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).

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  1. Patricia Pepper

    on September 29, 2013 at 9:10 pm

    In my experience as a patient with hypertrophic cardiomyopathy, it is important to assess the adrenal function. When the adrenal production of cortisol is low, under stress, the adrenals produce far more of the more aggressive stress hormones. Control of arrhythmia was achieved when I went into menopause and had more problems than previously, by physiologic hydrocortisone therapy and thyroid hormone. . Magnesium and taurine also helped, but the tendency to over produce adrenaline or other catecholamines was reduced by the physiologic dose hydrocortisone therapy. When the body lacks cortisol, it has to produce other catecholamines which are more aggressive, and cause arrhythmia . The physiology cortisone replacement therapy “funds the deficit”.

  2. Joe Taylor

    on December 15, 2013 at 6:10 am

    Drs. Michael & Mary Dan Eades, in their book entitled PROTEIN POWER, contend that beta blockers AND diuretics actually increase insulin levels, which contributes to hypertension as well as other serious problems. According to these doctors, their experience, and their studies, excess insulin causes many cardiovascular problems, and without dietary modification and discipline, these problems can be both serious and also irreversible, since most drugs do treat and control primarily symptoms rather than addressing root problems.

  3. Lois Cox

    on May 26, 2015 at 8:13 pm

    Hi Patricia
    I am post-menopausal and one year ago, I was diagnosed with high blood pressure and despite starting on a beta blocker and eventually altering the dose, I continued to have high blood pressure spikes with no real triggers. So after further diagnostic testing, I was diagnosed with an arrhythmia. So to clarify, your arrhythmia first began during menopause and eventually was controlled with hydrocortisone therapy and thyroid hormone therapy? Where did you undergo testing and treatment? What did or do the treatment involve? I have identified a bio-identical hormone specialist and plan to undergo thorough testing to learn the status of my hormone level!!!! Any recommendations?

  4. Daniel Snedden

    on June 5, 2015 at 3:26 pm

    I found at too late about COQ10 and statins. I have total heart block. My V-Tach is over 200 beats per minute. I had an Ablation in December 2014 and was placed on beat blockers. They cause severe joint pain, fatigue, nausea and trouble breathing. I am unable to exert myself due to the effects of the drugs. I am only 56 years old. I was on no medications until 7 years ago when my family doctor prescribed a statin. He told me my LDL was 163 and should be under 100. The statins have ruined my life. There was no warning by my doctor, the drug manufacturers, AMA or anyone else. I found out about the COQ10 problem and had myself tested at my expense. I was severely deficient in COQ10 as well as several other critical nutrients.

  5. Daniel Snedden

    on June 5, 2015 at 3:28 pm

    I found at too late about COQ10 and statins. I have total heart block. My V-Tach is over 200 beats per minute. I had an Ablation in December 2014 and was placed on beat blockers. They cause severe joint pain, fatigue, nausea and trouble breathing. I am unable to exert myself due to the effects of the drugs. I am only 56 years old. I was on no medications until 7 years ago when my family doctor prescribed a statin. He told me my LDL was 163 and should be under 100. The statins have ruined my life. There was no warning by my doctor, the drug manufacturers, AMA or anyone else. I found out about the COQ10 problem and had myself tested at my expense. I was severely deficient in COQ10 as well as several other critical nutrients.

  6. Dr.Munawar Aziz

    on June 10, 2015 at 11:42 am

    Statins do cause Q10 deficiency,it can be overcome by taking Q10 tabs/capsules on your physician’s advice.

  7. Olly

    on June 26, 2015 at 1:00 pm

    Hi, does any one know if a beta blocker can be found in a dead body after 5 months???? Thanks?

  8. Pat

    on November 18, 2015 at 3:52 pm

    I have been on a beta blocker for 2 weeks .. twice during that time I have awoken out of a deep sleep with my heart racing. It takes about 15 minutes before it calms down. My bp on beta blockers is consistently 137/89 Would a diuretic be a better choice?

