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Doctors' Answers to "Frequently Asked Questions" - Beta Blockers

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 03/31/2000]
Question: I have suffered from migraine headaches for 5 yrs. The first at the age of 40. I have tried all the new and old treatments for these headaches. I finally asked to be tested for diabetes and hypoglycemia. Results are as follows: fasting 54 two hours after eating a large meal
the count was 94. Now my question is, will the drug atenolol 50 mg 1 daily help decrease the frequency or severity of these headaches? I have tried so many things. I hope you can help me. Thank You for your time and attention.

Answer: Beta blockers are useful for prevention of migraine headaches. So, are worth a try , what are the "new and old treatments" that you have tried? Beta blockers are usually one of the first and one of the older treatments.

[posted 08/21/1999]
Question: I am currently on propronol for my migraine headaches and I am feeling very fatigued all the time. Is there any way to counter act some of the side effects without interfering with the medicine?

Answer: Not really, you might try a calcium channel blocker instead. Often works without the fatigue.

Beta Blockers & Sexual Dysfunction [posted 10/30/98]
Question: What are the possible, short term or long term, side effects from having to take Tapazole & Propanol (Beta Blocker) in combination, specifically in regards to sexual function or dsyfunction?

Answer: Beta blockers may decrease sexual drive and erectile force, Tapazole's side effects are usually directed at the bone marrow, sexual problems develop rarely with this drug-although the underlying thyroid disease can cause problems.

Beta Blockers & Physical Activity [posted 10/21/98]
Question: I have had tremors in my hands for as long as I can remember. I am 43 years old and in good health. I have tried Inderal when I have had very important social or professional occasions with good results. However, I am a school teacher and I think I would like to take it daily so the students would not ask me why I am always nervous. I also am very physically active such as playing tennis several times a week. Is it safe to take a beta blocker and participate in extreme physical activity since it tends to slow down the heart rate?

Answer: Very safe.

Lack of Sleep on Beta Blockers [posted 10/9/98]
Question: I take 95 mg beta blocker/Bloc-Zok/ daily during one week and have the sleeplessness. I can not sleep until 4 a.m. The blood pressure is o.k. What can help me against sleeplessness?

Answer: Switching to another drug class. About 10% of patients on beta blockers have difficulty sleeping or nightmares. These do not change with time.

Beta Blockers [posted 8/5/98]
Question: What exactly is a beta blocker?

Answer: This is a class of drugs which chemically block the beta adrenergic site. There are selective and non-selective Beta one and Beta two classes of drugs. These drugs are used for hypertension, angina, migraine prevention, anxiety, tremor, cardiac arrhythmia, etc.

Beta Blockers [posted 8/5/98]
Question: I wanted to know what the side affects of a beta-adrenergic blocking agent (specifically Toprol) are? I wanted to know specifically if stomach cramps and diarrhea are associated with this drug and/or if taking Immodium ID would cause some kind of negative reaction with this drug?

Answer: Beta blockers are used for a variety of clinical problems. Side effects include slow pulse, fatigue, nightmares, nausea, and shortness of breath. Stomach cramps are occasionally seen, diarrhea is rarely seen.

Beta Blocker's Effects [posted 8/4/98]
Question: I am on propranolol, 80 mg daily, for migraines, and slightly high blood pressure. I have read that some beta blockers interfere with insulin production. Does this drug have any effect on weight loss? Could it make it more difficult to lose weight? Can you gain weight more easily? I'd also like to know if prolonged use of a beta blocker would eventually cause any weakening of the heart muscle, since it blocks beta receptors, and causes a slower pulse. Any information on these two areas would be of interest.

Answer: They do interfere a slight amount with release. However, clinically it doesn't seem to make a difference. High dosages of beta blockers would have more effect. Most of the time, we don't use the high doses as much as 20 years ago due to other alternatives. It doesn't seem to clinically seem to affect diabetic control or weight, although theoretically possible.

