A guide to beta blockers

Written by: Hussain Abdeh MPharm: 2211840

Published on: 04/05/2021

Updated on: 04/05/2021

 

In this guide, our superintendent pharmacist Hussain Abdeh will explain what beta blockers are and how they effectively treat such a wide range of conditions.

Beta blockers are a group of prescription only medicines that are very diverse and can be used to treat a wide range of conditions.

Typically, beta blocks are used to treat a number of heart related conditions from heart failure, high blood pressure, angina; however, they can also be used to treat migraines and anxiety symptoms.

What are beta blockers?

Beta-adrenergic blocking agents, most commonly known as beta-blockers are a type of medicine that work by slowing down the rate at which the heart beats. By slowing down the rate of the heart, beta blockers can treat quite a wide range of conditions from high blood pressure to anxiety.

Beta blockers are a prescription only medicine and are commonly prescribed by heart specialists and GP’s. They are a relatively low risk medicine and when taken as prescribed will present very few side effects.

They get their name due to their beta-adrenergic blocking agents which stop the body’s natural adrenaline/stress messages being sent to the heart. Both adrenaline and stress increase the heart rate and cause the heart to pump harder and faster putting more pressure on the heart to pump blood around the body.

By slowing the heart rate down, blood is pumped around the body using less force from each of the hearts contractions and in turn reduces the pressure on the heart.

Beta blockers are not limited to treating heart related conditions, one of the most common symptoms of anxiety is an increased heart rate, because of this; beta blockers are effective at treating the signs and symptoms of anxiety.

There are several commonly prescribed beta blockers available, the type you are given will depend on the condition you are trying to treat and whether you have used that beta blocker before.

What are beta blockers used for?

Beta blockers are used to treat a number of heart conditions; however, they are not limited to heart conditions. Some of the most common conditions that beta blockers treat are:

Angina

Angina is a pain in the chest which is caused when the heart needs more oxygen. Beta blockers are a first line treatment options for Angina and help to slow the heart rate down and reduce the demand for oxygen as a result, reducing the frequency of angina attacks.

Heart Failure

Heart failure is when the heart is unable to effectively pump blood around the body. The heart cannot contract forcefully contract enough and as a result blood is not effectively pumped around the body. Beta blockers are usually prescribed in conjunction with other treatment options such as ACE inhibitors.

Heart attack

In people who have already had a heart attack, beta blockers help to reduce the risk of having another. Beta blockers ensure the heart beats at a regular rate and reduces the force at which the heart beats, thus reducing pressure on the heart.

High blood pressure

Beta blockers are not a first line treatment option for high blood pressure unless the person being treated also has an underlying heart condition. For complicated high blood pressure beta blockers reduce the rate and the force at which the heart beats and as a result lowers blood pressure. Bisoprolol beta blocker is commonly used to treat high blood pressure.

Irregular heartbeat (Arrythmia)

Beta blockers help to regulate the rate at which the heartbeat. It ensures the heart beats consistently at a more normal rate.

Anxiety

By blocking the body’s natural stress hormones form reaching the heart, beta blockers; especially propranolol can help prevent one of the first and major symptoms of anxiety from occurring. Propranolol is effective at treating anxiety and is the most commonly prescribed beta blocker when it comes to treating the symptoms of anxiety. 

Glaucoma

Glaucoma is a pressure build up in the eye. Beta blockers help to reduce the pressure in the eye.

What are the most common beta blockers and what is the difference?

They are very similar in the conditions they treat, but what are the differences between them? Commonly prescribed beta blockers in the UK are:

	Treats	Available as
Propranolol	·         Anxiety ·         High blood pressure ·         Migraines ·         Irregular heartbeat ·         Angina ·         Heart attacks	·         Tablets ·         Modified Release Capsules ·         Oral liquid medicine
Bisoprolol	·         High blood pressure ·         Angina ·         Heart failure	·         Tablets
Metoprolol	·         High blood pressure ·         Angina ·         Arrhythmias ·         Heart attacks ·         Thyroid problems ·         Migraines	·         Tablets
Atenolol	·         High blood pressure ·         Arrhythmias ·         Angina ·         Heart attacks	·         Tablet ·         Oral liquid medicine

Some of the medicines above are available as generic and branded so may be sold under different names, however the active ingredients within each will remain the same.

