From the Guidelines
For athletes requiring beta blockers, cardioselective options like bisoprolol or metoprolol are generally preferred. These medications selectively block beta-1 receptors in the heart while minimizing effects on beta-2 receptors in the lungs and blood vessels, which helps reduce unwanted side effects like bronchospasm and impaired exercise capacity. Bisoprolol (typically 2.5-10 mg once daily) or metoprolol (25-100 mg twice daily) provide effective heart rate control with less impact on athletic performance compared to non-selective beta blockers like propranolol. However, it's essential to consider the specific medical condition being treated, the type of sport, and individual factors when choosing a beta blocker for athletes, as noted in studies such as 1 and 1.
Some key points to consider when selecting a beta blocker for athletes include:
- The potential for beta blockers to impair exercise performance in endurance sports, as mentioned in 1
- The importance of choosing a cardioselective beta blocker to minimize side effects, as discussed in 1
- The need for athletes to consult with a sports medicine physician before taking any beta blocker, as emphasized in 1
- The potential for beta blockers to be banned in certain competitive sports, as noted in 1 and 1
Starting with the lowest effective dose and monitoring for side effects like fatigue, dizziness, or decreased exercise tolerance is crucial when prescribing beta blockers to athletes. It's also important to be aware of the restrictions on beta blockers in competitive sports, as outlined in 1 and 1. Ultimately, the choice of beta blocker for athletes should be individualized and based on the specific needs and circumstances of each athlete, with consideration of the latest evidence and guidelines, such as those presented in 1 and 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Atenolol is a beta1-selective (cardioselective) beta-adrenergic receptor blocking agent without membrane stabilizing or intrinsic sympathomimetic (partial agonist) activities.
CLINICAL PHARMACOLOGY Mechanism of Action Metoprolol is a beta 1-selective (cardioselective) adrenergic receptor blocker.
The FDA drug label does not answer the question.
From the Research
Beta Blockers for Athletes
- The study 2 found that beta-blocker therapy, including atenolol, bisoprolol, and metoprolol, reduced exercise-induced intraventricular gradients and symptoms in symptomatic athletes.
- The choice of beta blocker for athletes may depend on individual factors, but atenolol, bisoprolol, and metoprolol have been shown to be effective in reducing exercise-induced cardiac symptoms 2.
- Carvedilol, a vasodilating beta-blocker, has been found to have unique properties and may confer more potent beneficial effects on cardiovascular mortality and morbidity compared to other beta-blockers, including atenolol, bisoprolol, metoprolol, and nebivolol 3.
Comparison of Beta Blockers
- A meta-analysis 3 found that carvedilol significantly reduced all-cause mortality compared to beta 1 selective beta-blockers (atenolol, bisoprolol, metoprolol, and nebivolol) in patients with heart failure.
- Another study 4 found that different beta-blockers have distinct pharmacological and physiological properties, which may explain their divergent effects on cardiovascular disease.
- The study 5 found that beta-blockers, including atenolol, propranolol, pindolol, and metoprolol, did not adversely affect walking distance, calf blood flow, or skin temperature in people with intermittent claudication.
Considerations for Athletes
- Beta-blockers can be effective in reducing exercise-induced cardiac symptoms in athletes, but the choice of beta blocker and dosage should be individualized and monitored by a healthcare professional 2.
- Athletes should be aware of the potential effects of beta-blockers on their physical performance and cardiovascular health, and should discuss these factors with their healthcare provider before starting treatment 6, 4.