Beta Blockers
Question: Is there a medication called potol used as a beta blocker for hypertension? If so, what are it's effects and side reactions?

Answer: Propanolol is a beta blocker. I can't figure any other beta blocker that would start with P or this spelling. General side effects are fatigue, slow pulse, nightmares, nausea and lack of sex drive.

Beta Blockers - Ziac
Question: What are the specific side effects of the beta blocker Ziac?

Answer: Beta blockers come in two classes B1 and B2 with the B2 being somewhat selective. That is they produce less pulmonary side effects, etc. General side effects are fatigue, insomnia or nightmares, nausea, occasional hair loss, and slow pulse. Fatigue is the side effect which causes most patients to avoid these drugs. Ziac tries to avoid the side effects of beta blockers by using a very small dose. However, some patients are very sensitive to beta blockers and will experience side effects at small doses.

Beta Blockers
Question: I am a military musician and am about to take an audition to determine whether or not I am eligible for promotion. Failing this audition could get me dismissed from military service, and in the light of the 'politics' in my field, I'm extremely nervous. I have taken past auditions, but they do not become less stressful as they go, and each time I am glad I am seated because my legs do not feel like they could hold my weight. I sweat and have tremors. Also, things I know by heart are suddenly gone. A co-worker has seen beta blockers help others in my position I think she has taken them herself. What are the effects and would this be safe for occasional or rare use?

Answer: Beta Blockers are common drugs used to treat many different problems. They are very effective in treating hypertension, angina, rapid heart beats, preventing migraine headaches, and have been used to treat Stage fright and occasionally anxiety. They also have similar side effects. Beta Blockers come as selective and non-selective. The non-selective beta blockers can cause some bronchospasm and asthma. The selective blockers can also, but much less frequently. Common side effects to both selective and non-selective beta blockers are fatigue, slow heart rate, nausea, nightmares and difficulty sleeping, impairment of insulin release, depression, and occasional skin rash. These drugs should never be stopped abruptly and require a tapering if discontinued. These should work well with you, but give them a trial first before the "big day" to ensure they do not lower your blood pressure excessively.

Beta Blockers
Question: We have taking our son to a psychiatrist because of problems with school and discipline. He has recomended putting him on a beta blocker for anxiety. Do you think it is safe? What could the side effects be? My son is 15 years old.

Answer: Beta-blockers are used for a variety of problems. Anxiety and stage fright are common uses. This drug has been studied and used for years and the side effects are well known. These side effects include fatigue, slow pulse, depression, nightmares, nausea and occasionally asthma. The other drugs available for chronic or acute anxiety are klonopin(potentially addicting)and SRI anti-depressants, which have a shorter time of evaluation compared to the beta-blockers. In general, I start young people on beta blockers before going to other potentially more limiting drugs. Young people tend to have much fewer side effects than older adults with these drugs.

Question: My husband has been suffering from severe headaches and double vision. A catscan was done and showed no signs of tumor, stroke, etc. This headache has been almost continuous for 3 months. The Dr. put him on 50 mg of metoprolol tartrate twice a day. I'm concerned that this will lower his blood pressure too much, and also wonder if a MRI is not indicated.

Answer: The beta-blocker metaprolol is useful in limiting or preventing migraine headaches. I doubt seriously if a headache which has lasted three months is a migraine. While I would not disagree with trying it, I doubt that it will work. I agree with you an MRI is certainly indicated and a visit to a specialist in headaches if the MRI is negative.

Question: I had a heart attack in April 1996 and am taking Atenolol 50 mg for high blood pressure. Recently I missed a dose of atenolol and I noticed that my heart rate got very high during an aerobics class (150 vs 96-102 usually). Is this normal? How dangerous is it to miss one dose? How dangerous is it to vary the time that I take the dose by a couple of hours?

