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How long does it take for beta blockers to work


Propranolol: medicine for heart problems, anxiety and migraine

1. About propranolol

Propranolol belongs to a group of medicines called beta blockers. It's used to treat heart problems, help with anxiety and prevent migraines.

If you have a heart problem, you can take propranolol to:

  • treat high blood pressure
  • treat conditions that cause an irregular heartbeat (arrhythmia), like atrial fibrillation
  • help prevent future heart disease, heart attacks and strokes
  • help prevent chest pain caused by angina

Propranolol can help reduce your symptoms if you have too much thyroid hormone in your body (thyrotoxicosis). You'll usually take it together with medicines to treat an overactive thyroid.

This medicine is only available on prescription. It comes as tablets, slow release capsules, or as a liquid that you swallow.

2. Key facts

  • Propranolol slows down your heart rate and makes it easier for your heart to pump blood around your body.
  • It's usually prescribed for high blood pressure and other heart problems, but it can also help with the physical signs of anxiety, like sweating and shaking.
  • Your very first dose of propranolol may make you feel dizzy, so take it at bedtime. After that, if you do not feel dizzy, you can take it in the morning.
  • The main side effects of propranolol are feeling dizzy or tired, cold hands or feet, difficulties sleeping and nightmares. These side effects are usually mild and short-lived.

3. Who can and cannot take propranolol

Most adults and children aged 12 and over can take propranolol. But it is not officially approved for treating high blood pressure in children under 12 years old.

Propranolol is not suitable for everyone. To make sure it's safe for you, tell your doctor before starting to take propranolol if you:

  • have ever had an allergic reaction to propranolol or any other medicine
  • have low blood pressure or a slow heart rate
  • have heart failure which is getting worse
  • have diabetes
  • have liver or kidney problems
  • have severe blood circulation problems in your limbs (such as Raynaud's phenomenon), which may make your fingers and toes tingle or turn paler than usual or blue
  • have metabolic acidosis, when there is too much acid in your blood
  • have lung disease or asthma
  • are pregnant, trying to get pregnant or breastfeeding

4.

How and when to take propranolol

Propranolol comes as 2 different types of medicine:

  • standard release – this releases propranolol into your body quickly, so you may need to take it several times a day depending on your dose
  • slow release – this releases the medicine slowly so you do not have to take it as often, once a day is usually enough

If you are taking it once a day, your doctor may advise you to take your first dose before bedtime, because it can make you feel dizzy. After the first dose, if you do not feel dizzy, take propranolol in the morning.

Important

Keep taking propranolol even if you feel well. You will still be getting the benefits of the medicine.

Dosage and strength

Propranolol tablets come in strengths of 10mg, 40mg, 80mg or 160mg. The slow release capsules are 80mg or 160mg. The liquid comes in strengths of 5mg, 10mg, 40mg or 50mg in 5ml.

How much you take depends on why you need propranolol.

The usual doses for adults are:

  • high blood pressure – the starting dose is usually 80mg, taken twice a day. If this dose is not working well enough to reduce your blood pressure, your doctor may increase it to a maximum of 160mg twice a day
  • migraine or angina (chest pain) – 40mg, taken 2 or 3 times a day. This can be increased to 120mg to 240mg a day. Your doctor or pharmacist will explain how to split the dose over the day
  • irregular heartbeat (arrhythmia) – 10mg to 40mg, taken 3 or 4 times a day
  • anxiety – 40mg taken once a day which can be increased to 40mg taken 3 times a day
  • too much thyroid hormone (thyrotoxicosis) – 10mg to 40mg, taken 3 or 4 times a day

Doses are usually lower for people aged over 65 or people with a kidney or liver problem.

If your child needs propranolol, your doctor will usually use your child's weight to work out the right dose.

How to take it

Propranolol does not usually upset your stomach so you can take it with or without food. It's best to do the same each day.

Swallow the tablets whole with a drink of water. If you find the tablets difficult to swallow, some brands have a score line to help you break the tablet in half. Check the information leaflet for your brand to see if you can do this.

If you're taking capsules, swallow them whole with a drink of water. Do not break, chew or crush them.

If you're taking propranolol as a liquid, it will come with a plastic syringe or spoon to help you measure out the right dose. If you do not have one, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not measure the right amount of medicine.

