From the Guidelines
Beta blockers should not be stopped abruptly, but rather tapered off gradually, unless absolutely necessary, due to the increased risk of myocardial infarction, chest pain, and mortality associated with their withdrawal, as seen in studies such as 1 and 1. When considering stopping beta blockers, it is crucial to weigh the potential benefits against the risks, particularly in patients with underlying cardiovascular disease. The decision to discontinue beta blockers should be made on a case-by-case basis, taking into account the individual patient's clinical status and medical history. Some key points to consider when stopping beta blockers include:
- The risk of myocardial infarction and chest pain associated with beta blocker withdrawal, as reported in studies such as 1 and 1
- The potential for increased mortality, as seen in studies such as 1 and 1
- The importance of tapering off beta blockers gradually, rather than stopping them abruptly, to minimize the risk of adverse effects
- The need for close monitoring of patients who are stopping beta blockers, to quickly identify and address any potential complications Common beta blockers that may need to be stopped or tapered off include metoprolol, atenolol, carvedilol, propranolol, and bisoprolol. If a decision is made to stop beta blockers, the patient should be evaluated by a healthcare provider immediately, and alternative medications that don't affect AV conduction may need to be substituted to manage the patient's underlying condition. It is also important to note that the most recent and highest quality study, 1, suggests that discontinuation of beta blockers is associated with a higher risk for mortality compared with those continued on beta blockers, emphasizing the need for careful consideration before stopping these medications.
From the FDA Drug Label
If signs or symptoms of heart failure develop, treat the patient according to recommended guidelines. It may be necessary to lower the dose of metoprolol or to discontinue it If severe bradycardia develops, reduce or stop metoprolol Patients with bronchospastic disease, should, in general, not receive beta-blockers, including metoprolol
The conditions that may require stopping beta blockers (beta-adrenergic blocking agents) include:
- Heart failure: if signs or symptoms of heart failure develop
- Severe bradycardia: if severe bradycardia develops
- Bronchospastic disease: in patients with bronchospastic disease, beta-blockers should be avoided in general 2 2
From the Research
Conditions Requiring Stopping Beta Blockers
- There are no specific conditions mentioned in the provided studies that require stopping beta blockers, but rather situations where the dose may need to be reduced or withheld temporarily, such as in decompensated heart failure or coexisting bronchospasm 3.
- The studies focus on the benefits and usage of beta blockers in various cardiovascular conditions, including heart failure, post-myocardial infarction, and arrhythmias 4, 5.
- Discontinuation of beta blockers is discussed in the context of its potential risks, such as increased risk of myocardial infarction, particularly in the first 180 days after discontinuation of selective beta blockers 6.
- The decision to stop beta blockers may depend on individual patient circumstances, such as the presence of heart failure or other comorbidities, and should be made under the guidance of a healthcare professional.
Risks Associated with Stopping Beta Blockers
- Discontinuation of beta blockers may be associated with an increased risk of myocardial infarction, particularly in the first 180 days after discontinuation of selective beta blockers 6.
- Stopping beta blockers beyond 1 year after acute myocardial infarction may be associated with an increased risk of death or readmission for acute coronary syndrome 7.
- However, the overall risk of discontinuing beta blockers is not well established and may depend on various factors, including the specific type of beta blocker, patient characteristics, and clinical context 6, 7.