Beta Blockers in Depth

By pjain      Published Oct. 27, 2019, 11:18 p.m. in blog Health   

Beta Blockers Takeaways

Monitor BP and HR - can reduce dose as needed

Exercise lowers HR similar to Beta Blockers

“Your blood pressure and heart rate are similarly changed by exercise and beta blockers,” said Gerald Fletcher, M.D., Professor of Medicine at the Mayo Clinic in Jacksonville, Florida. “When you become exercise-trained your heart slows and your blood pressure lowers.”

Effective combination therapies

Metoprolol may be used as part of a combination therapy. That means you may have to take it with hydrochlorothiazide or chlorthalidone.

Beta Blockers 101

What meds

How they Work

Blood pressure is often raised because blood vessels are tightened. This puts a strain on the heart and increases the body’s oxygen demand.

Beta-blockers work by “block” the effects of and preventing norepinephrine (adrenalin) from acting on beta receptors in blood vessels and in the heart.

  1. This causes blood vessels to relax. By relaxing the blood vessels, beta-blockers help to lower the heart rate and decrease the heart’s demand for oxygen. This in turn helps decrease blood pressure and reduce chest pain.

  2. This also slows the nerve impulses that travel through the heart. As a result, your heart does not have to work as hard because it needs less blood and oxygen.

  3. Beta-blockers also block the impulses that can cause an arrhythmia.

Beta receptors

Beta-blockers work by “block” the effects of and preventing norepinephrine (adrenalin) from acting on beta receptors in blood vessels and in the heart.

Your body has 2 main beta receptors: beta 1 and beta 2.

  1. Selective, which means that they block beta 1 receptors more than they block beta 2 receptors. Beta 1 receptors are responsible for heart rate and the strength of your heartbeat.

  2. Nonselective beta-blockers block both beta 1 and beta 2 receptors. Beta 2 receptors are responsible for the function of your smooth muscles (muscles that control body functions but that you do not have control over).

Brand names, including Propranolol (Inderal), Metoprolol (Lopressor), Atenolol (Tenormin) Acebutolol (Sectral), Bisoprolol (Zebeta) and Nadolol (Corgard).

Use: Reduce HR

Beta blockers relieve stress on your heart by slowing the heartbeat. This decreases the force with which the heart muscle contracts and reduces blood vessel contraction in the heart, brain and throughout the body.

Use: Abnormal heart rhythms

Beta blockers may be used to treat abnormal heart rhythms and to prevent abnormally fast heart rates called tachycardia, or irregular rhythms like atrial fibrillation.

Since they reduce the demand of the heart muscle for oxygen, they may be useful in treating angina, or chest pain, which occurs when the oxygen demand of the heart exceeds the supply. Beta blockers improve survival after a heart attack and also are used to treat high blood pressure and other heart conditions.

Side effects and Interactions

Common side effects:

Drowsiness or fatigue.
Cold hands and feet.
Weakness or dizziness.
Dry mouth, eyes, and skin.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

  • Low blood pressure (hypotension). Symptoms can include: severe dizziness lightheadedness fainting

  • Cold hands and feet. Symptoms can include hands and feet that are cold and may be painful

  • Very slow heart rate (severe bradycardia)

  • Extreme fatigue. Symptoms can include: feeling more tired than usual tiredness that gets progressively worse each day

  • Serious depression. Symptoms can include: continuous feelings of sadness or anxiety feelings of hopelessness or worthlessness lack of interest in hobbies you once enjoyed eating too much or too little trouble concentrating

Less common side effects:

Wheezing, trouble breathing, or shortness of breath.
Slow heartbeat.
Trouble sleeping or vivid dreams while asleep.
Swelling of the hands and feet.

Rare side effects:

Abdominal cramps.
Throwing up.
Back or joint pain.
Skin rash.
Sore throat.
Memory loss, confusion, or hallucinations.

Watch Out for Interactions with other Drugs

Other medicines that you may be taking can increase or decrease the effect of beta-blockers. These effects are called an interaction. Be sure to tell your doctor about every medicine and vitamin or herbal supplement that you are taking, so he or she can make you aware of any interactions.

You can check these sites - A consumer-based site by the American Society of Health-System Pharmacists that provides information about all types of medicines as well as safety tips for their proper use. The site’s search feature lets users search medicines by the brand or generic name.

The following are categories of medicines that can increase or decrease the effects of beta-blockers.

