015
    • Anti-arrhythmic drugs. PatientPlus. Patient.co.uk/patientplus.asp, published 1 December 2014
    • Migraine prophylaxis in adults. PatientPlus. www.patient.co.uk/patientplus.asp, published 24 October 2014
    • Map of Medicine. Stable angina. International View. London: Map of Medicine; 2015 (Issue 2)
    • Map of Medicine. Atrial fibrillation. International View. London: Map of Medicine; 2015 (Issue 2)
    • Map of Medicine. Heart failure. International View. London: Map of Medicine; 2014 (Issue 4)
    • Map of Medicine. Glaucoma. International View. London: Map of Medicine; 2014 (Issue 1)
    • Map of Medicine. Acute coronary syndrome (ACS). International View. London: Map of Medicine; 2015 (Issue 2)
    • Map of Medicine. Hypertension. International View. London: Map of Medicine; 2015 (Issue 3)
    • Map of Medicine. Thyroid disorders. International View. London: Map of Medicine; 2012 (Issue 3)
    • Essential tremor. Medscape. www.emedicine.medscape.com, published 23 June 2015
    • Gorre F and Vandekerckhove H. Beta-blockers: focus on mechanism of action. Acta Cardiol 2010; 65(5):565–70. doi:10.2143/AC.65.5.2056244
    • Anxiety and panic attacks. Mind. www.mind.org.uk, published February 2015
    • How do beta blocker drugs affect exercise? American Heart Association. www.heart.org, published July 2015
    • Exercise and medication: how do they interact? Canadian Society for Exercise Physiology. www.csep.ca, published November 2007
    • Physical activity improves quality of life. American Heart Association. www.heart.org, published January 2015
    • Mosenkis A, Townsend RR. Antihypertensive medications and weight gain. J Clin Hypertens 2004; 6:90. doi:10.1111/j.1524-6175.2004.02847.x
    • Sharma A, Pischon T, Hardt S, et al. Hypothesis: β-adrenergic receptor blockers and weight gain. Hypertension 2001; 37:250–54. doi: 10.1161/01.HYP.37.2.250
    • Messerli F, Bell D, Fonseca V, et al. Body weight changes with beta-blocker use: results from GEMINI. Am J Med 2007; 120:610–15. doi:10.1016/j.amjmed.2006.10.017 

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    Reviewed by Dylan Merkett, Bupa Health Content Team, October 2015.

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