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Beta blockers

Beta blockers are medications that reduce your heart rate, and are used to treat various conditions relating to the heart and blood pressure.

  1. Treat various heart related conditions and symptoms.
  2. May also treat anxiety.
  3. Usually administered in tablet form. 

If you have any concerns about your heart or blood pressure, you can speak with one of our registered clinicians via our online video consultation service, which is available from 9.30am-4.30pm, Monday to Friday.  

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Product information

What are beta blockers? 

Beta blockers are usually prescribed to treat various conditions related to the heart, including angina and heart failure. They may also be prescribed for anxiety and hypertension. Beta blockers work by slowing down the heart rate, which is achieved by blocking certain hormones, such as adrenaline.

What is angina?

Angina is described as a chest pain that is caused by a reduction of the flow of blood to the heart. In itself it is not considered as life threatening, but it can be a sign that you are at higher risk of serious events, such as heart attacks and strokes. There are two types of angina: stable and unstable. Stable angina is by far the most common and predictable, whereas unstable angina can appear out of the blue and not dissipate while at rest. Unstable angina is thought to be the most serious type of angina. 

What symptoms can angina cause?

Symptoms include a dull or tight pain that may spread from the chest to the neck, shoulder, arm, jaw and back, that is triggered by exercise or stress and subsides when at rest. Occasionally, nausea and loss of breath may also present. Symptoms of angina should be reported immediately and tests carried out as they may be a sign of something more serious, such as a heart attack. This is particularly the case if symptoms do not subside when at rest. 

How is angina treated?

The condition is lifelong, and lifelong treatment is required, including the use of medications, such as beta blockers, taken alongside others. Reducing the risk of heart attacks and high blood pressure is also likely to require treatment with medication.

What is heart failure?

Heart failure, sometimes referred to as congestive heart failure, is the body’s inability to pump blood around the body properly, typically due to the fact that it has become too weak or stiff. It does not mean the heart has stopped working, rather that it needs some help to fully function. It can occur at any age but is far more prevalent in the elderly. 

What symptoms can heart failure cause?

Symptoms include loss of breath (even while at rest), fatigue, swollen legs or ankles, dizziness, coughing and a noticeably rapid heart rate. Causes of the condition are varied, including a build-up of fatty substances in the arteries (coronary heart disease), high blood pressure, problems with the heart’s muscles (cardiomyopathy), problems with the rhythm of the heart (such as an arrythmia), genetic issues (such as congenital heart disease) and damage to the valves of the heart.

How can heart failure be managed?

There is no cure for heart failure and it worsens over time, but there are many ways to slow down the progression of the disease and manage symptoms. Lifestyle changes are key, and quitting smoking, cutting down on alcohol and getting plenty of exercise are all recommended. Beta blockers are a common treatment in terms of medication, and devices to control the heart’s rhythm may be fitted. In some circumstances, surgery is required, such as bypass surgery or a heart transplant.

What is anxiety?

Anxiety is a sense of discomfort and unease that can range from mild to severe. While it is normal to feel anxiety at times, such as before a job interview, people who experience generalised anxiety disorder are persistently anxious over an extended period of time. 

What symptoms can anxiety cause?

Anxiety can cause dizziness, irritability, fear, worrying, poor concentration, palpitations and restlessness. In more severe cases, this can result in panic attacks, sweating, not being able to catch your breath, pins and needles, back pain, fatigue, headaches, nausea, vomiting, shaking, aches and pains and digestive problems. Causes of anxiety may be straightforward to pinpoint, such as a phobia of heights when you are up a ladder, for example. In other cases, the trigger may be non-specific, and the cause more difficult to identify. 

How is anxiety diagnosed?

It’s likely that you will be diagnosed with generalised anxiety disorder if you have experienced it for six months or longer. As such, it is known as a long term condition that may require the use of medications, lifestyle changes, relaxation practices and psychological treatments. Medications can include antidepressants for long-term use, benzodiazepines for short-term use and beta blockers. Lifestyle changes depend on the individual, but reducing alcohol consumption and doing more exercise are common adjustments that people make. 

