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General side effects of beta blockers

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

These include:

  • bronchospasm
  • heart failure
  • impotence
  • headache
  • nightmares
  • depression
  • reduced glucose
  • lethargy/fatigue
  • rarely a rash and dry eyes

A quantitative review of 15 randomised controlled trials (RCTs) of beta-blocker therapy for myocardial infarction, heart failure or hypertension investigated the reported frequency of side effects experienced with beta-blocker treatment in such trials. The RCTs involved more than 35,000 patients, with follow-up periods ranging from six to 59 months. The beta-blockers examined were acebutolol, atenolol, bucindolol, carvedilol, metoprolol, oxprenolol, pindolol, propranolol, sotalol and timolol (bucindolol is not available in the UK).

Results:

  • depressive symptoms - were assesssed in seven trials (n=10,662) and were similar in frequency in both the beta-blocker (20.1%) and the placebo group (20.5%). Beta-blocker therapy was not associated with a significant increased risk of reporting depressive symptoms
  • fatigue - assessed in 10 trials (n=17,682) and was shown to substantial in both the beta-blocker (33.4%) and placebo group (30.4%). Beta-blocker use was associated with a statistically significantly increased risk of experiencing fatigue but the absolute risk was 18 per 1,000 patients (95% CI 5-30). This is equivalent to one additional report of fatigue for every 57 patients treated for one year
  • sexual dysfunction - assessed in six trials (n=14,897) using measures ranging from decrease in sexual frequency to impotence. When all measures were considered together, the frequency of sexual dysfunction in the beta-blocker therapy group was 21.6% compared with 17.4% in the placebo group. There was an absolute increase in risk of 5 reports of sexual dysfunction per 1,000 patients treated (95% CI 2-8), equivalent to one additional report for every 199 patients treated for one year
  • note that the review was limited because different beta-blockers and different dosage regimens could not be compared. Also patients enrolled in RCTs may not be typical of those treated in primary care, especially elderly patents, who are often more susceptible to side effects of drugs.

Reference:

  1. Ko DT et al. Beta-blocker therapy and symptoms of depression, fatigue and sexual dysfunction. JAMA 2002;288:351-7.

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