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Beta-blockers

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Beta-blockers



Introduction 

Beta-blockers, also known as beta-adrenoceptor blocking agents, are medications used to treat conditions such as angina, heart failure and high blood pressure.

They decrease the activity of the heart by blocking the action of hormones like adrenaline.

Beta-blockers are prescription-only medicines (POMS), which means they can only be prescribed by a GP or other suitably qualified healthcare professional.

 

When are beta-blockers used?

Beta-blockers may be used to treat:



angina – chest pain caused by narrowings of the arteries supplying the heart 



heart failure – failure of the heart to pump enough blood around the body 



atrial fibrillation – irregular heartbeat 



heart attack – an emergency where the blood supply to the heart is suddenly blocked



high blood pressure – when other medicines have been tried



Less commonly, beta-blockers are used to prevent migraine or treat:



an overactive thyroid (hyperthyroidism)



anxiety conditions



tremor



glaucoma – as eye drops 



There are several types of beta-blocker, and each one has its own characteristics. The type prescribed for you will depend on your condition.

 

Things to consider

There are several things to consider before taking beta-blockers.

Make sure you tell your doctor if you have a history of:



asthma or any type of lung disease



heart disease



kidney disease



diabetes – particularly if you have frequent episodes of low blood sugar



allergic reaction to any medication



Your GP can advice you about which medicine to use if you're pregnant or breastfeeding. It's important not to stop taking beta-blockers without seeking your GP's advice. In some cases, suddenly stopping the medicine may make your condition worse.

Ask your GP or pharmacist if you're not sure whether other medicines are safe to take with beta-blockers.

You may experience side effects while taking beta-blockers, including:



dizziness



tiredness



blurred vision



cold hands and feet



slow heartbeat



diarrhoea and nausea



Less common side effects include:



insomnia (sleep disturbance)



loss of libido (sex drive)



depression



Missed or extra doses

With the exception of special beta-blockers for use during pregnancy, and Sotalol which is given twice or three times a day, most beta-blockers are taken once a day.

If you forget to take a dose of beta-blockers, follow the general advice below:



If it's more than eight hours from your next dose, take the dose you missed.



If it's less than eight hours from your next dose, you can skip it, but make sure you take the next dose.



If you're not sure what to do about your dose, check the patient information leaflet that comes with your medicine. It should include advice about what to do.

 





Cardiac risk assessment

Find out how a cardiovascular risk assessment can detect whether you're at risk of heart disease.


Media last reviewed: 14/05/2013

Next review due: 14/05/2015







Names of beta-blockers

Examples of commonly used beta-blockers include:



acebutolol (Sectral)



atenolol (Tenormin)



bisoprolol (Cardicor, Emcor)



carvedilol 



metoprolol (Betaloc, Lopresor)



nadolol (Corgard)



nebivolol (Nebilet)



propranolol (Inderal)



See beta-blockers medicines information for a full list.






Pharmacy and medicines

Using your local pharmacy's services could save you an unnecessary trip to your GP

Uses of beta-blockers 

Beta-blockers block the action of hormones like adrenaline in certain parts of the body.

Angina

Beta-blockers are particularly important for people with angina (chest pain caused by narrowing of the arteries to the heart), or for those who have had a heart attack.

They slow the heart down, help it pump more effectively and give it more time to receive its own blood supply. It helps prevent angina attacks and reduces your risk of having another heart attack if you've already had one.

Rhythm problems

Beta-blockers can also control irregular heartbeats by blocking or slowing the electrical nerve impulses that stimulate the heart.

This decreases the activity of the heart, and can also slow heart rate and prevent rhythm problems, such as atrial fibrillation.

Heart failure

Beta-blockers are also commonly used to treat heart failure. They help the heart pump more strongly and efficiently, and they also reduce rhythm problems. Patients then feel better and live longer.

 

Other uses

Beta-blockers are also sometimes used to prevent migraine or treat:



an overactive thyroid (hyperthyroidism)



anxiety conditions



tremor



glaucoma



Special considerations 

Before taking beta-blockers, make sure your doctor is aware of any other conditions you have, because they may not be suitable to use.

