Carvedilol Coreg does both. The Oregon researchers found compelling evidence that taking a beta blocker after having had a heart attack lowers the chances of a repeat heart attack or an early death. These drugs also increase the chances of living longer and better with heart failure. The reviewers found that different beta blockers work better for different conditions. Beta blockers are generally safe to take. Side effects tend to be annoying, not life-threatening.
Doctors long withheld beta blockers from people with chronic obstructive pulmonary disease over worries that these drugs would worsen symptoms, but a report in the Archives of Internal Medicine showed that judicious use of beta blockers may decrease flare-ups of this common breathing problem and improve survival.
Which one is right for you depends on the reason you need it, your other cardiovascular and medical conditions, and side effects.
As part of its Best Buy Drugs series, Consumer Reports offers recommendations based on effectiveness, safety, and cost. You can download the report at health. How often you take a beta blocker depends on the medication.
Some are once-a-day, extended-release pills; others must be taken in the morning and in the evening. As with every medication and supplement you take, talk with your doctor or nurse if you have questions.
Starting a beta blocker isn't like starting aspirin or many other drugs, with everyone taking the same dose. It's important to start at a low dose and gradually work your way upward. Starting with too large a dose right off the bat could lower your heart rate and your blood pressure into dangerous territory.
You need to be just as careful stopping a beta blocker as starting one. Quitting suddenly can cause what is known as "rebound angina. Gradually decreasing the dosage can help prevent these problems. If beta receptors existed only in heart cells, beta blockers would be a more ideal cardiac drug. But since beta receptors are found in so many other tissues, these drugs can have unwanted effects throughout the body.
That beta blockers have been in use for half a century is a plus, because it has given doctors and researchers plenty of time to observe how well these medications work, how safe they are, and what side effects they cause. Most people who take a beta blocker experience at least one side effect from the drug. Although these are usually tolerable, about one in five people ends up switching to a different beta blocker or to another type of drug because of side effects.
The most common ones include. The lower the dose, the lower the chances that a beta blocker will cause noticeable side effects. The combination of individual differences and medication differences means it can be a balancing act to find the drug and dosage that work best with the fewest side effects.
If a side effect appears, don't be too quick to switch — adverse effects sometimes go away as the body gets used to the drug. There is some evidence that sudden withdrawal may cause an exacerbation of angina and therefore gradual reduction of dose is preferable when beta-blockers are to be stopped. There is a risk of precipitating heart failure when beta-blockers and verapamil are used together in established ischaemic heart disease.
For recommendations on the use of beta-blockers following a myocardial infarction, see Secondary prevention of cardiovascular events in Acute coronary syndromes. Several studies have shown that some beta-blockers can reduce the recurrence rate of myocardial infarction. However, uncontrolled heart failure, hypotension, bradyarrhythmias, and obstructive airways disease render beta-blockers unsuitable in some patients following a myocardial infarction.
Atenolol and metoprolol tartrate may reduce early mortality after intravenous and subsequent oral administration in the acute phase, while acebutolol , metoprolol tartrate , propranolol hydrochloride , and timolol maleate have protective value when started in the early convalescent phase.
The evidence relating to other beta-blockers is less convincing; some have not been tested in trials of secondary prevention.
Beta-blockers act as anti-arrhythmic drugs principally by attenuating the effects of the sympathetic system on automaticity and conductivity within the heart. They can be used in conjunction with digoxin to control the ventricular response in atrial fibrillation, especially in patients with thyrotoxicosis. Beta-blockers are also useful in the management of supraventricular tachycardias, and are used to control those following myocardial infarction.
Esmolol hydrochloride is a relatively cardioselective beta-blocker with a very short duration of action, used intravenously for the short-term treatment of supraventricular arrhythmias, sinus tachycardia, or hypertension, particularly in the peri-operative period. It may also be used in other situations, such as acute myocardial infarction, when sustained beta-blockade might be hazardous.
Sotalol hydrochloride , a non-cardioselective beta-blocker with additional class III anti-arrhythmic activity, is used for prophylaxis in paroxysmal supraventricular arrhythmias. It also suppresses ventricular ectopic beats and non-sustained ventricular tachycardia. It has been shown to be more effective than lidocaine in the termination of spontaneous sustained ventricular tachycardia due to coronary disease or cardiomyopathy.
However, it may induce torsade de pointes in susceptible patients. Beta-blockers may produce benefit in heart failure by blocking sympathetic activity.
Bisoprolol fumarate and carvedilol reduce mortality in any grade of stable heart failure; nebivolol is licensed for stable mild to moderate heart failure in patients over 70 years. Ideally, treatment should be initiated by those experienced in the management of heart failure. Beta-blockers are used in pre-operative preparation for thyroidectomy. Administration of propranolol hydrochloride can reverse clinical symptoms of thyrotoxicosis within 4 days.
Routine tests of increased thyroid function remain unaltered. The thyroid gland is rendered less vascular thus making surgery easier. Beta-blockers have been used to alleviate some symptoms of anxiety ; probably patients with palpitation, tremor, and tachycardia respond best. Simply click the "Reply to comment" button and complete the form. Your reply, once signed off, will appear below the comment to which you replied if multiple replies to a comment, they will appear in order of submission.
