Talk:Beta blocker/Archive 1

Anon comment
Hi all, a comment about citation 19- Its assertion that beta blockers are vasodilatory is confusing. Beta blockade should induce vasoconstriction- while it may be true that inhibition of renin release leads to vasodilation, and furthermore that in the myocardium, beta blocker induced vasoconstriction is mostly counteracted by autoregulation and accumulation of local metabolites (Lilly, Pathophysiology of Heart Disease 4th Ed. pg 162) the claim attributed to 19 is confusing without further explanation, especially since different beta blockers have differential effects and multiple mechanisms that contribute to vasodilation (Goodman and Gillman, Manual of Pharmacology and Therapeutics, 176) 65.78.153.17 (talk) 04:25, 10 December 2010 (UTC)

Someone else's comment
Just like to point out that reference 1 is not relevant to the diabetes claim, and has little relevance to the NICE guidelines Jun 2006. They were downgraded in 2004, latest guideline updates as of 2006 stop all use of B-Blockers as a hypertension treatment unless for another condition such as angina/MI.

&beta;2 blockers
Nobody mentions a selective &beta;2 blocker, and I am not finding any in the subsequent disease/affliction pages which list any. anything would be nice. note also that the template doesn't mention them either. Avriette 21:27, 25 Mar 2005 (UTC)


 * Butoxamine ia a selective beta 2 blocker but it has no clinical utility.--Dr M Tariq Salman 19:03, 27 April 2006 (UTC)

Anon question
hey i've got a question, is this just pretty much an anti-fear kind of thing. like you're more relaxed, more courageous really, right?

it mentions the use of beta blockers for stage fright, so i suppose i'm somewhat correct.

and what are the side effects really, say of using it when you don't really have the diseases that it is used for


 * I fixed your question. You should not have deleted Avriette's question, although it went unanswered.
 * Beta blockers are primarily used to lower blood pressure and to take strain of the heart. Some of its side-effects are suppression of tremors, flushing and other signs mediated by the sympathetic nervous system. Hence it will not reduce your stage fright, but stop you from getting the symptoms, which tend to make stage fright worse in some sort of a viscious circle. So they don't make you more courageous (there are some recreational substances that do that).
 * As for side-effects: they may make the blood pressure too low, leading to fainting, and some men report impotence. JFW | T@lk  14:23, 20 July 2005 (UTC)

My understanding is that, while it does suppress some physical symptoms of "stage fright" or common anxiety, the inhibition of β-receptors also decreases the ability of the CNS to go into "fight or flight" mode, thereby staving off the biochemical component of panic attacks. With less adrenaline in play, the feeling of fear subsides (to a degree, as adrenaline and noradrenaline also affect alpha-receptors). Beta blockers are being used with more regularity as an off-label for panic and anxiety disorder, so there is more to be told in the future about it's anxiolytic properties. Certainly it's not in line with Xanax® or Valium®, but modern psychiatry is moving away from the use of such "dirty" drugs that foster dependence... Anyway the Wiki on Anxiolytics mentions beta blockers, but needs work itself, and I have no sources to cite. I do know that beta blockers like propranolol are used at 10-30mg doses for anxiety and performance enhancement, higher doses start affecting blood pressure to the point of negating the effects (hard to play the piano when dizzy). Conversely the lightheadedness itself at higher doses may help with social anxiety disorder, I suppose. Bottom line for the question at hand, most anxiety is indeed caused by thought patterns, which this will not change. Medication for anxiety should only be used along with CBT because the problem will get worse untreated. As to the article, hopefully someone with more on the subject can expand on this. Rainman420 09:02, 19 April 2006 (UTC)

Cleanup needed
Marked this article with   as it contains many medical-related abbreviations, such as pt., ds., etc. Also, the format of the article needs significant cleanup to show which information goes with which beta blockers. I'd like to take care of this myself, but I'm marking it (and leaving the note here) in case I don't get around to it soon. --Animated Cascade talk 05:35, 21 February 2006 (UTC)
 * Done. -Techelf 10:55, 16 April 2006 (UTC)
 * Is the section "Side Effects / Health Consequences" under the Examples a duplicate, or does it only apply to β2-Selective agents? If it doesn't, it should probably be removed or combined the adverse effects section Bobtheowl2 04:03, 1 June 2007 (UTC)

Edits
Edited content to more accurately detail the action of beta blockers and added additional information. Also fixed spelling errors. Will continue work. CHurst5841 01:58, 13 April 2006 (UTC)

&beta;2 receptors
&beta;2 receptors are in the heart as well, but not to the extent of &beta;1.