If you forget to take it

If you forget to take a dose of propranolol, take it as soon as you remember, unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose at the usual time.

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you often forget doses, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

If you take too much

An overdose of propranolol can slow down your heart rate and make it difficult to breathe. It can also cause dizziness and trembling.

The amount of propranolol that can lead to an overdose varies from person to person.

Urgent advice: Contact 111 for advice now if:

  • you take more than your prescribed dose of propranolol

Call 111 or go to 111 online

If you need to go to A&E, do not drive yourself. Get someone else to drive you or call for an ambulance.

Take the propranolol packet or leaflet inside it plus any remaining medicine with you.

5. Side effects

Like all medicines, propranolol can cause side effects in some people, but many people have no side effects or only minor ones.

Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects happen in more than 1 in 100 people. They're usually mild and short-lived.

Talk to your doctor or pharmacist if the side effects bother you or last more than a few days:

  • headaches
  • feeling tired, dizzy or weak
  • cold fingers or toes
  • feeling or being sick (nausea or vomiting), or diarrhoea
  • stomach pain

Serious side effects

It happens rarely, but some people have serious side effects when taking propranolol.

Tell a doctor or contact 111 straight away if:

  • the whites of your eyes turn yellow, your skin turns yellow although this may be less obvious on brown on black skin, or you have pale poo or dark pee – these can be signs of liver problems
  • you get nosebleeds that last for more than 10 minutes, unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)

Go to 111.nhs.uk or call 111.

Immediate action required: Call 999 or go to A&E now if:

  • you have shortness of breath with a cough which gets worse when you exercise (like walking up stairs), swollen ankles or legs, chest pain, or an irregular heartbeat – these are signs of heart problems
  • you have shortness of breath, wheezing and tightening of your chest – these can be signs of lung problems
Serious allergic reaction

In rare cases, propranolol may cause a serious allergic reaction (anaphylaxis).

Immediate action required: Call 999 or go to A&E now if:

  • you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
  • you're wheezing
  • you get tightness in the chest or throat
  • you have trouble breathing or talking
  • your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

These are not all the side effects of propranolol. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

6. How to cope with side effects of propranolol

What to do about:

  • headaches – make sure you rest and drink plenty of fluids. Try not to drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if the headaches last longer than a week or are severe.
  • feeling tired, dizzy or weak – as your body gets used to propranolol, these side effects should wear off. If propranolol makes you feel dizzy, sit or lie down until you feel better. It's best not to drink alcohol as it will make you feel worse. Do not drive or ride a bike until you feel better.
  • cold fingers or toes – put your hands or feet under warm running water, massage them and wiggle your fingers and toes. Do not smoke or have drinks with caffeine in, as this can make your blood vessels narrower and further restrict blood flow to your hands and feet. Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.
  • feeling or being sick or diarrhoea – stick to simple meals and do not eat rich or spicy food. It might help to take your propranolol after a meal or snack. Drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if you're being sick. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea and vomiting without speaking to a pharmacist or doctor. If you take contraceptive pills and you're being sick or have severe diarrhoea, your contraception may not protect you from pregnancy. Check the pill packet for advice.
  • stomach pain – try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your tummy may also help. If you are in a lot of pain, speak to your pharmacist or doctor.

7. Pregnancy and breastfeeding

Propranolol and pregnancy

Propranolol is not thought to be harmful during pregnancy, but it may affect your baby's growth in later pregnancy. Discuss taking propranolol with your doctor or midwife as you may need extra scans to check your baby's growth.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about the benefits and possible harms of taking propranolol. There may be other medicines that are better to use during pregnancy.

Propranolol and breastfeeding

If your doctor or health visitor says that your baby is healthy, it's OK to take propranolol while breastfeeding.

Propranolol passes into breast milk in tiny amounts. It has not been known to cause any side effects in breastfed babies.

It's important to treat your high blood pressure to keep you well. Breastfeeding will also benefit both you and your baby.

If you notice that your baby is not feeding as well as usual, or seems unusually sleepy, or if you have any other concerns about your baby, then talk to your doctor or health visitor.

Non-urgent advice: Tell your doctor if you're:

  • trying to get pregnant
  • pregnant
  • breastfeeding

For more information about how propranolol can affect you and your baby during pregnancy, visit the Best Use of Medicines in Pregnancy (BUMPS) website.