When to avoid them

You should usually avoid taking beta-blockers if you have:



a history of asthma – beta-blockers are occasionally used in people with these conditions, but only under careful supervision



heart block – where the heart beats slower than usual



severe narrowing of the arteries to the legs or arms



Make sure your doctor is aware if you have a history of allergic reaction to any medication.

Using them with caution

Beta-blockers should be used with caution if you have:



diabetes – particularly if you have frequent episodes of low blood sugar



myasthenia gravis – a condition that causes muscle weakness 



slow heart rate



phaeochromocytoma – high blood pressure caused by a tumour of the adrenal gland



Prinzmetal's angina – a type of chest pain 



Pregnancy and breastfeeding

Some beta-blockers may be suitable for use in some stages of pregnancy and during breastfeeding.

Your GP can advise you about which medicine to use if you're pregnant or breastfeeding.

Stopping beta-blockers

You shouldn't stop taking beta-blockers without first consulting a doctor who is aware of your medical conditions. Suddenly stopping the medicine may cause your condition to get worse.

Side effects of beta-blockers 

Most people taking beta-blockers have either no or very mild side effects.

Although there are often many side effects listed on the patient information leaflets that come with the medicine, they usually include all of the symptoms that have been reported by people taking beta-blockers – some of which may have occurred naturally.

Contact your GP if you're experiencing symptoms that affect your everyday life. They can discuss with you whether the symptoms are a result of the medication, and what to do.

Symptoms that are commonly reported both by people taking beta-blockers and those taking a placebo (dummy medication) include:



dizziness



tiredness



blurred vision



cold hands and feet



slow heartbeat



diarrhoea and nausea



Less common symptoms include:



insomnia (sleep disturbance)



loss of libido (sex drive)



depression



impotence – in men, problems getting or maintaining an erection



Driving

Beta-blockers are unlikely to affect your ability to drive safely. However, don't drive if you feel dizzy, tired or if your vision is affected.

 


Yellow Card Scheme

The Yellow Card Scheme allows you to report symptoms from any type of medicine you're taking.

It's run by the Medicines and Healthcare products Regulatory Agency (MHRA) – the medicines safety watchdog.

Interactions with other medicines 

When two or more medicines are taken at the same time, the effects of one medicine can be altered by the other.

This is sometimes known as a "drug-drug interaction". Beta-blockers, including beta-blocker eye drops, can interact with other medicines.

Some of the more common interactions are listed below. However, this isn't a complete list.

Read the patient information leaflet that comes with your medicine to check that it's safe to take with beta-blockers. If you're still unsure, you could also ask your GP or pharmacist.

Anti-arrhythmics

Anti-arrhythmics are medicines that control irregular heartbeats. They usually slow the heart down. When taken with beta-blockers, which also slow the heart, there's a small risk of the heart beating too slowly.

Antihypertensives

Antihypertensives are medicines that are used to lower blood pressure. They can cause low blood pressure (hypotension) when taken with beta-blockers.

Antipsychotics

Antipsychotics are medicines used to treat severe mental health problems. Some types of beta-blockers, such as Sotalol, can increase the risk of arrhythmias if they're used by people taking antipsychotics.

Other medication

Some other medicines that are known to interact with beta-blockers are listed below:



Clonidine is a medicine used to treat high blood pressure and migraine. Rebound hypertension (a sharp and sudden rise in blood pressure) can occur if you stop taking clonidine while taking a beta-blocker.



Mefloquine can cause a slow heart rate when used with beta-blockers.



Missed or extra doses 

If you miss or take an extra dose of your beta-blockers, read the patient information leaflet that comes with the medication.

It should include advice about what to do. If you're still unsure, ask your GP or pharmacist.

Missed doses

Most beta-blockers are taken once a day, apart from special beta-blockers that are used during pregnancy and Sotalol, which is given two or three times a day.

If you forget to take a dose of beta-blockers you should:



take the dose you missed if it's more than eight hours from your next dose



skip it if it's less than eight hours from your next dose, but make sure you take the next dose



If you're not sure what to do, check the patient information leaflet that comes with your medicine. It should include advice about what to do.

Your GP or pharmacist can also give you further advice.

Extra doses






Beta-blockers