Beta-blockers are among the most widely used heart medicines in the world. They protect the heart in many conditions, but they also have side effects that are worth understanding.
Imagine being started on bisoprolol after a heart attack. A week later, your hands feel cold, you are more tired than usual and you wonder whether the tablets are doing more harm than good. Knowing what to expect helps you stay on a medicine that protects your heart.
How beta-blockers work
Beta-blockers block the effects of adrenaline and similar hormones on the heart and blood vessels. This slows the heart rate, reduces the force of each heartbeat and lowers blood pressure, so the heart needs less oxygen.,Common beta-blockers include bisoprolol, atenolol, metoprolol, carvedilol, nebivolol and propranolol. They differ in how selectively they act on the heart and how long they last.
What they are used for
- Angina, to reduce chest pain
- After a heart attack, to protect the heart
- Heart failure with reduced ejection fraction, where specific beta-blockers improve survival
- Atrial fibrillation and other fast heart rhythms
- High blood pressure, usually not as first choice
- Migraine prevention
- Physical symptoms of anxiety, such as shaking and a racing heart
- An overactive thyroid, to ease symptoms
- Glaucoma, as eye drops
Common side effects
- Tiredness and reduced exercise tolerance, often improving after a few weeks
- Cold hands and feet
- Dizziness, especially when standing up
- Slow heart rate
- Sleep disturbance or vivid dreams, more with some beta-blockers
- Erectile dysfunction
- Mild stomach upset
Who needs extra caution
- People with asthma: non-selective beta-blockers such as propranolol can trigger serious asthma attacks; even heart-selective ones are used cautiously
- People with very slow heart rates or certain heart blocks
- People with diabetes, because beta-blockers can mask warning signs of low blood sugar such as a racing heart and shaking
- People with severe circulation problems in the legs
Never stop suddenly
Stopping a beta-blocker abruptly can cause a rebound increase in heart rate and blood pressure. In people with heart disease, this can trigger angina or even a heart attack.,If side effects are troubling you, talk to your healthcare provider. They can often lower the dose, switch to a different beta-blocker or reduce it gradually if it needs to be stopped.
Beta-blockers in heart failure
In heart failure with reduced ejection fraction, specific beta-blockers such as bisoprolol, carvedilol and metoprolol succinate are part of standard treatment because they help the heart work more efficiently and reduce the risk of death. They are started at a low dose and increased slowly, every couple of weeks, to the highest dose tolerated. You may feel a little more tired during dose increases, which usually settles.
Exercise on beta-blockers
Beta-blockers limit how fast your heart can beat, so heart rate targets on fitness trackers may not apply to you. Use how you feel instead: you should be able to talk while exercising moderately. Warm up and cool down gradually. Your cardiac rehabilitation team can give tailored advice.
Interactions to know about
- Some calcium channel blockers, such as verapamil and diltiazem, can slow the heart dangerously when combined with beta-blockers
- Other blood pressure medicines can increase dizziness
- Some anti-inflammatory painkillers can reduce their blood pressure-lowering effect
- Always tell your pharmacist about all your medicines
Beta-blockers for anxiety
Propranolol is sometimes used to control physical symptoms of anxiety, such as trembling, sweating and a fast heartbeat, for example before public speaking. It does not treat the worry itself. It must be used carefully, as it can be dangerous in overdose, and it is not suitable for people with asthma. Talk to your healthcare provider about the full range of anxiety treatments, including talking therapies.
Frequently asked questions
Can I drink alcohol on beta-blockers?
Moderate alcohol is usually fine, but it can increase dizziness. Follow your healthcare provider’s advice.
Do beta-blockers cause weight gain?
Some people gain a small amount of weight, often in the first months.
Will I need them for life?
It depends on why you take them. After a heart attack or for heart failure, they are often long term.
What should I do if I miss a dose?
Take it when you remember unless it is nearly time for the next dose. Do not double up.
But I feel so tired. Should I stop?
Do not stop suddenly. Tiredness often improves after a few weeks. Talk to your healthcare provider about adjusting the dose or trying a different medicine.
Your next step: If you take a beta-blocker, check your pulse occasionally and tell your healthcare provider if it is often below 50 beats per minute or if you feel faint.
Related: Angina · Heart failure nursing care
Sources: British National Formulary (BNF), National Institute for Health and Care Excellence, British Heart Foundation, American Heart Association, European Society of Cardiology.
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