8. Cautions with other medicines

There are some medicines that may affect the way propranolol works.

Tell your doctor if you're taking:

  • other medicines for high blood pressure. The combination with propranolol can sometimes lower your blood pressure too much. This may make you feel dizzy or faint. If this keeps happening to you, your doctor may change your dose
  • other medicines for an irregular heartbeat such as amiodarone or flecainide
  • other medicines which can lower your blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson's disease medicines such as levodopa
  • asthma or chronic obstructive pulmonary disease (COPD) medicines
  • diabetes medicines, particularly insulin – propranolol may make it more difficult to recognise the warning signs of low blood sugar. Speak to your doctor if you have low blood sugar levels without getting any of the usual warning signs. Check your blood sugar after exercise, and follow usual advice about checking it before driving, cycling or operating machinery
  • medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
  • medicines for allergies, such as ephedrine, noradrenaline or adrenaline
  • non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, diclofenac or naproxen. These medicines may increase your blood pressure, so it's best to keep them to a minimum

Mixing propranolol with herbal remedies or supplements

There's very little information about taking herbal remedies and supplements with propranolol. They are not tested in the same way as pharmacy and prescription medicines.

Important: Medicine safety

Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.

9. Common questions about propranolol

How does propranolol work?

Propranolol is a type of medicine called a beta blocker.

Like other beta blockers, propranolol works by changing the way your body responds to some nerve impulses, including in the heart. It slows down your heart rate and makes it easier for your heart to pump blood around your body.

It works differently if you're using it for anxiety. When you are anxious, your brain makes chemical messengers called adrenaline and noradrenaline. These make your heart rate faster and make you sweat or shake. Propranolol helps block the effects of these chemical messengers. This reduces the physical signs of anxiety.

It's not fully understood how propranolol prevents migraines. It may work by relaxing the blood vessels involved, or by reducing activity in the visual cortex. This is the part of the brain where migraines are believed to start.

How long does propranolol take to work?

Propranolol usually starts to work in a few hours.

For heart conditions or high blood pressure, propranolol can take up to a week to reach its full effect. You may not feel any different but that does not mean it is not working. It's important to keep taking your medicine.

For migraines, it can take several weeks for propranolol to start making a real difference, so keep taking it.

How long will I take it for?

This depends on why you're taking propranolol.

For heart conditions or high blood pressure, treatment is usually long term and may be for the rest of your life.

For anxiety, you'll usually take propranolol for a short amount of time, to help with your physical symptoms. Speak to your doctor about the risks and benefits of taking it for more than a few months. This will depend on your symptoms, whether it's a one-off or a recurring problem, how well propranolol works for you and whether you get side effects.

For migraines, treatment can last for several months or years, depending on how bad your symptoms are.

Can I take propranolol for a long time?

Propranolol is generally safe to take for a long time.

If you're taking it for a heart condition, or to prevent migraines, it works best when you take it long term.

If you're taking it for anxiety, there do not seem to be any lasting harmful effects if you take it for several months or years. But it's best to take propranolol only for as long as you need it.

You'll need to have your blood pressure checked regularly if you're taking propranolol for a long time for migraines or anxiety.

What will happen if I stop taking it?

Talk to your doctor if you want to stop taking propranolol. If you're bothered by side effects, your doctor may be able to prescribe a different medicine instead.

Stopping propranolol suddenly may make your health problem worse. In addition, if you stop suddenly after taking it for a long time, you may get extra side effects as a reaction to stopping it. These include an irregular heart rate, sweating and shaking.

If you stop taking propranolol, it will take about 1 to 2 days for it to be completely out of your body but the side effects can last for up to 1 week.

How does propranolol compare with other heart medicines?

Propranolol works as well as other beta blockers for reducing blood pressure. The main difference between propranolol and other beta blockers is that it does not just affect your heart. It can affect other parts of your body too, such as your lungs.

There are lots of other medicines to lower your blood pressure and treat chest pain. They work in a different way to beta blockers and include:

  • ACE inhibitors like ramipril and lisinopril
  • angiotensin receptor blockers like candesartan
  • calcium channel blockers like amlodipine
  • medicines that make you pee more (diuretics) like furosemide

Beta blockers are not usually the first choice for high blood pressure. The medicine your doctor prescribes depends on your age and ethnicity.

