Natural Beta Blockers

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

Beta blockers

They are prescription-only medicines, which means they can only be prescribed by a GP or another suitably qualified healthcare professional.

Commonly used beta blockers include:

atenolol (also called Tenormin)
bisoprolol (also called Cardicor or Emcor)
carvedilol
labetalol (also called Trandate)
metoprolol (also called Betaloc or Lopresor)
propranolol (also called Inderal or Angilol)
sotalol

Uses for beta blockers

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
heart attack – an emergency where the blood supply to the heart is suddenly blocked
high blood pressure – when other medicines have been tried, or in addition to other medicines

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

an overactive thyroid (hyperthyroidism)
anxiety
tremor
glaucoma – as eyedrops

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

Who can take beta blockers

Beta blockers are not suitable for everyone. Tell your doctor if you have:

uncontrolled heart failure
had an allergic reaction to a beta blocker or any other medicine in the past
low blood pressure or certain conditions that affect the rhythm of your heart
metabolic acidosis – when there’s too much acid in your blood
lung disease or asthma

Tell your doctor if you’re trying to get pregnant, are already pregnant or breastfeeding.

It’s important not to stop taking beta blockers without seeking your doctor’s advice. In some cases, suddenly stopping the medicine may make your health condition worse.

Cautions with other medicines

There are some medicines that may interfere with the way that beta blockers work, including beta blocker eyedrops.

Tell your doctor if you’re taking:

other medicines for high blood pressure. The combination with beta blockers can sometimes lower your blood pressure too much. This may make you feel dizzy or faint
other medicines for an irregular heartbeat such as amiodarone or flecainide
other medicines that can lower your blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson’s disease medicines such as levodopa
medicines for asthma or chronic obstructive pulmonary disease (COPD)
medicines for diabetes, particularly insulin – beta blockers may make it more difficult to recognise the warning signs of low blood sugar
medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
medicines for allergies, such as ephedrine, noradrenaline or adrenaline
non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen. These medicines may increase your blood pressure, so it’s best to keep them to a minimum

Side effects of beta blockers

Most people taking beta blockers have either no or very mild side effects that become less troublesome with time.

Contact your GP if you’re having symptoms that bother you or last more than a few days.

Side effects commonly reported by people taking beta blockers include:

feeling tired, dizzy or lightheaded (these can be signs of a slow heart rate)
cold fingers or toes (beta blockers may affect the blood supply to your hands and feet)
difficulties sleeping or nightmares
difficulty getting an erection or other difficulties with sex
feeling sick

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
shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
yellowish skin or the whites of your eyes turn yellow, although this may be less obvious on brown or black skin – these can be signs of liver problems

These are not all the side effects of beta blockers. For a full list, see the leaflet inside your medicine packet.

You can report suspected side effects using the Yellow Card Scheme – find out more on the Yellow Card website.

For more information on the side effects of beta blockers, read about the specific medicine you take in our Medicines A to Z.

Missed or extra doses

Depending on your beta blocker, you can take it up to 4 times a day. Some must be taken once a day, others between 2 and 3 times a day. Check the information included with your medicine.

What if I forget to take it?

If you forget to take a dose of your beta blocker, take it as soon as you remember, unless it is nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

What if I take too much?

If you take more than your prescribed dose, beta blockers can slow down your heart rate and make it difficult to breathe. It can also cause dizziness and trembling.

Beta-blockers

Beta-blockers are a class of medicines most commonly used for problems involving your heart and your circulatory system. They also are sometimes used to treat conditions related to your brain and nervous system. Beta-blockers work by slowing down certain types of cell activity, which can help control blood pressure, heart rate and more.

Overview

What are beta-blockers?

Beta-blockers are a class of medicines commonly used to treat a wide range of problems involving your heart and your circulatory system. They also are sometimes used to treat conditions related to your brain and nervous system.

How do they work?

Your body uses a chemical signaling system to control certain processes and functions. This uses specific sites on the surface of your cells, called receptors, where certain chemicals — called neurotransmitters — can latch on.