  9. Maff

    on December 21, 2015 at 9:48 pm

    I’m on 1.25 mg of beta blocker after a heart attack in 2012, but now I can’t run or climb stairs because I get out of breath would beta blockers cause this & if so is there a lower dose than 1.25 mg

  10. gabs

    on August 25, 2016 at 8:25 pm

    I know someone who does not tolerate beta-blockers, but has been prescribed one for CHF. He was on Propanalol many years ago for Hypertension, and had to be taken off of it, because of all the side effects, that was making his life miserable.
    His Cardiologist put him on Metroprolol at 25 mg, cut in half to be taken twice a day, and he is having the same side effects he had on the other Beta Blocker mentioned above. He is a Veteran that goes to the VA hospital for his care, so he called them and was wondering if another Beta Blocker might be available, that doesn’t have severe side effects, and he was told that the one he is on, is his only option, I don’t know why, except perhaps that’s what he can get through the VA. I did a search and found one called “Nebivolol” that supposedly doesn’t have as severe as side effects, as Metroprolol. Of course we could ask if the dosage could be cut. I want him to be able to take this, while we are doing our new program of a plant based diet, and supplementation, to possibly reverse his heart disease. I was wondering what you thought Dr. Sinatra.

  11. Amanda V.

    on February 8, 2017 at 10:05 pm

    Hello, my Mother died, 22 Months ago, aged 93. Her Mother also lived well into her nineties. As she left her house to seven of us, we have been gradually clearing her many years of collections, even though one sister and a nephew remained in the house. They have only just moved out, despite the rest of us supporting her and offering help. She ‘dug her heels in’ and they just wouldn’t leave. Another sister, single, and who lives next door to our Mum’s house has been co-dependent with the other. They have created and caused the rest of us no end of worry and distress. The sister in our Mum’s house has had many health problems over the years. These all began with drug use which Mum tried to rectify…mostly, to no avail. Our nephew doesn’t work and he, also, smokes cigarettes and other substances. Two Months before they finally left to live with a daughter (sister), I was so full of anxiety regarding this situation that I had trouble sleeping and feared facing the house, each time we arranged to go there to do some more work. The house was always full of smoke and my nephew played loud head-banging music the whole time we were there. One day, after doing some productive clearing with a brother, I began feeling pain in my upper chest and up into my throat. Also, I could feel my heart beating loudly in my ears. Eventually, after about four days, I went to my Doctor who did blood tests and an ECG. Although I hadn’t had a Heart Attack, the ECG did show some strange abnormality. She sent me to a Cardiologist. I then had a CT scan of the Coronary Arteries. My Arteries are clear, I don’t have high blood pressure or diabetes however, with the aid of a Holter Monitor, I was diagnosed with Atrial Fibrillation. I was started on Sotolol, half in the morning and half at night. Also a Blood thinner. The Cardiologist said that I would be on the Blood Thinner for “the rest of my life”. Well, I am attributing the Atrial Fibrillation to the extreme stress that I was under and, although I am now seventy, I have been strong and healthy and still work in the Emergency Dept. of my local hospital. Now that our Mum’s house is about to be sold, I no longer have that ‘hanging over my head’. During the past 22 Months, as well as grieving for my Mother, I lost four close friends and a few other people connected to the family. My question is….as I was under an extremely stressful situation that I could identify without any doubt, is it not possible that my condition could improve or even disappear? I realize that as one gets older there is more chance of developing organ issues but I DO NOT want to ever be taking Blood thinners….especially for the rest of my life, however long that may be. I am continuing with half a Beta Blocker in the morning as my pulse is stable and does not go up at night. It is still the same twenty-four hours later. I have just begun taking COQ10 but have read conflicting ideas about this as well. I would like to get off all medications and have also cut down on tea and coffee. Thank you.

  12. Roy F.

    on April 1, 2017 at 5:58 pm

    Ref Margaret G. Age 72
    history 2007; anomoly in ECG ignored, diagnosed with depression
    feb 2010; Propranolol for anxiety; Amilopidine for Hypeetension followed by Ramipril and Losartan
    Aug 2012 Citalopram added
    Jan 2013 Excessive colonic bleed; Citalopram stopped Merzatopne started
    April 1 2013; MI PCI stents inc bifucated stent
    April 11 2013; MI sent for emergency 3 CABG on pump
    Question: would the cumulative effects of CoQ10 depletion by this drug regime have accelerated the cardiac events?
    Question: would the addition of CoQ10 depletion of mophine post CABG on pump have enhanced somatic or psychological results of the pump operation
    April 2017: Somatic symptom disorder diagnosed with PTSD; continual nausea left chest and arm pains headaches; intermittent UTI
    Question: If Ubiquinol is supplemented, what dosage?
    Regards Roy Foster

  13. robert moffett

    on May 19, 2017 at 2:17 pm

    Amanda, go watch the videos of cardiologist Dr Gupta on youtube, I think the channel is York cardiology. He has many a fib videos that wil help you with information on how risk factors play a part on prescribing blood thinners. I have afib and received more info and hope from his videos than both of my cardilogists put together.

