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Beta-blockers

Beta-blockers are medicines which make your heart beat more slowly and with less force. There are many different types of beta-blockers. Doctors prescribe them for a wide variety of conditions, although they’re probably most commonly known for treating heart problems.

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When to take beta-blockers

Your doctor may recommend you take 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.

Beta-blockers are used to treat a variety of different conditions, and we can’t cover them all here. If your doctor recommends that you take beta-blockers they’ll explain why. Don’t be afraid to ask them questions or to clarify anything that you don’t understand.

How do beta-blockers work?

Beta-blockers get their name from the way they work. They block certain hormones (adrenaline and noradrenaline) from attaching to some of their target sites, called beta receptors.

There are different types of beta-blockers. Some block beta receptors in the heart and at other places around the body, including the lungs, and blood vessels in your arms and legs. Others, such as atenolol and bisoprolol, block beta receptors more selectively in the heart. They exert most of their effect here, so are less likely to cause changes elsewhere in the body.

For more information on these changes, see our section on side-effects below.

Beta-blockers and the heart

Beta-blockers 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, which is helpful if you have angina. Angina is a pain or tightness in your chest that happens when your heart can’t get enough oxygen. By slowing the heart down it decreases how much oxygen your heart needs. This is particularly helpful to prevent symptoms of angina when exercising. By reducing the work done by your heart, beta-blockers are also used to help protect against further heart attacks.

Beta-blockers can also affect the way electrical signals are passed through your heart, so may be helpful if you have an irregular heart rhythm.

If you have heart failure, your doctor may prescribe beta-blockers. Heart failure is when your heart can’t pump blood around your body properly. Your body sends signals to your heart to make it beat harder. Although this seems helpful, long term, this can damage your heart and make heart failure worse. Beta-blockers block these signals to help protect your heart.

Doctors know that beta-blockers can also help to reduce your blood pressure, although they’re not completely sure how they do this.

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)

Depending on what your medical condition is, your doctor may prescribe beta-blockers in combination with other medicines.

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. For more information about this, see our FAQ below on stopping beta-blockers.

Always follow the instructions your doctor or pharmacist gives you about when to take your medicines. Read the patient information leaflet that comes with your medicine carefully. If you have any questions about your medicines or how to take them, ask your pharmacist.

Can anyone take beta-blockers?

Beta-blockers may affect other parts of your body, such as your lungs and muscles. They aren’t suitable for everyone. Your doctor will need to take into account other medical conditions you may have when deciding to recommend them.

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


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

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.

  • You may feel tired, or even exhausted. This may be most obvious when you first start taking beta-blockers or if your dose is increased.
  • Your hands and feet may feel cold. You may need to wear gloves and thick socks in cold weather.
  • You may feel dizzy, with a slow heart rate. One of the ways in which beta-blockers work is to slow down your heart rate, so it’s to be expected that your heart rate is slow. However, if it becomes too slow, you may feel dizzy. If you’re feeling dizzy on beta-blockers, see your doctor.

Other side-effects can include:

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

Doctors don’t think that beta-blockers cause memory loss.

If you have side-effects from your beta-blocker medicine which concern you, it’s important to talk to your doctor rather than just stop taking it. They may suggest changing the dosage or your medicine. Beta-blockers aren’t addictive – but you do need to be careful not to stop them suddenly. See our FAQ below on why beta-blockers should be stopped gradually.

Interactions of beta-blockers with other medicines

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

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

FAQ: 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.

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: Why aren’t beta-blockers generally used to treat high blood pressure?

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

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.

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

  • 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: 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.

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 them completely.

FAQ: Will taking a beta-blocker affect my ability to exercise?

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. 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.

Beta-blockers work by slowing your heart rate, and 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 exercising, 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: Will taking beta-blockers make me put on weight?

Doctors don’t know for certain, but weight gain isn’t usually a problem with beta-blockers.

Studies have found that some people do put on a little weight when they take beta-blockers. It’s not clear exactly why this may happen. It’s probably due to a number of different factors acting together and may be linked to the underlying condition for which beta-blockers were given. Taking beta-blockers can also make you tired, which may lead to you resting more and being less active. It’s important to keep physically active.

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. It’s important that you don’t just stop taking your beta-blocker as that could be harmful (see our FAQ above).

Details

  • Other helpful websites Other helpful websites

    Further information

    Sources

         
    • Beta-adrenoceptor blocking drugs. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 24 January 2018
    • Propranolol hydrochloride. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 24 January 2018
    • Timolol maleate. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 24 January 2018
    • Interactions – propranolol. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, accessed 24 January 2018
    • Drugs for the heart. Oxford handbook of Cardiology (online). Oxford Medicine Online. www.oxfordmedicine.com, published May 2012 (online version)
    • Hypertension treatment. PatientPlus. patient.info/patientplus, last checked 19 December 2016
    • Wiysonge CS, Bradley HA, Volmink J, et al. Beta-blockers for hypertension. Cochrane Database of Systematic Reviews 2017, Issue 1. doi: 10.1002/14651858.CD002003.pub5
    • Drug cabinet: Beta blockers. British Heart Foundation. www.bhf.org.uk, accessed 24 January 2018
    • Medicines for my heart. British Heart Foundation 2017. www.bhf.org.uk
    • Anxiety and panic attacks. Mind. www.mind.org.uk, published September 2017
    • Essential tremor. Medscape. www.emedicine.medscape.com, updated 27 November 2017
    • How do beta blocker drugs affect exercise? American Heart Association. www.heart.org, updated 22 August 2017
    • 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
    • Mosenkis A, Townsend RR. Antihypertensive medications and weight gain. J Clin Hypertens 2004; 6:90. doi:10.1111/j.1524-6175.2004.02847
    • 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
    • Personal communication, Dr Tim Cripps, Consultant Cardiologist, January 2018
    • Prescriptions dispensed in the community, statistics for England 2005–2015. National Statistics. digital.nhs.uk, published July 2016
    • Angina. Clinical knowledge Summaries. cks.nice.org.uk, last revised January 2017
    • Kezerashvili A, Marzo K, De Leon J. Beta blocker use after acute myocardial infarction in the patient with normal systolic function: when is it "OK" to discontinue. Curr Cardiol Rev. 2012; 8(1):77–84. doi: 10.2174/157340312801215764
    • Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published November 2013
    • Kishi T. Heart failure as an autonomic nervous system dysfunction. J Cardiol 2012 59(2):117–22. doi:10.1016/j.jjcc.2011.12.006
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    Reviewed by Dr Kristina Routh, Freelance Health Editor, February 2018
    Expert reviewer Dr Tim Cripps, Consultant Cardiologist
    Next review due February 2021

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