Beta Blockers

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

The most widely used drugs in this class are metoprolol, atenolol, and propranolol.

Beta receptors exist in other systems of the body, such as the lungs. Some drugs target specifically the receptors in the heart, and are known as cardioselective beta blockers. Examples are metoprolol, atenolol, and acebutolol. Other beta blockers include propranolol and nadolol. The specific drug of choice depends on the patient’s health status and condition being treated.


Over the years I found beta blockers especially effective for the following reasons:

  • They reduce the risk of lethal ventricular arrhythmias after a heart attack. Patients who suffer a heart attack develop a scar (tissue damage from lack of oxygen) in the heart muscle. Such scars are often a trigger point for ventricular arrhythmias that shut down the heart’s pumping action and cause sudden cardiac arrest.
  • They reduce high blood pressure, particularly if it is stress-related. Beta blockers are great for patients with hypertension who are nervous or stressed-out or obsessive about taking their blood pressure readings.
  • They calm down the sympathetic nervous system that governs the fight-or-flight mode in the body and help improve heart rate variability (HRV), the intervals between heart beats. Disturbed HRV is an indicator of stress and contributes to cardiovascular events, including sudden death.
  • They help patients with heart failure who develop reflex tachycardia (rapid heart beat), a common result of sympathetic overstimulation. Beta blockers lower the heart rate and promote a better cardiac output.
  • They reduce readmission rates to hospitals for cardiac patients.
  • They really improve quality of life in patients. I have seen this hundreds of times.
  • At low dosage they even help people who have a fear of flying, golfers who routinely become nervous when putting, and actors struggling with stage fright. I’ve used beta blockers very successfully for patients in those situations.

Types of Arrhythmias

Common Side Effects

Most patients tolerate beta blockers very well, but the drugs do have the potential to create side effects. The most common problem I’ve seen was overwhelming fatigue. Reducing the dosage can usually minimize the fatigue, as well as other side effects. I soon learned that a small amount goes a long way.

Other side effects include impotence, weakness, slow heart beat, dizziness, difficulty breathing, depression, confusion, anxiety, nervousness, sleeplessness, disorientation, constipation, diarrhea, nausea, vomiting, cramps, and rash.

Nutritional Deficiencies

Beta blockers deplete CoQ10 and melatonin. If you take a beta blocker, you must also supplement with CoQ10 (100 mg once or twice a day). This is very important. CoQ10 protects against heart attacks, heart failure, and fatigue, and helps keep the immune system strong.

Many conventional doctors will prescribe a beta blocker, a statin, and an oral hypoglycemic agent at the same time. All three drugs deplete the body of CoQ10. I have seen overwhelming CoQ10 deficiencies in new patients who came to me taking such a combination.

Beta blockers can also lower melatonin levels and have the potential to create insomnia. I’ve seen that in a number of patients. To head off the problem I would recommend melatonin (500 mcg to 5 mg, before bedtime, starting with a low dose).

So Many Dietary Supplements – How Do You Choose?

Caution and Contraindications

  • I usually would not prescribe beta blockers for individuals with diabetes, particularly poorly controlled patients on insulin. Beta blockers can mask a hypoglycemic episode because they block the normal adrenaline response to low blood sugar—increased heart rate, sweating, brain fog, etc. However, I did treat my own mother, who was a brittle diabetic, with low-dose propranolol to help control her symptomatic angina and arrhythmias. So it can be used, if necessary, but with caution, for a diabetic who develops arrhythmia after a heart attack, or who has angina. In cases like this the medication saves and prolongs lives.
  • Not for elderly people who are forgetful, unless a beta blocker is absolutely essential.
  • Use with caution for people with insomnia and nightmares, because of the melatonin-lowering effect.
  • Patients with asthma should not use a beta blocker. The medication may cause airways to be become tense and constricted. I even encountered problems among asthmatics when I used cardioselective beta blockers. So this is a definite contraindication.
  • As with any prescription, be sure your doctor knows the details of your health status, such as your use of any other medications.

How to Get Off the Drug

Beta blockers are one medication that you probably shouldn’t ditch for a natural alternative. However, if you experience undesirable side effects, tell your doctor immediately so that you can work together to reduce your dosage or find a suitable alternative drug.


I found that the use of beta blockers is not well understood among doctors who don’t practice cardiology. No supplement can replace the adrenaline-inhibiting effect, but a fish oil supplement can be supportive in all these situations because it will improve HRV.

This article originally appeared in the March 2011 issue of Dr. Sinatra’s monthly written newsletter, Heart, Health & Nutrition. HMDI has reprinted this article with permission from Healthy Directions, LLC (© 2011 Healthy Directions, LLC).

Most Popular