Relaxation practices, such as applied relaxation techniques and mindfulness, have proven to be very effective for some people, and courses are available through the NHS and on a private basis. CBT (cognitive behavioural therapy) is one of the most effective treatments for generalised anxiety and focuses on changing your thought patterns. It typically requires one-to- one sessions for up to four months.

What is hypertension? 

Hypertension, sometimes referred to as high blood pressure, does not present with noticeable symptoms, but can lead to serious events, such as heart attacks. It is thought that as many as 33% of adults in the UK have hypertension, but many people are unaware that they have it. Hypertension can be determined by taking a simple and non-invasive blood pressure test at your doctor’s surgery or local pharmacy. 

What causes hypertension?

It’s not clear what triggers high blood pressure, but certain factors can increase the risks of it developing, such as genetics (being of African or Caribbean origin or having family members with the condition), age (risk increases as we get older), not getting enough exercise, consuming large amounts of alcohol, smoking, lack of sleep and eating too much salt.

About 5% of cases of hypertension are caused by other conditions, including kidney disease, diabetes, hormone issues, lupus, sleep apnoea, scleroderma, glomerulonephritis, narrowing arteries and infection of the kidneys. It is thought that birth control pills, SNRI antidepressants, NSAIDs (non-steroidal anti-inflammatory drugs), various steroids and amphetamines may also have an effect.

How is hypertension treated? 

In the majority of cases, the most effective treatment for hypertension is lifestyle changes. Taking exercise, following a healthy diet and quitting smoking have been shown to have a positive impact on blood pressure levels. If these measures aren’t effective, or there are further risks involved, medication may be recommended. Medications include ACE inhibitors, which relax the blood vessels, allowing blood to flow more freely, and angiotensin-2 receptor blockers (ARBs), which function in the same way, for people under the age of 55. 

If you are over the age of 55 or from an African or Caribbean background, you may be offered a calcium blocker, which widens the blood vessels. In some cases, beta blockers (which reduce heart rate) or diuretics (which flush excess salt and fluid from the body) may also be recommended. 

If you would like to discuss beta blockers or any related conditions with a GMC-registered clinician, you can make an appointment using our online video consultation service between 9.30am and 4.30pm, five days a week. Our clinicians can also issue referral to specialists for treatment and fit notes, where appropriate.  

Page last reviewed:  01/07/2020
Side effects and warnings

What side effects can beta blockers cause?

Because there are many different types of beta blockers, the side effects of your specific treatment will need to be discussed with your prescribing clinician or by reading the patient information leaflet that comes with your medication. 

The following information relates to propranolol.If you experience any of these symptoms whilst taking propranolol, you should discontinue use and seek immediate medical assistance: low blood pressure, dizziness, light-headedness, fainting, blurred vision, itching, difficulty breathing and swelling of the face, lips, throat or tongue.

Other side effects include:

Common (may affect up to 1 in 10 people): tiredness, weakness, cold extremities, insomnia, irregular heartbeat, Raynaud’s syndrome and nightmares. 

Uncommon (may affect up to 1 in 100 people): nausea, vomiting and diarrhoea. 

Rare (may affect up to 1 in 1,000 people): bruising, nosebleeds, sore throats, worsening of heart failure, heart block, low blood pressure, fainting when standing, dizziness, pain and cramping in the leg caused by reduced blood flow, skin rashes, worse psoriasis, hair loss, dry flaky skin, itchy skin, blood spots, discolouring of the skin, hallucinations, mood changes, pins and needles, psychosis, memory loss, confusion, breathing problems in people with asthma, dry eyes and visual issues.

Very rare (may affect up to 1 in 10,000 people): myasthenia gravis (muscle weakness, difficulty chewing and slurred speech).