Receptors work similarly to locks. If a chemical with the right structure latches onto a receptor, it works like a key and activates the cell to respond a certain way. How the cell responds depends on where it is and what it does. If your body needs certain cells to act, it can produce more of the chemical that can activate the cells’ receptors.

Many medications work by artificially affecting that chemical signaling process. Medications that work like this fall into two categories:

These medications attach to and activate receptor sites. In effect, they pretend to be the right kind of chemical compound and the cell falls for the deception. This can stimulate cells that wouldn’t be active otherwise.
These medications attach to the receptor sites but don’t do anything else. The effect is similar to breaking a key after inserting it into a lock. The broken part of the key stays in place and blocks another key from entering. Antagonists reduce the number of receptors that are available for activation, which slows down cell activity.

Beta receptors

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

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

What do beta receptors control?

Beta receptors come in three different sub-types and have different functions depending on their location.

Beta-1 (B1)

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

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

Beta-2 (B2)

The beta-2 receptors are found mainly in smooth muscle tissue. That tissue is in your respiratory system (especially your trachea and bronchial tubes), blood vessels and your nervous system). When activated, these receptors affect various body systems in the following ways:

Respiratory: Cause smooth muscle to relax so people breathe more easily.
Blood vessels: Cause smooth muscle to relax and lowers blood pressure.
Liver: Activate liver’s conversion of glycogen into glucose (which your body uses for energy).
Heart: Increase pumping force and heart rate.
Nervous system: Cause muscle tremors.

Beta-3 (B3)

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

Cause fat cells to break down.
Cause relaxation and increase in bladder capacity
Causes tremors, which limits potential medical applications for B3 receptor-targeted medications.

What conditions are treated by this class of medication?

Because beta-receptors are found in several locations throughout the body, beta-blockers can treat a wide range of problems and conditions.

Beta-blockers are mainly used to treat heart and circulatory conditions, including the following:

Aortic dissection.
Arrhythmias.
Chest pain (angina).
Coronary artery disease.
Heart attack.
Heart failure (especially chronic heart failure).
High blood pressure (hypertension).
Hypertrophic obstructive cardiomyopathy (enlarged heart).
Migraines (preventive).
Portal hypertension.

Outside of the heart and circulatory system, they can treat several other conditions:

Essential tremor
Glaucoma
Hyperthyroidism (overactive thyroid)

Types of beta-blockers

Some beta-blockers are only effective on certain beta receptors, a property known as “selectivity.” It’s a key consideration when healthcare providers choose which beta-blocker to prescribe.

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

Cardioselective (B1 receptor)	Nonselective
Acebutolol*	Carvedilol*
Atenolol	Labetalol*
Betaxolol	Nadolol
Bisoprolol	Penbutolol
Esmolol	Pindolol*
Metoprolol	Propanolol
Nebivolol*	Sotalol
Timolol
Cardioselective (B1 receptor)
Acebutolol*
Nonselective
Carvedilol*
Atenolol
Nonselective
Labetalol*
Betaxolol
Nonselective
Nadolol
Bisoprolol
Nonselective
Penbutolol
Esmolol
Nonselective
Pindolol*
Metoprolol
Nonselective
Propanolol
Nebivolol*
Nonselective
Sotalol
Nonselective
Timolol

*These medications have distinctive or unique properties. Examples of those properties include:

Carvedilol and labetalol: Both of these can also block some alpha-receptors. This can help lower heart rate and blood pressure even further, making these medications more effective.
Esmolol: This medication is only available in an IV form, which limits its use to hospitals and similar medical settings.
Nebivolol: This medication causes blood vessels to expand (the term for this is vasodilation), which can help further lower blood pressure.

Off-label prescribing of beta-blockers

Beta-blockers are sometimes used for “off-label” purposes. This means that they’re prescribed for conditions other than the ones they’re specifically approved to treat.