Because there are so many kinds of medicines within each category, not every type of medicine is listed by name. Tell your doctor about every medicine that you are taking, even if it is not listed below.

Heart rhythm drug Interactions

Taking heart rhythm drugs with metoprolol can slow down your heart rate too much. Examples of these drugs include:


Other BP Drug Interactions and Calcium channel blockers

Like metoprolol, these drugs are used to treat high blood pressure and several other heart problems. Combined with metoprolol, calcium channel blockers may slow your heart rate even more. Doctors sometimes use this combination under close supervision. Examples of calcium channel blockers include: amlodipine diltiazem felodipine isradipine nicardipine nifedipine nimodipine nisoldipine verapamil

Mental health drugs and Interactions

Also, certain anti-depressants.

Taking metoprolol with reserpine and monoamine oxidase inhibitors (MAOIs) may increase or add to the effects of metoprolol. They may also increase lightheadedness or slow your heart rate more. MAOIs can continue to interact with metoprolol for up to 14 days after taking them. Include:


Diabetes Drug Interactions

Medicines to treat diabetes, including oral medicines (pills that you swallow) and insulin.

Drugs that can raise levels in body

COPD, Asthma, Pulmonary drugs, Allergy

Medicines to treat asthma, chronic bronchitis, emphysema, or COPD.

Allergy shots.

Tell doctor if ..

You have allergies to foods or dyes. Beta-blockers may make your allergic reactions worse. You are thinking of becoming pregnant, you are pregnant, or you are breast-feeding your baby. You are over 60. Younger people tend to have fewer problems while taking beta-blockers. You have heart disease or poor circulation to your hands or feet. You have a slow heart rate (bradycardia) or heart block. You have asthma. Beta-blockers may make your condition worse. You have hay fever symptoms, chronic bronchitis, emphysema, or COPD. You have diabetes or hypoglycemia. Beta-blockers may hide the symptoms of low blood sugar. You have an overactive thyroid. You have kidney or liver disease.

Watch Out: Beta-Blockers Affect Exercise - Plan for lower target rates and intensity

Since they lower HR, don’t overdo it trying to get your heart rate up to previous levels

There are a couple of ways to monitor your exercise intensity.

  1. If you have been using a target heart rate to get to the right intensity, determine your new target heart rate using a brief exercise stress test . This test is used because beta blockers affect everyone differently. You can ask your doctor, or use your own perception of effort to do so.

  2. Monitor your intensity is simpler: making sure you’re not too exhausted. Exercise hard – to the point of being tired – but not excessively hard

  3. Can Beta-Blockers Affect Exercise? - Kick Health

  4. Beta blockers: How do they affect exercise? - Mayo Clinic
  5. How Beta Blockers Affect Your Target Heart Rate

Problem: Lack Of Restful Sleep




Basic Uses

  • It is used to lower high blood pressure reduce chest pain (angina) Lowers the Heart Rate and reduces stress on heart to prevent it going to high HR

Now common as a generic or brand in different doses in pill forms. It also comes in an injectable form that’s only given by a healthcare provider.

It comes in different salt forms which enable the drugs to be used to treat different conditions eg as immediate-release and extended-release tablets, and an extended-release capsule.

Brand name Lopressor is metoprolol tartrate which is an immediate-release version of metoprolol. Metoprolol tartrate is also used to treat and prevent heart attacks.

Toprol XL is metoprolol succinate an extended-release version of metoprolol, so it remains in your bloodstream for a longer time. Metoprolol succinate is also used to treat heart failure.

Metoprolol may be used as part of a combination therapy. That means you may have to take it with hydrochlorothiazide or chlorthalidone.

Drugs that Increase Levels in Body

Drugs used to treat depression and other mood disturbances are processed in your body by the same systems as metoprolol. Using these drugs with metoprolol could increase the levels of metoprolol in your body.

Examples of these drugs include:


Other drugs that are processed in the body the same way as metoprolol include these drugs which can all increase the level of metoprolol in the body.

the antiretroviral ritonavir
antihistamines, including diphenhydramine
antimalarial drugs, such as hydroxychoroquine and quinidine
antifungal drugs, such as terbinafine
the blood pressure drug hydralazine

Warning on Senior dosage (ages 65 years and older)

Your body may process this drug more slowly. Your doctor may start you on a lowered dosage so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous.



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