Beta Blockers

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.

Benefits

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.

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).

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.

Alternatives

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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10 Comments

  1. Patricia Pepper

    on September 29, 2013 at 9:10 pm

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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

    Reply

    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.

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