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

Off-label prescribing is a legal practice and is medically acceptable and justified when evidence shows a medication 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 (substituting one beta-blocker for another).
Anxiety (such as stage fright or performance anxiety).
Reducing tremors (beta-blockers are banned in certain sports because of their performance-enhancing capabilities).

Are beta-blockers commonly prescribed?

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

Risks / Benefits

What are the advantages of beta-blockers?

Beta-blockers are commonly used for several reasons:

They’re effective for a wide range of medical problems. Because so many heart and circulatory problems are connected, using a beta-blocker to treat one problem can often benefit multiple related problems.
They’ve been studied extensively. Beta-blockers have been in use for decades, with the first clinical trials for them taking place in the 1960s. Because of that, their effects are better understood, and it’s easier to use them safely and avoid negative effects.
Most (especially generics) are inexpensive. Beta-blockers are typically very affordable, making it easier to ensure patients aren’t going without medications because they can’t afford the cost.

What are the possible side effects of these medications?

Because beta-blockers affect your heart and circulatory systems, they can have a wide range 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 heart rate (bradycardia).
Low blood pressure (hypotension).
Irregular heart rhythms (arrhythmias).
Fatigue.
Dizziness.
Nausea.
Insomnia, sleep changes and nightmares.
Dry mouth or eyes.

Rare side effects include:

Sexual and erectile dysfunction.

What are the reasons I should not take these medications?

Beta-blockers can negatively impact several diseases, conditions and health concerns. These are known as contraindications and include:

Moderate to severe asthma. Nonselective beta-blockers can aggravate or cause an asthma attack or trouble breathing. Healthcare providers will often prescribe B1-selective beta-blockers to minimize this for people with milder cases of respiratory problems but will avoid using beta-blockers entirely in people with moderate to severe cases.
Certain types of arrhythmias. Beta-blockers can aggravate some arrhythmias.
Slow heart rate or low blood pressure. Most beta-blockers will aggravate either of these conditions by further lowering heart rate and blood pressure.
Raynaud’s phenomenon. This condition causes decreased circulation in your hands and feet (especially fingers and toes) and sometimes in parts of your face. Beta-blockers may aggravate the condition. Raynaud’s can happen on its own (primary, also known as Raynaud’s syndrome or Raynaud’s disease) or occur because of another disease (secondary Raynaud’s).
Hypoglycemia (low blood sugar). Beta-blockers can delay feeling most of the effects of low blood sugar. For people with conditions that cause low blood sugar like diabetes (especially Type 1), this can delay taking action to stabilize blood sugar levels. If the 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 individuals who take beta-blockers and are at risk of having low blood sugar.

Do beta-blockers interact with any other medications?

Beta-blockers can interact with a wide range of medications, especially those related to the side effects or contraindications above. Your healthcare provider can best inform you of the side effects that are of greatest concern to you.

Recovery and Outlook

How long can I stay on beta-blockers?

You can use beta-blockers for extended periods. In some cases, especially for adults over 65, it’s possible to use them for years or indefinitely.

When To Call the Doctor

When should I see my healthcare provider?

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

Shortness of breath.
Chest pain.
Heart palpitations (where you can feel your heartbeat racing, pounding or skipping beats).
Fainting unexpectedly, or having multiple episodes where you feel dizzy or lightheaded.

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

Slow heart rate, low blood pressure and confusion or behavior changes, especially when they happen at the same time. This combination of symptoms can indicate a beta-blocker overdose.
Recurring episodes of low blood sugar. When not treated, long-term low blood sugar can cause brain damage.

A note from Cleveland Clinic

Beta-blockers are a widely used, commonly prescribed class of medications. They can treat a wide range of problems, ranging from high blood pressure and heart problems to preventing migraines and anxiety attacks. Though they’ve been in use for decades, there are still instances where they aren’t the best choice. It’s a good idea to talk to your healthcare provider about any concerns or questions you might have. They can answer your questions and help you use these medications in the best way possible.