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Latest Articles View Articles. Prescribing Reports View reports. Audits View all audits. Peer Group Discussions View all discussions. Hello there! Remember me. This item is 4 years and 4 months old; some content may no longer be current. Cardiovascular system Medicine indications Pharmacology. Beta-blockers for cardiovascular conditions: one size does not fit all patients Metoprolol succinate accounts for almost three-quarters of the beta-blockers dispensed in New Zealand.
Please login to save this article. Log in. Key practice points: Beta-blockers are a diverse group of medicines and prescribers should consider their different properties, along with the presence of co-morbidities, to individualise care for patients with cardiovascular conditions When a beta-blocker is initiated, a slow upwards titration of dose is recommended to minimise adverse effects. Beta-blockers should also be withdrawn slowly, ideally over several months, to prevent rebound symptoms such as resting tachycardia.
From months onwards post-myocardial infarction, consider withdrawing beta-blockers for patients without heart failure or arrhythmias, if re-vascularisation has occurred Bisoprolol is an alternative to metoprolol succinate in many cases; both are once-daily cardioselective beta-blockers that are less likely to cause fatigue and cold extremities than non-specific beta-blockers and are often preferred for patients with co-existing chronic obstructive pulmonary disorder COPD because they cause less bronchoconstriction.
Reliance on one medicine may cause problems The recent disruption of the supply of metoprolol succinate where dispensing was limited to fortnightly or monthly amounts highlights the risk of depending on one beta-blocker.
What is the difference between metoprolol succinate and metoprolol tartrate? The pharmacology of beta-blockers All beta-blockers produce competitive antagonism of beta-adrenoceptors in the autonomic nervous system. Non-selective, cardioselective and vasodilating beta-blockers Beta-blockers are classified according to their adrenoceptor binding affinities Table 1 , the degree of which varies within each class.
Table 1 : Properties of beta-blockers subsidised in New Zealand. Beta-blockers can be water or lipid soluble Water-soluble beta-blockers, e. Beta-blockers may influence other medicines All beta-blockers can potentiate bradycardia, hypotension and cardiac effects caused by other medicines, e.
Cardiovascular indications for beta-blockers The indications for beta-blockers have shifted over the years. Stable angina: preference and co-morbidities determines treatment choice Beta-blockers or calcium channel blockers are recommended as the first-line anti-anginal medicines. Arrhythmias: bisoprolol and metoprolol succinate are often preferred Beta-blockers are the first-line treatment for long-term symptomatic rate control in patients with a range of cardiac arrhythmias, including atrial fibrillation and ventricular tachycardia.
Hypertension: beta-blockers are fourth-line For patients with uncomplicated hypertension beta-blockers are generally a fourth-line option as angiotensin converting enzyme ACE inhibitors, angiotensin II receptor blockers ARBs , diuretics or calcium channel blockers are associated with better outcomes.
Post-myocardial infarction: initiated in secondary care, but when should they be stopped? The optimal duration of treatment post-myocardial infarction is uncertain There are two reasons why the optimal duration of beta-blocker treatment post-myocardial infarction is uncertain: 16 Reperfusion techniques and the routine use of statins and anti-platelet medicines post-myocardial infarction mean that patients now gain less benefit from the use of beta-blockers than they did decades ago There are no recent prospective randomised studies assessing the long-term benefits of beta-blockers in patients with uncomplicated myocardial infarction A systematic review of sixty trials that divided studies into either the reperfusion era or the pre-reperfusion era, found that beta-blockers reduced mortality in patients post-myocardial infarction in the pre-reperfusion era, but not the reperfusion era.
Minimising the adverse effects of beta-blockers The adverse effect profile varies between beta-blockers according to their properties Table 1. Initiating beta-blockers: start low and go slow if treating heart failure Beta-blockers should be started at a low dose and slowly titrated to maximum tolerated dose when used to treat patients with heart failure.
Beta-blockers are usually not recommended in patients with asthma Beta-blockers should generally be avoided in patients with asthma.
Cardioselective beta-blockers are generally safe and beneficial in patients with COPD There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit to those with co-existing heart failure; 23 cardioselective beta-blockers are preferred. Cardioselective beta-blockers may reduce peripheral vasoconstriction and fatigue Cardioselective beta-blockers, e.
Water soluble beta-blockers are less likely to cause sleep disturbances Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing the blood brain barrier.
Indication Recommendation Co-morbidities and considerations Angina All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred. Celiprolol and pindolol tend not to be used Cardioselective beta-blockers, e.
Withdrawal of beta-blockers is sometimes appropriate Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite. Stopping treatment: go slow to get low Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include ischaemic cardiac symptoms, e. References Ministry of Health. Pharmaceutical Claims Collection.
Australian Government. Medicare statistics. Available from: www. Cardio-selective beta-blocker: pharmacological evidence and their influence on exercise capacity. Cardiovasc Ther ;— The role of the new beta-blockers in treating cardiovascular disease. Am J Hypertens ;S—S. NZF v Stable angina: management. Long-term beta blockers for stable angina: systematic review and meta-analysis.
Eur J Prev Cardiol ;— G Ital Cardiol ;—
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