Answer: Beta-blockers are one of the most effective drugs in preventing initial and subsequent heart attacks. They act by blocking the beta receptors in the bodies nervous system. Consequently, when these receptors have been blocked for any significant amount of time and then are open or unblocked they actually are more responsive. Exercise, stress, anger, etc will produce faster heart rates and higher blood pressures than they would normally. When physicians need to stop beta-blockers for any reason we taper the dose over several days to minimize this effect. Missing the dose by a few hours is usually not a major concern-missing several doses can he critical.

Atenolol and Stroke
Question: My dad is insulin-dependent diabetic who has had a triple by-pass (8 years ago) and has been taking 60mg daily of procardia and two insulin shots along with 1 aspirin a day. Last week his doctor prescribed 50mg of atenolol and the one and only time dad took it within the same day he suffered a mild stroke. All of the tests on his arteries (neck) as well as his heart have come back negative to contributing to the stroke and the neurological workup can't pinpoint how the stroke occurred. My question is could taking atenolol have caused this stroke to happen?

Answer: It's always a problem when a severe problem occurs at the same time that a new drug is either started or stopped. It is agonizing for the physician, patient and their family to try and decide whether this is just unfortunate circumstance or whether the drug had anything to do with the medical problem. Off hand, I can't come up with any senario which starting a beta-blocker would cause a stroke. I suspect it is the intrinsic small vessel disease from his diabetes mellitus.

Omeprazole and H2 Blocker
Question:Is there a good reason to use both Omeprazole and H2 blocker at the same time?

Answer: H2 Blockers are drugs that block acid in the stomach. This is accomplished by "blocking" the H2 receptor on the cells in the stomach that produce acid. Omeprazole(Prilosec) belongs to a class of drugs called proton pump inhibitors. This class of drugs blocks acid production by not allowing the cell to pump hydrogen charges through the cell membrane. In general, the proton pump inhibitors are more powerful in reducing acid. The H2 blockers have the advantage of minimal short or long term side effects. They are so well tolerated that they are now generally available over the counter without a prescription. There is no absolute contraindication to combining these drugs. On occasion, I have maintained a patient on H2 blockers for the first 2-3 days of treatment with omeprazole since the omeprazole can theoretically take a few days to be maximally effective. I guess if acid symptoms were still present, a combination of the two would be effective. I haven't seen this tested clinically.

Possible Tolerence to Zebeta
Question:I have been taking beta blockers for the last 20 years due to a prolapsed mitral valve, borderline blood pressure (130/90), and one incident in 1987 of atrial fibrillation. I am 40 years of age. The changes in beta blockers were due to the previous medications not working any longer, resulting in palpitations. Is it likely that I would also develop a tolerance to Zebeta, and possibly have to change medications again. If so, what options would I have? I have some BP related thickening of the heart walls, but, though the prolapse is pronounced, the regurge is slight. I also have allergenic asthma that is not a problem, unless I have a respiratory infection. I would very much like to have longevity so that I can watch my 7 and 9 year olds grow up, and be there for them. I have been told that not taking the medication would probably affect my health.

Answer: Are you having palpitations or tachycardia? Palpitations are usually only a nuisance and don't affect longevity-actually most patients with MVP live longer than those without unless there is severe mitral regurgitation. Tachcardia(runs of fast beats) is a different story. If you are not having symptoms of vertigo , syncope, etc. with the palpitations, I wouldn't worry about it. Occasionally, verapamil( a calcium channel blocker) with work where beta blockers don't. Also, avoid chocolate, coffee, caffeine in any soft drink, get normal rest, avoid alcohol-see if any of these help.

Question:I need to find the beta blocker that is least likely to cause hypoglycemia.

Answer: I'm not sure that this data is known-the drug companies certainly don't discuss it as an advantage of their own beta blocker.

Stage Fright
Question:I need a beta blocker for žstage frightÓ to reduce nerves. Can you suggest something?

Almost any will do. Focus on the selective short term beta-blockers, Metaprolol for example would be a good one.
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