&beta;2 β-Receptor antagonism
&beta;2 I think the section on B-adrenoceptor antagonism should be changed to mention that the B1 subtype is a G-protein coupled metabotropic receptor. The current phrasing:

Stimulation of β1 receptors by epinephrine induces a positive chronotropic and ionotropic effect on the heart and increases cardiac conduction velocity and automaticity.

is open to misinterpretation that the receptors themselves are linked ionotropic proteins. —Preceding unsigned comment added by 82.69.124.50 (talk) 10:23, 6 April 2008 (UTC)

Erectile dysfunction

 * Beta blockers decrease nocturnal melatonin release, perhaps explaining the impotence side effect through suppression of morning erections. Stoschitzky K, Sakotnik A, Lercher P, Zweiker R, Maier R, Liebmann P, Lindner W. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol. 1999 Apr;55(2):111-5. 

I removed this excerpt during my subedit initially because the Stoschitzky article doesn't appear to discuss the relationship between beta blockers, melatonin levels and erectile dysfunction. Erectile dysfunction may be an adverse effect associated with beta blocker therapy, though some have argued that this a psychosomatic effect (Silvestri et al., 2003; ). Even if it's a pharmacological adverse effect, Occam's Razor applies here and it is far more likely to be a central adrenergic effect (since prevalence appears to be greater in more lipophilic agents (Smith & Talbert, 1986; )) rather than a melatonin-mediated effect. I may have missed something, however, so feel free to restore the text if you have a reference that indicates erectile dysfunction is melatonin-mediated. -Techelf 07:29, 17 April 2006 (UTC)
 * It seems that a centrally acting lipophillic compound is what it would take to suppress melatonin release. Given, the importance of the melatonin to the body clock, a link to an established clock associated phenomena like morning erections is plausible.  It is the only explanation I've been able to find.  As someone who constantly screws up his body clock, I find melatonin very helpful in this regard.--Silverback 21:27, 17 April 2006 (UTC)..

Beta2 selectivity
- yeah right. JFW | T@lk  14:22, 2 May 2006 (UTC)

Use for treatment of Glossophobia.
As a jurisprudent fellow the concept of using beta blockers to prevent court room jitters is a godsend, just as with mmusicians I am sure there are many barristers out there who'd utilise this and not mention it to anyone; I've seen many an oration in hectic matters with high tension where some orators seem to be almost bored of the matter delivering perfect rhetoric.

I'm curious as to whether this is a restricted family of substances, whether it is perscribed, et cetera? Whilst I can understand doctors being loathe to perscribe such to musicians, it's worth noting that glossophobia, or the fear of public speaking, could easily be transliterated across to fear of public performance or performance anxiety as a whole; thus indicating that if it's applicable to use it for a phobia it's applicable for musicians and vice versa. Or one would hope.

And yes, before anyone asks. I'm a closet glossophobic. Jachin 17:00, 1 May 2007 (UTC)

Alternatives
The entry says that the use of beta-blockers was downgraded in the United Kingdom last year due to the fact that the treatment bears an unacceptable risk of provoking diabetes, especially when applied to the elderly.

Could anyone please tell me what the alternatives are. In my case, beta-blockers are being applied in order to control extensive high blood pressure (sometimes as high as 200/120).

Thank you very much indeed for any useful insight or information.


 * They were not downgraded because of diabetes risk. They were downgraded because the evidence now favours other agents. This guideline will give you all the necessary information. JFW | T@lk  12:53, 1 July 2007 (UTC)

Hello, I've edited this part of the article a little. Now it's pretty much what the source said, the last version was misleading. —Preceding unsigned comment added by 62.78.232.114 (talk) 20:08, August 30, 2007 (UTC)

Weight
Some beta blockers cause mild weight gain. But the results are really inconsequential - we're talking about 1 kilogram on metoprolol. JFW | T@lk  12:53, 1 July 2007 (UTC) so what i think is that u are not giving us the specific answer,,,,

Sotalol
Hello, I don't know who can edit the page but sotalol is not a beta blocker it is actually a Class III anti-arrhythmic which functions to block K+ channels. Beta blockers are considered class II anti-arrhythmics. —Preceding unsigned comment added by 12.106.89.75 (talk) 23:14, 30 May 2008 (UTC)
 * While sotalol is used solely as an antiarrhythmic, it does have (relevant) beta-blocker activity. By the way, you can edit the page :) Fvasconcellos (t·c) 23:58, 30 May 2008 (UTC)

Vasospasm/Contraindications
It is well known among medical practioners that there are contraindicaions to using Beta blockers, and one of these is vasospasm. Vasospasm is worsened and can be life threatening when taking Beta blockers. This should be mentioned in the article.Cheresherri (talk) 00:14, 23 July 2008 (UTC)Cheresherri


 * What kind of vasospasm? JFW | T@lk  02:26, 4 November 2008 (UTC)

Shouldn't it be mentioned that beta blockers can cause blunted recognition of hypoglycemia (as seen in the diabetic hypoglycemia article? 24.99.86.24 (talk) 20:16, 12 January 2009 (UTC)