If you're under 55 and not of African Caribbean or black African origin, you'll usually be offered an ACE inhibitor or an angiotensin receptor blocker.

If you're 55 or older, or you're any age and of African Caribbean or black African origin, you'll usually be offered a calcium channel blocker.

Sometimes you may have to try other blood pressure-lowering medicines if you get side effects. Many people need to take a combination of different medicines to lower their blood pressure.

How does it compare with other medicines for preventing migraine?

Atenolol, metoprolol, timolol and nadolol are all beta blockers and they work well in preventing migraines. However, most doctors prescribe propranolol.

There are some other medicines that are known to prevent migraines but they are not officially approved in the UK. They include amitriptyline, sodium valproate and gabapentin and they may have different side effects.

Topiramate can also be used to prevent migraines. It works just as well as propranolol. However, topiramate has not been officially approved for migraine for children under the age of 16.

Ask your doctor or pharmacist which medicine is best for you.

How does it compare with other medicines for anxiety?

Propranolol treats the physical symptoms of anxiety – for example, it stops your heart beating too fast. You'll usually only take propranolol for a short time.

The physical symptoms of anxiety are caused by chemical imbalances in the brain. Your doctor may prescribe an antidepressant like sertraline to treat these imbalances. You usually take antidepressants long term.

Many doctors prefer medicine-free treatments for anxiety. These include talking therapies like cognitive behavioural therapy. If you're having talking therapy, your doctor may prescribe propranolol at the same time. This will help you with your physical symptoms.

Will I need to stop taking propranolol before surgery?

Tell your doctor that you're taking propranolol if you're going to be put to sleep using general anaesthetic, or you're having any kind of major operation.

Your doctor may advise you to stop taking propranolol before surgery. This is because propranolol can lower your blood pressure too much when it's combined with some anaesthetics.

Can I drink alcohol with it?

Drinking alcohol can increase the blood pressure-lowering effect of propranolol, which can make you feel dizzy or lightheaded.

During the first few days of taking propranolol or after an increase in your dose, it's best to stop drinking alcohol until you see how the medicine affects you.

If you find propranolol makes you feel dizzy it's best to stop drinking alcohol.

Is there any food or drink I need to avoid?

Apart from being careful with alcohol, you can eat and drink normally while taking propranolol.

Eating a healthy, balanced diet can help if you have high blood pressure or another heart condition.

Will it make me put on weight?

Some people on propranolol say they put on weight, especially in the first few months of taking it. This is not known to be a common side effect of taking propranolol, and there is not enough information to say for sure why some people put on weight.

It could, for example, be because propranolol can make you feel tired which could make you less active. It could also affect the way your body uses energy.

If you're worried about putting on weight with propranolol, speak to your doctor.

Will it affect my contraception?

Propranolol will not stop your contraception working.

However, some types of hormonal methods of contraception, like the combined pill and contraceptive patch, are not usually recommended if you're taking propranolol or other medicines for high blood pressure. This is because some hormonal contraceptives can raise your blood pressure and stop propranolol working properly.

Talk to your doctor if you're taking a hormonal contraceptive.

If propranolol makes you sick (vomit) or have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Look on the pill packet to find out what to do.

Read more about what to do if you're on the pill and you're being sick or have diarrhoea.

Will it affect my fertility?

There is no evidence that propranolol affects fertility in men or women.

If you're trying to get pregnant, or you're having problems getting pregnant while on propranolol, speak to your doctor.

Will it affect my sex life?

Some people on propranolol say their sex drive goes down and some men find they cannot get an erection. However, this is not a common side effect and there is not enough evidence to say for sure that propranolol is causing it.

If you're having problems with your sex life, talk to your doctor.

Do I need to avoid playing sports?

You do not need to stop playing sports if you take propranolol. But do not push yourself too much.

Regular exercise is good for you because it lowers blood pressure by keeping your heart and blood vessels in good condition.

Be aware, though, that in some sports propranolol is not allowed if you're competing at a high level.

Can I drive or ride a bike?

Propranolol can make some people feel dizzy, especially when they first start taking it or after taking a bigger dose. If this happens to you, do not drive a car, ride a bike, or use tools or machinery.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking propranolol. GOV.UK has more information on the law on drugs and driving.

Can lifestyle changes help?

If you have heart problems, you can boost the health of your heart by making some key lifestyle changes. These changes will also help if you have high blood pressure.

