Beta Blockers (cont.)

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For what conditions are beta blockers used?

Beta blockers are used for treating:

They also have been found to prevent further heart attacks and death after a heart attack. Other uses include the treatment of hyperthyroidism, akathisia (restlessness or inability to sit still), and anxiety. Some beta blockers reduce the production of aqueous humor in the eye and therefore are used for reducing pressure in the eye caused by glaucoma.

Are there any differences among beta blockers?

Beta blockers differ in the type of beta receptors they block and, therefore, their effects.

  • Non-selective beta blockers, for example, propranolol (Inderal), block β1 and β2 receptors and, therefore, affect the heart, blood vessels, and air passages.
  • Selective beta blockers, for example, metoprolol (Lopressor, Toprol XL) primarily block β1 receptors and, therefore, mostly affect the heart and do not affect air passages.
  • Some beta blockers, for example, pindolol (Visken) have intrinsic sympathomimetic activity (ISA), which means they mimic the effects of epinephrine and norepinephrine and can cause an increase in blood pressure and heart rate. Beta blockers with ISA have smaller effects on heart rate than agents that do not have ISA.
  • Labetalol (Normodyne, Trandate) and carvedilol (Coreg) block beta and alpha-1 receptors. Blocking alpha receptors adds to the blood vessel dilating effect of labetalol and carvedilol.

With which drugs do beta blockers interact?

  • Combining propranolol (Inderal) or pindolol (Visken) with thioridazine (Mellaril) or chlorpromazine (Thorazine) may result in low blood pressure (hypotension) and abnormal heart rhythms because the drugs interfere with each others' elimination and result in increased levels of the drugs.
  • Dangerous elevations in blood pressure may occur when clonidine (Catapres) is combined with a beta blocker, or when clonidine or beta blocker is discontinued after their concurrent use. Blood pressure should be closely monitored after initiation or discontinuation of clonidine or a beta blocker when they have been used together.
  • Phenobarbital and similar agents may increase the breakdown and reduce blood levels of propanolol (Inderal) or metoprolol (Lopressor, Toprol XL). This may reduce effectiveness of the beta blocker.
  • Aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs) (for example, ibuprofen) may counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins. Prostaglandins play a role in control of blood pressure.

Reference: FDA Prescribing Information


Last Editorial Review: 10/21/2013



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