Beta Blockers vs. Valium

• Beta blockers and Valium (diazepam) are used to treat anxiety.
• A difference is beta blockers are usually used to treat high blood pressure and heart problems, and they are prescribed off-label for anxiety. Valium belongs to a different drug class called benzodiazepines that are often prescribed for anxiety.
• Taking a beta-blocker with Valium may help increase the effectiveness of the benzodiazepine.
• Beta blockers are generally prescribed for short-term event-related anxiety, such as social phobias and stage fright. They block the physical symptoms of anxiety such as rapid heart rate, tightness in the chest, or sweating. They don’t affect the psychological and emotional aspects of anxiety such as worry.
• Propranolol (Inderal) and atenolol (Tenormin) are the beta blockers most commonly prescribed for anxiety.
• Valium acts as a sedative but it can be taken during an acute episode of anxiety or a panic attack, and it can relax people to help reduce stress and worry.
• Side effects of beta blockers and Valium that are similar include diarrhea, rash, blurred or double vision, insomnia, muscle cramps/spasms, and fatigue.
• Side effects of beta blockers that are different from Valium include stomach cramps, nausea, vomiting, disorientation, hair loss, weakness, and sexual dysfunction.
• Side effects of Valium that are different from beta blockers include drowsiness, euphoria, loss of balance, paradoxical reactions with excitability, rage, confusion, and speech problems.
• Do not suddenly stop taking beta blockers because sudden withdrawal may worsen angina (chest pain) and cause heart attacks, serious abnormal heart rhythms, or sudden death. Abrupt discontinuation of Valium after prolonged use may cause withdrawal symptoms such as insomnia, headaches, nausea, vomiting, lightheadedness, sweating, anxiety, fatigue, and seizures.

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

Valium (diazepam) is a benzodiazepine used to treat anxiety. Other benzodiazepines include alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and flurazepam (Dalmane).

Beta Blockers

Beta blockers may cause:

• Diarrhea
• Stomach cramps
• Nausea
• Vomiting

Other important side effects include:

• Rash
• Blurred vision
• Disorientation
• Insomnia
• Hair loss
• Weakness
• Muscle cramps
• Fatigue

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:

• Headache
• Depression
• Confusion
• Dizziness
• Nightmares
• Hallucinations

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
• Toxic epidermal necrolysis

Valium

The most common side effects of diazepam are:

• Drowsiness
• Fatigue
• Diarrhea
• Rash
• Euphoria
• Ataxia (loss of balance)

Other important side effects include:

• Paradoxical reactions with excitability
• Muscle spasm
• Lack of sleep
• Rage
• Confusion
• Speech problems
• Double vision

Possible serious side effects:

• Respiratory depression
• Neutropenia
• Depression

Warning: Diazepam can lead to addiction (dependency), especially when higher dosages are used over prolonged periods of time. In patients addicted to diazepam or after prolonged use, abrupt discontinuation may cause symptoms of withdrawal such as:

• Insomnia
• Headaches
• Nausea
• Vomiting
• Lightheadedness
• Sweating
• Anxiety
• Fatigue

Seizures can occur in more severe cases of withdrawal. Therefore, after extended use, diazepam should be slowly tapered under a doctor's supervision rather than abruptly stopped.

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.

Valium

Alcohol or medications that cause sedation may add to the sedative effects of diazepam. Patients taking benzodiazepines should avoid such combinations. The following drugs may prolong the effects of diazepam by inhibiting liver enzymes that eliminate diazepam:

• cimetidine (Tagamet)
• ketoconazole (Nizoral)
• itraconazole (Sporanox)
• omeprazole (Prilosec, Rapinex)
• erythromycin
• clarithromycin (Biaxin)
• darunavir (Prezista)
• fluvoxamine (Luvox)
• fluoxetine (Prozac)

Dosages may need to be decreased when these drugs are used with diazepam.

Carbamazepine (Tegretol), rifampin (Rifadin), and St. John's Wort decrease levels of diazepam by increasing the elimination of diazepam by liver enzymes.