From the Guidelines
Beta blockers can cause significant side effects, including fatigue, dizziness, and cold extremities, and patients should be closely monitored for these effects, particularly bradycardia, hypotension, and respiratory issues, as noted in the 2022 study 1. The most common side effects of beta blockers include:
- Fatigue
- Dizziness
- Cold extremities
- Bradycardia (slowed heart rate)
- Hypotension (decreased blood pressure)
- Sleep disturbances, such as vivid dreams or insomnia
- Sexual dysfunction, including decreased libido and erectile difficulties
- Masking of hypoglycemia symptoms in diabetic patients
- Potential triggering or worsening of depression in susceptible individuals
- Respiratory effects, including bronchospasm, particularly in patients with asthma or COPD
- Weight gain of approximately 1-2 kg
- Potential effects on cholesterol levels, including increased triglycerides and decreased HDL.
According to the 2013 study 1, the initiation of beta blocker treatment may produce adverse reactions, such as fluid retention, worsening heart failure, fatigue, bradycardia, and hypotension, which require attention and management. The 2022 study 1 also highlights the importance of considering individualized beta blocker treatment for patients with high blood pressure, taking into account medical comorbidities and potential side effects. Additionally, the 2007 study 1 provides a comprehensive overview of the properties of beta blockers in clinical use, including their selectivity, partial agonist activity, and usual doses for angina.
Overall, beta blockers should be used with caution and under close monitoring, particularly in patients with certain comorbidities or those who are at risk for specific side effects, as emphasized in the 2022 study 1.
From the FDA Drug Label
WARNINGS Cardiac Failure Sympathetic stimulation may be a vital component supporting circulatory function in patients with congestive heart failure, and its inhibition by beta-blockade may precipitate more severe failure Nonallergic Bronchospasm (e.g., chronic bronchitis, emphysema) - Patients with Bronchospastic Diseases Should in General Not Receive Beta-Blockers Diabetes and Hypoglycemia Beta-adrenergic blockade may prevent the appearance of premonitory signs and symptoms (e.g., tachycardia and blood pressure changes) of acute hypoglycemia. Exacerbation of angina and, in some cases, myocardial infarction and ventricular dysrhythmias have been reported after abrupt discontinuation of therapy with beta-adrenergic blocking agents in patients with coronary artery disease Abrupt withdrawal of these agents in patients without coronary artery disease has resulted in transient symptoms, including tremulousness, sweating, palpitation, headache, and malaise.
The major side effects of beta blockers include:
- Cardiac Failure: Beta-blockade may precipitate more severe failure in patients with congestive heart failure.
- Nonallergic Bronchospasm: Beta-blockers may worsen bronchospastic diseases such as chronic bronchitis and emphysema.
- Diabetes and Hypoglycemia: Beta-adrenergic blockade may mask signs and symptoms of acute hypoglycemia.
- Exacerbation of Angina and Myocardial Infarction: Abrupt discontinuation of beta-blocker therapy may lead to exacerbation of angina and myocardial infarction in patients with coronary artery disease.
- Transient Symptoms: Abrupt withdrawal of beta-blockers may result in transient symptoms such as tremulousness, sweating, palpitation, headache, and malaise 2.
From the Research
Major Side Effects of Beta Blockers
The major side effects of beta blockers include:
- Hypotension (low blood pressure) with an absolute annual increase in risk of 11 per 1000 patients 3
- Dizziness with an absolute annual increase in risk of 57 per 1000 patients 3
- Bradycardia (slow heart rate) with an absolute annual increase in risk of 38 per 1000 patients 3
- Fatigue, although the absolute risk is not significant with 3 per 1000 patients 3
Beta Blockers in Patients with Chronic Obstructive Pulmonary Disease (COPD)
In patients with COPD, beta blockers may be associated with:
- A reduced risk of death by 31% if used 4
- A lower risk of mortality in patients with COPD alone, as well as in those with COPD and heart failure 5
- Minimal effect on respiratory function, with cardioselective beta blockers being safe and well tolerated 5, 6
Precautions and Considerations
When using beta blockers in patients with COPD, it is essential to:
- Start treatment outside of COPD exacerbation and from a small dose 6
- Monitor carefully for possible new symptoms, such as shortness of breath, cough, or changes in dosing of other drugs 6
- Use cardioselective beta blockers, such as bisoprolol, metoprolol, or nebivolol, which are considered safe for patients with cardiovascular diseases and COPD 6