  • Quit smoking – smoking increases your heart rate and blood pressure. Quitting smoking brings down your blood pressure and relieves heart failure symptoms. Try to avoid second-hand smoke too.
  • Cut down on alcohol – drinking alcohol while you're taking propranolol can make you feel dizzy or light headed. Also drinking too much alcohol raises blood pressure over time and makes heart failure worse. It's best to keep to the recommended limit of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol.
  • Exercise – regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition. It does not need to be too energetic, walking every day will help.
  • Eat well – aim to eat a diet that includes plenty of fruit and vegetables, wholegrains, fat-free or low-fat dairy products and lean proteins. It's a good idea to follow these tips for a lower salt diet too. Eating too much salt is the biggest cause of high blood pressure. The more salt you eat, the higher your blood pressure will be. Aim for no more than 6g of salt a day.
  • Deal with stress – when you're anxious or upset, your heart beats faster, you breathe more heavily and your blood pressure often goes up. This can make heart failure worse too. Find ways to reduce stress in your life. To give your heart a rest, try napping or putting your feet up when possible. Spend time with friends and family to be social and help avoid stress.

If you get severe headaches, there are steps you can take to help prevent migraines. This includes working out what things trigger an attack so you can avoid them.

How quickly does propranolol work for anxiety?

Doctors typically prescribe propranolol for heart-related issues, but it can also relieve the physical symptoms of anxiety, such as shaking and sweating. The effects are most noticeable between 1 and 4 hours after taking a dose.

Propranolol, which is available as a generic drug and under the brand name Inderal, is a type of beta-blocker. Beta-blockers work by blocking the heart’s receptors for epinephrine. Doctors may also prescribe it to treat migraine and essential tremor.

Epinephrine acts as a stimulant for the heart, causing it to beat harder and faster. By blocking epinephrine, propranolol helps relax the heart. In some cases, it can also help relax the blood vessels.

In the 1960s, researchers found that propranolol has an antianxiety effect in people. Doctors have since prescribed it off-label to treat anxiety. Off-label means that the prescribed medication is not specifically intended for that use and does not have current approval from the Food and Drug Administration (FDA) for that use.

Propranolol does not treat the underlying psychological causes of anxiety. Instead, it may help with some of the physical symptoms that anxiety can cause. These can include:

  • rapid heartbeat
  • sweating
  • feeling dizzy
  • shaky hands or voice

A 2016 review found that for short-term use, it was just as effective in treating panic disorders as benzodiazepines, which include Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). However, despite this, the authors conclude that there is insufficient evidence to support the use of propranolol for the treatment of any anxiety disorders.

If a doctor does prescribe propranolol for anxiety, it typically starts to work relatively quickly to alleviate the physical symptoms of anxiety.

This article reviews how quickly propranolol works for anxiety and provides other information about the time frames surrounding its use.

Doctors may prescribe propranolol off-label to help with the physical symptoms of anxiety or stage fright. Athletes and other performers may also benefit from using propranolol, although its use is not permitted in certain sports and competitions.

When people take propranolol for anxiety symptoms, it should start to work within an hour.

Propranolol has a half-life of about 4 hours, which means that the effects will likely start to fade about 4 hours after taking a dose.

An extended-release version of the drug is also available, which will take longer to start working but remain effective for longer. However, doctors do not generally prescribe this form of the drug for anxiety.

Propranolol has a 4-hour half-life. Its concentration in the blood is highest between 1 and 4 hours after taking a dose.

Depending on the person’s need, a doctor may recommend taking a dose three or four times a day to maintain the effects of the medication. Some people may only need to take it shortly before a stressful event, such as a performance or speech.

The best time to take propranolol will vary depending on the person’s needs and any other medications they take.

Evidence suggests that taking propranolol with protein-rich foods increases its bioavailability in the blood by 50%.

A doctor will provide instructions on when a person should take propranolol for their anxiety symptoms. They may recommend daily dosing or only taking it on an as-necessary basis.

In either case, a person should follow the recommended dosage and only take it according to their prescription. They should also continue with other therapies for their anxiety, which may include psychotherapy, other medications, or certain lifestyle adjustments.

Propranolol is relatively safe for most people, meaning that someone should be able to take it for as long as necessary or for the duration their doctor prescribes.

