Major side effects of beta blockers
- Philip J Podrid, MD, FACC
Philip J Podrid, MD, FACC
- Professor of Medicine, Professor of Pharmacology and Experimental Therapeutics
- Boston University School of Medicine
- Lecturer, Harvard Medical School
Most of the major adverse effects of beta blocking drugs result from beta-adrenoreceptor blockade. Many signs and symptoms can therefore be induced because the beta receptors affect multiple metabolic and physiologic functions. Other reactions apparently unrelated to beta blockade can occur, but they are uncommon.
The major side effects associated with the use of beta blockers will be reviewed here. Beta blocker intoxication (overdose) and the clinical use of these drugs for the treatment of arrhythmias, hypertension, myocardial infarction, and heart failure are discussed separately. (See "Beta blocker poisoning" and "Choice of drug therapy in primary (essential) hypertension", section on 'Beta blockers' and "Acute myocardial infarction: Role of beta blocker therapy" and "Use of beta blockers in heart failure with reduced ejection fraction".)
ADVERSE CARDIAC EFFECTS DUE TO BETA BLOCKADE
Major cardiac effects caused by beta blockade include the precipitation or worsening of congestive heart failure, and significant negative chronotropy.
Heart failure — Beta blockers are an important component of long-term therapy for patients with chronic heart failure and reduced left ventricular systolic function, as these drugs reduce the detrimental effects of excess chronic catecholamine stimulation. However, beta blockers may exacerbate symptoms in patients with acute decompensated heart failure or in those with preexisting myocardial dysfunction and borderline compensation, since the maintenance of cardiac output in such patients depends in part upon sympathetic drive. Hence, beta blockers should not be administered as new therapy until after heart failure is compensated. However, patients already receiving beta blockers can be continued on this therapy if there is decompensated heart failure.
Increased peripheral vascular resistance, induced by nonselective beta blockers, also may contribute to the decline in myocardial function in this setting. On the other hand, drugs with intrinsic sympathetic activity (ISA), such as pindolol, may be less likely to impair myocardial function .
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- ADVERSE CARDIAC EFFECTS DUE TO BETA BLOCKADE
- Heart failure
- Negative chronotropic effects
- Beta blocker withdrawal
- ADVERSE NONCARDIAC EFFECTS DUE TO BETA BLOCKADE
- Increased airways resistance
- Exacerbation of peripheral artery disease
- Facilitation of hypoglycemia
- Depression, fatigue, sexual dysfunction
- Lipid metabolism
- Weight gain
- ADVERSE EFFECTS UNRELATED TO BETA BLOCKADE
- Drug interactions
- Antinuclear antibodies
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS