Beta-blockers: types, side effects, and interactions

Beta-blockers: types, side effects, and interactions

Beta-blockers slow the heart beat to treat conditions in which the heart is under stress.

Beta-blockers are medicines that work by temporarily stopping or reducing the body's natural 'fight-or-flight' responses.

In turn, they reduce stress on certain parts of the body, such as the heart and the blood vessels in the brain. They lower blood pressure, protect against heart attacks, and can improve the outlook for people with heart failure.

They are prescribed for several different conditions including high blood pressure, angina, some abnormal heart rhythms, heart, anxiety, migraine, glaucoma, and overactive thyroid symptoms.

They are also sometimes known as beta antagonists, beta-adrenergic blocking agents, or beta-adrenergic antagonists.

Pharmacologist James Black won the Nobel Prize in Physiology and Medicine for his development in 1964 of the first receptor-blocking drug, propranolol, which is still in use today.

  • Beta-blockers are prescribed in conditions where the heart rate needs to be slowed.
  • Doctors commonly recommend beta-blockers for patients with irregular heartbeats, angina, and high blood pressure.
  • Beta-blockers also offer relief for glaucoma, overactive thyroid, and anxiety.
  • There are many different brands of beta-blocker.
  • Taking beta-blockers can cause dizziness, cold hands and feet, weight gain, and fatigue.

How do they protect the heart?

Beta-blockers block the hormones adrenaline and noradrenaline in the sympathetic nervous system.

The sympathetic nervous system is part of the autonomic nervous system. It activates the 'fight-or-flight' response.

Adrenaline and noradrenaline prepare the muscles in the body for exertion. This is a crucial part of responding to danger.

Overexposure to these hormones can be harmful. Too much adrenaline can lead to rapid heartbeat, high blood pressure, excessive sweating, anxiety, and palpitations.

Blocking the release of these hormones blockers decreases the oxygen demands and reduces stress on the heart.

This lowers the force of the contractions of the heart muscles, and of blood vessels in the heart, the brain, and the rest of the body.

Beta-blockers also obstruct the production of angiotensin II, a hormone produced by the kidneys.

Reducing the amount of angiotensin relaxes and widens the blood vessels, easing the flow of blood through the vessels.

Beta-blockers are used to treat the following:

  • Angina, or chest pain
  • Heart failure
  • Hypertension, or high blood pressure
  • Atrial fibrillation, or irregular heartbeat
  • Myocardial infarction, or heart attack

Other uses

Beta-blockers can help to relieve the 'fight-or-flight' reactions that fuel anxiety.

Less commonly, they may be used for migraines, glaucoma, overactive thyroid, tremors, and anxiety.


The high pressure within the eyeball is reduced using beta-blocker eye drops. The medication lowers the production of fluid inside the eyeball.


Beta-blockers block the effects of stress hormones. As a result, they can also reduce the physical symptoms of anxiety such as trembling and sweating.

A person experiencing persistent anxiety, however, may also need additional treatment, such as counseling.

Hyperactive thyroid and tremor

Beta-blockers can reduce symptoms such as tremor and slow the heart rate of patients with an overactive thyroid.

Types and brands

Beta-blockers can be selective or non-selective. Selective beta-blockers mostly affect the heart, while non-selective ones affect other parts of the body.

Here are some common types and brands of beta-blockers:

  • acebutolol (Sectral, brand discontinued)
  • atenolol (Tenormin)
  • betaxolol (Kerlone, brand discontinued)
  • bisoprolol (Cardicor, Emcor, Zebeta all brands discontinued)
  • metoprolol (Lopressor, Toprol XL)
  • nadolol (Corgard)
  • propranolol (Inderal LA, Inderal XL, Hemangeol, InnoPran XL)
  • timolol ophthalmic solution (Betimol, Istalol, Timoptic)

Side effects

The most common side effects of beta-blockers are:

  • cold feet and hands
  • fatigue
  • nausea, weakness, and dizziness
  • dry mouth, skin, and eyes
  • slow heartbeat
  • swelling of the hands and feet
  • weight gain

The following less common side effects are also possible:

  • sleeping difficulties and disturbances
  • erectile dysfunction
  • abdominal cramps
  • constipation
  • diarrhea
  • depression, memory loss, or confusion
  • back or joint pain

Patients who feel dizzy or fatigued should not drive.


People with asthma should advise their doctor before taking beta-blockers.

People should advise their doctor if they have a history of the following before taking beta-blockers:

  • asthma
  • bronchospasm
  • severe peripheral arterial disease, including Raynaud's syndrome
  • slow heart rate
  • uncontrolled heart failure

Beta-blockers can be taken by those with stable heart failure.

Patients with diabetes, especially hypoglycemia, or low blood sugar, should monitor their blood sugar regularly, as beta-blockers can obstruct signs of low blood sugar, such as rapid heart beat.

Some types of beta-blockers may be used during pregnancy if advised by a doctor.

Interactions with other drugs

Beta-blockers, like all drugs, can interact with a number of other medications.

As long ago as 1995, it was found that beta-blockers could interact with a range of common medications.

These include:

  • Anti-hypertensives
  • Anti-anginal drugs
  • Anti-arrhythmics
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Anti-ulcer medications
  • Anesthetics
  • Warfarin
  • HMG-CoA reductase inhibitors

Different beta-blockers can have different interactions.

A pharmacist or doctor will be able to provide a comprehensive and up-to-date list of beta-blocker interactions.

Always advise your treating doctor of any other courses of medication currently being followed.

Stopping a course of beta-blockers

Patients must not suddenly stop taking beta-blockers without their doctor's advice and close supervision.

Suddenly ceasing beta-blocker treatment may worsen the patient's condition, especially after a heart attack, or during the treatment of angina.

Beta blockers types and side effects - Dr. Ranjan Shetty (Video Medical And Professional 2020).

Section Issues On Medicine: Cardiology