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How to manage the side effects of beta blockers

Woman pouring beta blockers into her hand

These medications can be lifesaving for people with high blood pressure, but they can also have side effects. Doctors share advice on how to navigate the most common issues.

Rosemary Black

By Rosemary Black

For someone with a heart condition, beta blockers can do a lot of good — namely, reduce high blood pressure (also called HBP or hypertension). According to the Mayo Clinic, they work by blocking the effects of epinephrine, a hormone also known as adrenaline. The heart beats more slowly, reducing the workload and pushing less volume of blood.

As with other medications, beta blockers can have side effects. When you’re taking one, it’s vital that you keep the lines of communication open with your doctor.

“Talk with your doctor or pharmacist to ensure that you understand why you’re taking a beta blocker,” says Alyssa M. Wozniak, PharmD. She’s a clinical assistant professor at the D’Youville School of Pharmacy in Buffalo, New York. “All drugs can cause side effects. While some people may not experience them or only have minor side effects, it’s still important to be aware of the possible side effects of beta blockers,” Wozniak says.

It’s also critical that your doctor and pharmacist know about all the medications you take and any medical conditions you have so that “they can choose the safest beta blocker for you based on your specific factors,” she adds. “This is especially important in people who have respiratory diseases like asthma and COPD, as certain beta blockers may have a safer side effect profile in those cases.”

Side effects can vary depending on which beta blocker you take, Wozniak says. “That’s because some of them work with slightly different actions at their target sites in the body,” she explains. Some beta blockers mainly target the heart. Others work on both the heart and the blood vessels.

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The common — and not so common — side effects

  • Tiredness, dizziness and weakness. These can occur because beta blockers lower blood pressure and heart rate, Wozniak says.
  • Sleeplessness. “The frequency of this is low, but it’s possible to experience sleeplessness, rather than drowsiness with beta blockers,” she says.
  • Diarrhea or upset stomach
  • Weight gain
  • Erectile dysfunction (ED)
  • Shortness of breath. “Because beta blockers slow your heart rate, you may experience shortness of breath with exertion,” says Benjamin Hirsh, MD. He’s the director of preventive cardiology at Sandra Atlas Bass Heart Hospital at North Shore University Hospital in Manhasset, New York. (Call your doctor right away if you’re short of breath, have new or worsening chest pain, have very bad dizziness or you pass out, Wozniak says.)
  • Changes in your blood sugar. “Beta blockers can hide the signs of low blood sugar, which is important for people with diabetes,” Wozniak says. “This is especially important if they’re taking a medication that can cause low blood sugar, such as insulin, or they’re more active than usual, or are sick or eat less than usual.”
  • Depression. This is less common, but it can happen. “If you start a beta blocker and notice you develop a low mood, contact your doctor right away to discuss it,” Wozniak says. “Developing depression as a side effect can vary based on which beta blocker you’re taking.”

How to cope with side effects

It’s vital that you don’t stop taking a beta blocker suddenly. “If you do, it can cause chest pain or even a heart attack, especially if you have heart disease,” Wozniak says.

Ask your doctor if you can take the lowest possible dose to control symptoms, says Kathryn A. Boling, MD. She’s a primary care provider at Mercy Personal Physicians at Lutherville, a Mercy Medical Center Community Physician Site in the Baltimore area. “We can do this in two ways,” she says. “You can start on a low dose and increase it slowly until your symptoms are relieved. Or the doctor may start you on a higher dose and then go down to where the symptoms are controlled and there are no side effects.”

To lower the chances of feeling dizzy, get up slowly if you’ve been sitting or lying down, and be careful when going up and down stairs, Wozniak says. It also helps to drink plenty of fluids, Dr. Boling adds. “It’s important to stay well hydrated,” she says. “I tell my patients that if you’re starting to feel dizzy, increase your fluid intake.”

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Your doctor may recommend that you monitor your blood pressure and your heart rate. “This can ensure that these measurements aren’t too low, which would increase the chance of dizziness,” Wozniak says.

If you have fatigue as a side effect, your doctor may put you on a long-acting version of the beta blocker. That way, you can take it only at night, rather than in the morning and at night, Dr. Hirsh says.

With an upset stomach, your doctor can check whether you can take the beta blocker with food to lessen this side effect. “Be sure to discuss this with your health care team first to ensure that your beta blocker can be taken with food,” Wozniak says.

If you experience impotence, your doctor may prescribe Viagra® (sildenafil) or Cialis® (tadalafil) to help, Dr. Hirsch says.

Will you always need to take a beta blocker?

It depends on the particulars of your situation. If your blood pressure improves with a combination of medication and lifestyle changes like a healthy diet and exercise, you may be able to reduce the amount of medication you take or go off it altogether. Or your doctor may want you to stay on a beta blocker for the long term. “A good point to bring up with your doctor is whether you need to continue with the medication,” Dr. Hirsh says. “I think it’s really important to have a discussion where your doctor can clearly explain what’s beneficial about beta blockers and whether you need to stay on them.”

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Do you take a beta blocker because you’ve had heart failure? Your doctor may recommend that you stay on it. “There are a lot of benefits of beta blockers for people with heart failure, so we try to keep them on it,” says Dr. Hirsh.

If you need to stop the beta blocker, your doctor should work with you to come up with a plan to slowly and safely stop the medication, Wozniak says.

 

Additional sources
Understanding beta blockers: The Mayo Clinic
Beta blockers — types, uses and side effects: Cleveland Clinic
Lifestyle changes to manage high blood pressure: American Heart Association
Monitoring blood pressure at home: American Heart Association