  14. Diane

    on April 26, 2018 at 7:03 am

    Infrared saunas will increase the HRV and reduce or eliminate the need for beta blockers and the unwanted side effects. Infrared saunas are used routinely in Japan for heart patients. The infrared sauna was recommended by my integrative cardiologist. My EF went from 16% to 50-55% and I am no longer classified as having congestive heart failure.

  15. Marcia

    on January 13, 2019 at 10:50 am

    Does anyone knows if metoprolol can cause dizziness. nausea, weakness after ten years. Is there another pill apart from beta- blocker I could take for palpitation heart?

  16. Linds

    on February 2, 2019 at 4:09 pm

    Does anyone know if it is safe to take 30mg propranonol twice a day, and drink dandelion root tea or take one capsule? I only take a little, but do notice irregular heartbeat,

  17. Darrell C Bush

    on February 5, 2019 at 9:09 am

    My daughter is 14 very active and a swimmer. She has been on 50 mg of metoprolol off and on for about 2 years . She’s had a high heart rate since birth and was prescribed the medicine a few years ago. She gets fatigued very easy and she gets depressed because of these health issues. Is there anything she can do or take to help?

  18. Kimberly H

    on June 24, 2019 at 8:04 am

    I was always very healthy. Exercised every day. HIIT training, Crossfit, etc. In the fall of 2018 about an hour after my workout my heart started pounding very hard and faster than normal. It continued this way into the night. I finally went to the ER the next morning. They said everything was fine and to follow up with a cardiologist. After about a week my heart went back to normal. I saw the cardiologist, he had me wear a holter monitor for 24 hours. It came back fine. He did an echocardiogram, it was fine. About a week later I had another incident with the racing heart. This continued on and off through the winter. Then two weeks ago I was exercising (nothing like I used to)and I started feeling chest pains. I was home alone so I called the ambulance. At the hospital they said my bloodwork came back elevated. They admitted me under observation. They started me on Heparin, Plavix, Aspirin and Prednisone. They also gave me Tylenol which relieved the chest pains. Two days later I had a Cardiac Catheterization done. It came back clear. I was sent home that day with a prescription for Asprin 81mg once a day. The following day I was lightheaded with a headache. My blood pressure was slightly elevated as was my pulse. The doctor prescribed Metoprolol 12.5 mg once daily. Since then my BP has gone back to normal. I’m still having issues with my HR. It seems to increase with the slightest things. I can barely exercise anymore. I don’t like being on medication and was wondering if I can take Magnesium and CoQ10 while on the beta blocker? Also, Can I eventually wean myself off of this beta blocker? Also, I am a 52 yo female. Can any of this have to do with menopause? Any answers would be greatly appreciated. I am literally going crazy being on this medication.

  19. tori

    on July 10, 2019 at 6:04 pm

    To Kimberly H
    Severe dehydration after chronic dehydration and electrolyte imbalance.
    Sip water w a little added electrolytes. Sip, do not drink more than a few sips at a time. Sip all throughout the day for several days and you will feel a difference. So simple and so necessary. I’ve proven this over and over. Good luck.

  20. Linda B

    on September 22, 2019 at 4:50 pm

    Hello I have been on Beta blockers over 45 years now, I have been Dx with orthostatic hypotension years ago having severe tachycardia. I was later Dx with POTS as well as other forms of dysautonomia. In May 2019 I had a heart attack and open then open heart CABAG x 3. I have extreme insomnia now with a bradycardia, My medicine was changed from sectral to metropalol at that time. Severe fatigue to the point of not going to rehab yet. The insomnia is so bad I log average of less than 2 to 3 hours of very broken sleep. A sleep study documented 44 minutes of sleep in over 8 hours of studies. Please I am desperate at this point. I had been RX of benzodiazepines low dose and can sleep with them an hour or two and only take one every few days so I don’t got nuts, I am 70 now and have a low tolerance to meds.

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