The following side effects have been reported but their frequency has not been established: hyperthyroidism, changes in blood fats, altered kidney function, distortion of blood sugar levels in tests, fits, angina, headaches, depression, constipation, dry mouth, conjunctivitis, changes in sex drive or potency and joint pain.

Is it safe to use beta blockers alongside other treatments?

It’s important that you inform your prescribing clinician of any medications you are currently or have recently taken before starting treatment with beta blockers. 

In the case of Propranolol, it may not be suitable if you are taking any of the following medications: verapamil, diltiazem, nifedipine, nisoldipine, nicardipine, isradipine, lacidipine, dihydropyridine, disopyramide, quinidine, flecainide, amiodarone, propafenone, ergotamine derivates, rizatriptan, adrenaline, insulin, lidocaine, Non-Steroidal Anti-Inflammatory Drugs, digoxin, chlorpromazine, thioridazine, cimetidine (to treat stomach ulcers), other hypertension medications, clonidine, moxonidine, methyldopa, hydralazine, levodopa, monoamine-oxidase inhibitors, imipramine, fluvoxamine, warfarin, rifampicin, barbiturates, theophylline, diuretics, anaesthetics, prazosin and smoking tobacco.

Warnings and precautions for use of beta blockers

If you have (or are prone to) any other health conditions, you should discuss these with your prescribing clinician so that they can determine if beta blockers are suitable for you. 

Using propranolol as an example, you should avoid using it if any of the following applies to you: allergies to propranolol tablets, untreated heart failure, heart rhythm problems, slow heart rate, low blood pressure, circulation problems, diabetes mellitus, metabolic acidosis, are on a fasting diet, Prinzmetal’s angina, asthma, breathing difficulties and untreated pheochromocytoma. 

Propranolol may also be unsuitable for you if you have: a history of allergic reactions, myasthenia gravis, heart weakness, heart blockages, kidney or liver disease, hyperthyroidism, psoriasis, Raynaud’s disease, intermittent claudication, smoke and are elderly. 

It should also be noted that if you are having any tests or being given an anaesthetic you should tell your doctor before taking beta blockers. 

What types of beta blockers are available?

There are many types of beta blockers that your prescribing clinician can choose from, each with their own advantages and disadvantages. Some of the most common in the UK include: Atenolol (Tenormin), bisoprolol (Emcor or Cardicor), nebivolol, propranolol (Inderal), nebivolol (Nebilet) and cardevilol. 

Are beta blockers safe to use if you are pregnant? 

Beta blockers are not generally recommended for use if you are pregnant or breastfeeding. You should inform your doctor if you are pregnant, are thinking of becoming pregnant during treatment or are breastfeeding, before starting treatment with beta blockers.

Page last reviewed:  01/07/2020
Questions and Answers

Can beta blockers cause allergic reactions?

It depends on the medication, but allergic reactions have been known to occur with beta blockers, as is the case with all treatments. Treatments that contain the ingredient carmoisine (E122), have shown to be particularly likely to cause an allergic response. Some beta blockers may also contain lactose, which some people may have an intolerance of. 

Can I drink alcohol whilst taking beta blockers?

Alcohol consumption is not recommended during treatment with beta blockers. You should speak to your prescribing clinician or read the patient information leaflet that comes with your medication for more information. 

Will it affect my ability to drive?

Beta blockers have been known to cause side effects that can affect your ability to drive. These include fatigue, dizziness, visual issues and hallucinations. You should also assess how this treatment affects you before operating any heavy machinery.

Can I buy beta blockers over the counter?

No. Beta blockers are available via prescription only. 

How can I buy beta blockers online? 

You can discuss beta blockers and any related conditions with one of our GPhC-registered clinicians via our online video consultation service. They are available for appointments between 9.30am-4.30pm, Monday to Friday. Our clinicians can also provide referral to specialists for treatment and fit notes, where suitable.  

Page last reviewed:  01/07/2020

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