Beta Blockers vs. Calcium Channel Blockers

  • Medical Editor: John P. Cunha, DO, FACOEP
    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, FACOEP

    John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.

What is the Difference Between Beta Blockers and Calcium Channel Blockers?

What Are Beta Blockers and Calcium Channel Blockers?

Beta blockers, also called beta adrenergic blocking agents, block the neurotransmitters norepinephrine and epinephrine (adrenaline) from binding to beta receptors on nerves, which can reduce the heart rate and reduce blood pressure by dilating blood vessels. Beta blockers are used to treat high blood pressure, heart failure, angina (chest pain), abnormal heart rhythms, tremors, pheochromocytoma, hypertrophic subaortic stenosis, migraine headache prevention, hyperthyroidism, akathisia (restlessness or inability to sit still), panic disorder, anxiety, eye pressure caused by glaucoma, and aggressive behavior. Beta blockers can also prevent further heart attacks and death after a heart attack.

Calcium channel blockers (CCBs) dilate the arteries, reducing pressure within and making it easier for the heart to pump blood, and, as a result, the heart needs less oxygen. By reducing the heart's need for oxygen, calcium channel blockers relieve or prevent angina (chest pain). Calcium channel blockers also are used for treating high blood pressure, certain types of abnormally rapid heart rhythms, pulmonary hypertension, Raynaud's syndrome, cardiomyopathy, subarachnoid hemorrhage, and to prevent migraine headaches.

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What Are the Side Effects of Beta Blockers vs. Calcium Channel Blockers?

Beta Blockers

Beta blockers may cause:

Other important side effects include:

As an extension of their beneficial effect, they slow heart rate and reduce blood pressure, but they may cause adverse effects such as heart failure or heart block in patients with heart problems.

Beta blockers should not be withdrawn suddenly because sudden withdrawal may worsen angina (chest pain) and cause heart attacks, serious abnormal heart rhythms, or sudden death.

Central nervous system effects of beta blockers include:

Beta blockers that block β2 receptors may cause shortness of breath in asthmatics.

As with other drugs used for treating high blood pressure, sexual dysfunction may occur.

Beta blockers may cause low or high blood glucose and mask the symptoms of low blood glucose (hypoglycemia) in people with diabetes.

Other serious side effects of beta-blockers include:

  • Toxic epidermal necrolysis
  • Raynaud's phenomenon
  • Lupus erythematosus
  • Bronchospasm
  • Serious allergic reactions
  • Erythema multiform
  • Steven Johnson Syndrome

Calcium Channel Blockers

The most common side effects of calcium channel blockers are:

Liver dysfunction and over growth of the gums also occurs.

When diltiazem (Cardizem) or verapamil (Calan, Isoptin) are given to individuals with heart failure, symptoms of heart failure may worsen because these drugs reduce the ability of the heart to pump blood.

Like other blood pressure medications, calcium channel blockers are associated with sexual dysfunction.

What Drugs Interact with Beta Blockers and Calcium Channel Blockers?

Beta Blockers

  • 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 other's 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 anti-inflammatory drugs (NSAIDs) (for example, ibuprofen) may counteract the blood pressure reducing effects of beta blockers by reducing the effects of prostaglandins, which play a role in control of blood pressure.
  • Beta blockers may prolong hypoglycemia (low blood sugar) and mask symptoms of hypoglycemia in diabetics who are taking insulin or other diabetic medications.

Calcium Channel Blockers

Most of the interactions of calcium channel blockers occur with verapamil (Calan, Isoptin) or diltiazem (Cardizem). The interaction occurs because verapamil and diltiazem decrease the elimination of a number of drugs by the liver. Through this mechanism, verapamil and diltiazem may reduce the elimination and increase the blood levels of carbamazepine (Tegretol), simvastatin (Zocor), atorvastatin (Lipitor), and lovastatin (Mevacor). This can lead to toxicity from these drugs.

Grapefruit juice (approximately 200 ml) may elevate blood concentrations of felodipine (Plendil), verapamil (Calan, Isoptin), nisoldipine (Sular), nifedipine (Adalat, Procardia), nicardipine (Cardene), and possibly amlodipine (Norvasc). Grapefruit juice should not be consumed within 2 hours before or 4 hours after administration of affected calcium channel blockers.

What Are the Different Types of Beta Blockers and Calcium Channel Blockers?

Beta Blockers

  • acebutolol (Sectral)
  • atenolol (Tenormin)
  • betaxolol (Kerlone)
  • betaxolol (Betoptic S)
  • bisoprolol fumarate (Zebeta)
  • carteolol (Cartrol, discontinued)
  • carvedilol (Coreg)
  • esmolol (Brevibloc)
  • labetalol (Trandate [Normodyne - discontinued])
  • metoprolol (Lopressor, Toprol XL)
  • nadolol (Corgard)
  • nebivolol (Bystolic)
  • penbutolol (Levatol)
  • pindolol (Visken, discontinued)
  • propranolol (Hemangeol, Inderal LA, Inderal XL, InnoPran XL)
  • sotalol (Betapace, Sorine)
  • timolol (Blocadren, discontinued)
  • timolol ophthalmic solution (Timoptic, Betimol, Istalol)

Calcium Channel Blockers

The calcium channel blockers that have been approved for use in the US include:

  • amlodipine (Norvasc)
  • amlodipine and atorvastatin (Caduet)
  • amlodipine and benazepril (Lotrel)
  • amlodipine and valsartan (Exforge)
  • amlodipine and telmisartan (Twynsta)
  • amlodipine and olmesartan (Azor)
  • amlodipine and olmesartan and hydroclorothiazide (Tribenzor)
  • amlodipine and aliskiren and hydroclorothiazide
  • amlodipine and perindopril (Prestalia)
  • clevidipine (Cleviprex)
  • diltiazem (Cardizem)
  • felodipine (Cardene, Cardene SR)
  • isradipine
  • nicardipine
  • nimodipine
  • nisoldipine (Sular)
  • verapamil (Calan)

Summary

Beta blockers and calcium channel blockers are used to treat angina (chest pain), high blood pressure, and abnormal heart rhythms, and to prevent migraine headaches. Beta blockers and Calcium channel blockers (CCBs) both dilate the blood vessels through different mechanisms, reducing pressure within and making it easier for the heart to pump blood.

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Medically Reviewed on 3/21/2018
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