It is important to note that propranolol does not treat the underlying causes of anxiety. A person will need additional therapies to treat anxiety and may only need propranolol on an ad-hoc basis or for a short period.

Other treatments that can effectively treat anxiety include:

  • psychotherapy, or talking therapy, which includes cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT)
  • other medications, including antidepressants and antianxiety medications
  • stress management techniques
  • support from organizations and support groups

Propranolol is relatively safe to take, but it can cause side effects in some people. Possible side effects include:

  • gastrointestinal problems, such as nausea and diarrhea
  • rashes and other skin reactions
  • erectile dysfunction
  • a slow heart rate when stopping the medication
  • low blood pressure
  • an increased risk of anesthesia complications

A person should talk with their prescribing doctor about any medications they are taking. The doctor can determine whether propranolol may interact with these other medications and make any necessary changes to the prescription.

Propranolol may help with the physical symptoms of anxiety. It is relatively fast-acting and should be most effective for the first 4 hours.

A doctor may prescribe it for daily use or recommend using it as and when a person feels the need. A person should review all their medications with the doctor and take propranolol according to their prescription.

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European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of heart failure

What patients need to know

This European Society of Cardiology (ESC) patient guide is a summary of the most current evidence-based recommendations for the diagnosis and treatment of heart failure.

In particular, it is designed to help patients understand:

  • what are the main types of heart failure;
  • what medicines are used to treat heart failure;
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  • how important it is to take care of yourself and control your condition.

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Beta-blockers to prevent death or serious events after non-cardiac surgery

This review assessed evidence from randomized controlled trials (RCTs) on whether beta-blockers reduce mortality or other serious events during surgical operations, except for operations on the heart. Outcomes for cardiac surgery are discussed in another review.

Relevance

Surgical interventions lead to increased body stress, which reacts by releasing the hormones epinephrine and norepinephrine. Stress due to surgery can lead to death or other serious events such as heart attacks (heart attacks), stroke, or an irregular heartbeat. For surgeries that do not involve the heart, it is estimated that 8% of people may have heart problems during surgery. Beta-blockers are medicines that block the action of adrenaline and noradrenaline on the heart. Beta-blockers can slow down the heart and lower blood pressure, and this can reduce the risk of serious events. However, beta-blockers can cause very low heart rate or very low blood pressure, which can increase the risk of death or stroke. Prevention of early complications after surgery is important, but the use of beta-blockers to prevent these complications is controversial.

Study profile

Evidence is current to 28 June 2019. We included 83 RCTs involving 14,967 adults who underwent various types of surgery other than heart surgery. Eighteen studies are pending classification (because we did not have enough details to evaluate them), and three studies are ongoing. The types of beta-blockers used in studies are propranolol, metoprolol, esmolol, landiolol, nadolol, atenolol, labetalol, oxprenolol, and pindolol. The studies compared these beta-blockers to both a placebo (a drug that looks like a beta-blocker but does not contain a drug) and standard treatment.

Main results

Beta blockers have little or no effect on the number of people who die within 30 days of surgery (16 studies, 11446 participants; low-certainty evidence), the number of people with stroke (6 studies, 9460 participants; low-certainty evidence) or prior ventricular arrhythmias (irregular heart rhythms starting in the major chambers of the heart that are potentially life-threatening and may require immediate treatment; 5 studies, 476 participants; very low-certainty evidence). We found that beta-blockers can reduce the rate of atrial fibrillation (irregular heartbeats that start in the atria that increase the risk of stroke if left untreated; 9research, 9080 participants; low-certainty evidence) and the number of people with heart attacks (12 studies, 10,520 participants; low-certainty evidence). However, beta blockers may increase the number of people with very low heart rate (49 studies, 12,239 participants; low-certainty evidence) or very low blood pressure (49 studies, 12,304 participants; moderate-certainty evidence) during surgery.

In several studies, we also found little or no effect on the number of people who died after 30 days who died due to heart problems or had heart failure. We found no evidence that beta-blockers affect length of hospital stay.

There were no studies that assessed whether the quality of life of people who were given beta-blockers improved after heart surgery.

Certainty of evidence

The certainty of evidence in this review was limited to including some studies at high risk of bias, and we noticed that some of our results differed if we only included placebo-controlled studies or studies reporting how participants were randomized. We also found one large, well-conducted international study that differed from studies with fewer participants.

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