In the Uk the most commonly prescribed beta blockers are Propranolol 10mg and 40mg tablets.

How do beta blockers work?

Beta blockers work by blocking the body’s natural stress hormones being sent to the heart. Stress hormones such as adrenaline and noradrenaline cause the heart to beat faster with more force which in turn increases blood pressure and pressure on the heart in general.

Beta blockers primarily treat heart related conditions such as high blood pressure, irregular heartbeat (arrythmia), angina, heart failure, heart attack. They are also widely used to treat conditions unrelated to the heart such as anxiety, migraines, overactive thyroid, tremor, and glaucoma.

Some beta blockers are better suited to treat specific conditions, for example propranolol is most prescribed to treat anxiety, whereas bisoprolol is better suited to treat high blood pressure. To understand why Propranolol may not be the most suitable treatment option for hyertenstion you can read our guide on taking propranolol for high blood pressure.

How fast beta blockers get to work is dependent on the condition you are using them to treat. For example, if you are taking propranolol for anxiety, it usually starts to work within 1 hour with the full effects being felt within 2 hours.

If you are using beta blockers to help treat high blood pressure, it may be a few days/weeks until it has successfully lowered your blood pressure.

Although many beta blockers treat very similar conditions, some are recommended to treat certain conditions more than others.

How to take beta blockers

When and how to take beta blockers will depend on your condition and the dosage you have been prescribed by your doctor.

It is recommended taking beta blockers at bedtime, this is because it can sometimes cause dizziness or tiredness. Another recommendation is to take beta blockers with food as they are absorbed by the body slower and will be less likely to cause any side effects.

You should take your tablets like any other tablets, with water and exactly as prescribed by your doctor. If you forget to take a dose, you should take it as soon as you remember; however, if it is nearly time for your next dose, you should simply miss out the dose and continue with your next one as normal.

Missing a dose will not do any harm as the tablets will usually stay in your system for a couple of days. You should never suddenly stop taking your tablets; even if you feel better, you should always complete your full course as prescribed. Stopping suddenly can cause a relapse of your condition and increases the chances of experiencing side effects.

Side effects

The side effects experienced when taking beta blockers are usually common and subside within a couple of hours. Typically, if you are taking a medicine for the first time; you may experience some side effects, however as your body gets used to the medicine the side effects will become less troublesome over time.

Common side effects include:

• Tiredness
• Dizziness
• Lightheaded
• Nausea
• Cold hands and toes
• Difficulty sleeping

Common side effects will usually clear after a couple of days.

Serious side effects

If in the event you experience any of the below side effect, you should contact your doctor straight away.

• Shortness of breath
• Irregular heartbeat
• Swollen ankles or legs
• Chest pain
• Yellow tint to the whites of your eyes or skin

Please note that this is not a full complete list of side effects. For an exhaustive list of side effects please thoroughly read the patient information leaflet located inside of your medicine packet.

The Yellow Card Scheme

If you find that you have experienced a side effect that has not been listed in the patient information leaflet, you can report this via the Yellow Card Scheme.

The yellow card scheme is intended to give doctors and pharmacists information on new side effects related to specific medicines. To report a side effect using the yellow card scheme, you will need to detail the side effect you experienced, the name of your medication, who had the side effect, and your personal details.

Sources/References

https://www.nhs.uk/conditions/beta-blockers/

https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/drug-cabinet/beta-blockers

https://bnf.nice.org.uk/treatment-summary/beta-adrenoceptor-blocking-drugs.html