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.
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.
Metoprolol
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.
Atenolol
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.
