Cardiovascular
Beta-blockers
Beta-adrenoceptor blocking drugs — Slow the heart and reduce its workload — used in angina, heart failure, arrhythmia and more; names ending in "-olol".
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Beta-blockers reduce the effect of adrenaline on the heart and blood vessels. They are used across cardiology — for angina, after a heart attack, in stable heart failure, and to control heart rate in atrial fibrillation — as well as for some non-cardiac indications such as essential tremor, migraine prophylaxis and anxiety symptoms. Most end in "-olol".
How it works
By blocking beta-adrenergic receptors they slow the heart rate, reduce the force of contraction and lower the heart's oxygen demand. Some are "cardioselective" (more focused on the heart), while others also act on the lungs and blood vessels, which matters in asthma and peripheral vascular disease.
In practice
In heart failure the rule is "start low, go slow": begin at a small dose once the patient is stable and euvolaemic, then up-titrate gradually, accepting a transient dip before the long-term benefit appears. In atrial fibrillation they are a first-line rate-control choice. Check pulse and blood pressure at each step, and never stop them abruptly in ischaemic heart disease, where rebound can be dangerous.
Examples
Practical use
How to take it & use it well
- Take it at the same time each day. Some types are taken once daily and others more often, so follow the schedule on your label.
- Swallow modified-release versions whole and do not crush or chew them, as this can release the medicine too quickly.
- Do not stop taking it suddenly, as this can cause your heart rate and blood pressure to rebound and may be dangerous, especially if you have heart disease.
- If you miss a dose, take it when you remember on the same day unless it is nearly time for the next one, in which case skip it. Never take two doses together.
- Be aware they can mask the warning signs of low blood sugar (such as a fast heartbeat) if you have diabetes, so monitor as advised.
- Tell your doctor if you feel very tired, breathless, or notice cold hands and feet, so your treatment can be reviewed.
Common uses
- Angina and ischaemic heart disease
- Rate control in atrial fibrillation
- Stable chronic heart failure (specialist initiation)
- Essential tremor, migraine prophylaxis, anxiety
Monitoring
- Heart rate and blood pressure
- Symptoms of heart failure when up-titrating
- In heart failure, start low and increase slowly under supervision
Weighing it up
Advantages & disadvantages
Advantages
- They slow the heart rate and reduce the heart's workload, which helps with angina, certain irregular heart rhythms and heart failure.
- They lower blood pressure and have strong evidence for improving survival after a heart attack.
- Some types help reduce the physical symptoms of anxiety, such as a racing heart and shaking.
- They can be used to prevent migraines in some people.
- Many versions are taken just once a day.
Disadvantages
- They commonly cause tiredness, cold hands and feet, and sometimes vivid dreams or disturbed sleep.
- They can worsen breathing problems in people with asthma, so are used with caution or avoided in that group.
- They may mask the symptoms of low blood sugar in people with diabetes.
- They can cause a slow heart rate or dizziness, particularly when starting or increasing the dose.
- Stopping them abruptly can be harmful, so they must be reduced gradually under guidance.
Key safety principles
What to watch for
- Caution or avoidance in asthma and severe COPD (especially non-selective agents).
- Do not stop abruptly in ischaemic heart disease — rebound angina or arrhythmia can occur.
- Can mask the warning signs of hypoglycaemia in people with diabetes.
- Additive heart-rate slowing with other rate-limiting drugs (e.g. some calcium-channel blockers, digoxin).
Key interactions
What to avoid or check alongside
- Combining them with certain calcium-channel blockers used for heart rhythm (such as verapamil or diltiazem) can slow the heart too much.
- Taking them with other blood-pressure-lowering medicines can cause your blood pressure to drop too low.
- In people with diabetes, they can mask the warning signs of low blood sugar caused by insulin or other diabetes medicines.
- Some asthma inhalers and beta-blockers can work against each other, so this combination needs care.
- Alcohol can add to the dizziness and low blood pressure these drugs can cause.
- Some decongestants and stimulants can counteract their effect on blood pressure.
Patient & carer advice
- Do not stop suddenly without medical advice
- Report wheeze, severe tiredness or a very slow pulse
- Cold hands and feet and vivid dreams are common and usually settle
Use with
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Answers
Beta-blockers: frequently asked questions
Will it make me tired?
Tiredness is common in the first few weeks and often eases as your body adjusts. If it does not settle or is severe, speak to your GP about reviewing the dose or type.
Can I drink alcohol with it?
A small amount is usually fine, but alcohol can add to dizziness and low blood pressure, so be cautious, particularly when you first start treatment.
Can I stop it suddenly?
No. Stopping abruptly can cause a dangerous rise in heart rate and blood pressure. If you need to stop, your doctor will lower the dose gradually.
Can I take it if I have asthma?
Some beta-blockers can tighten the airways and are usually avoided in asthma. Always tell your doctor about any breathing problems so a safe choice is made.
Will it affect exercise?
It can limit how fast your heart rate rises, so you may feel you cannot push as hard as before. Build up activity gradually and discuss any concerns with your doctor.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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