History
- 50 years of beta blockers JFW | T@lk  02:26, 4 November 2008 (UTC) Although the article mentions Raynaud's, coronary vasospasm is a more urgent concern and a known side effect of beta blocker usage. There are many sources for this; one is from the Journal of Exercise Physiology, volume 10, number 10, October, 2006, and The Journal of Invasive Cardiology, volume 14, issue number 10, October, 2002. cheresherri76.109.22.126 (talk) 17:24, 30 July 2009 (UTC)

Side effects
As a side effect depression is mention. There is no backing at all for this. No serious study supports this claim. http://www.entrepreneur.com/tradejournals/article/189668678.html I quote: "The Conclusion. According to the authors of two of these three articles, the notion that [beta]-blockers cause depression originated from a letter to the editor by H.J. Waal, who reported 21 cases of depression in a group of 43 patients treated with propranolol for more than 3 months (Br. Med. J. 1967;2:50). Large, well-designed, multicenter studies, however, do not support an association between [beta]-blockers and depression." Depression is not even listed in the side effects note that comes with the medicine. I think it is wrong to mention depression as a side effect when there is no real support because it causes people to get depressed when they take beta blockers. It's not an effect of the drug but a psychological effect when people believe it might be a side effect. In studies people were taking placebo pills and they claimed to be depressed as much as those who take beta blockers. It is the same with impotance. It is not a real side effect. At least there are no real medical support there. Also a psychological effect. There is so much desinformation and ignorance regarding beta blockers. People eat 10 mg (which is such a small dose it wont even affect you. Even small children can take without problem) and claim to feel all sorts of side effects. It is kind of pathetic. —Preceding unsigned comment added by 80.217.234.107 (talk) 22:12, 2 February 2009 (UTC)

Memory erasure
I added the following:
 * The journal Nature Neuroscience reports that beta blockers can erase memories. Beta blockers interferes with this re-creation of the stressful memory - and prevents the brain renewing it. Wide-scale use of the drug was a long way off.

Ikip (talk) 15:04, 16 February 2009 (UTC)

disambig
In software development, a beta blocker is a bug that needs to be resolved before a beta release can happen. I'm not sure what's the right way to include that in the article.--92.78.102.247 (talk) 15:17, 9 November 2010 (UTC)

Developmental history
Can the different drugs be classified according to the time of their discovery / development? It is very important, as it gives one a good perspective about the growing lists of beta blockers.Bkpsusmitaa (talk) 05:40, 28 December 2011 (UTC)

On the ineffectiveness of Beta Blockers
I have removed the parapraph about the ineffectiveness of beta blockers, since it incorrectly and misleadingly cites scientific evidence. Such prominent information should correctly reflect the information in the papers. I replicate the paragraph here:
 * A study published in October 2012 in JAMA found that beta blockers did not prolong the lives of patients. The study followed approximately 45,000 patients for more than three years and found that beta blockers do not reduce risk of heart attacks, deaths from heart attacks or stroke. This study was further supported by another study published several days earlier in the Journal of the American Geriatrics Society which was looking at how drug compliance was affecting death rates in patients with a history of heart attacks.

The problems with this paragraph: The JAMA study does not generally conclude that Beta Blockers do not prolong lives. It only comes to this conclusion for certain classes of patients and certain indications. Please see the paper yourself or look at this statement from one of the authors: "To this end, he stresses that "it is important to understand what this study is not about. It's definitely not about patients who come in after an acute MI or those who have HF—we know there is plenty of data to suggest that beta blockers are beneficial in HF—and also it's not about patients who are on a beta blocker for any other reason, be that for arrhythmias or migraine prophylaxis."" http://www.theheart.org/article/1453397.do. i.E. the results from this study are blown out of proportion by the way they are presented here. Even worse for the next paper - the statement "This study was further supported by another" implies, that the study did not find a decrease in mortality through the use of beta blockers. But the opposite is true, from the summary: "All four drug classes were significantly associated with reductions in mortality; the magnitude of effect for the mortality outcome was largest for statins and smallest for BBs. Age modified the effect of statins on mortality." - Beta Blockers were inferior to other medications but neverheless effective. --Vzach (talk) 12:46, 8 January 2013 (UTC)

Research on long-term effects
Hello. I'm a layman. I'm interested in learning about the research (if it exists) on long-term effects in the spheres of:


 * Cognition
 * Behavior
 * Physiology

I understand that the pharmacokinetics of different beta-blockers can vary and have differing effects from one another even in the same class, therefore I'm curious what research exists, and I believe it should be added.

172.56.12.214 (talk) 19:19, 16 February 2015 (UTC)

Contractility?
I don't see the word anywhere, and b-blockers reduce contractility of the heart. Jobonki (talk) 01:03, 10 April 2015 (UTC)


 * Do you have a WP:RS?-- Shibboleth ink (♔ ♕) 03:28, 10 April 2015 (UTC)

Other content
There is this OA content here. Mostly appears to be duplication and primary sources. Doc James (talk · contribs · email) 02:51, 5 September 2015 (UTC)

Expand on Other Effects
The "Other effects" section mentions beta-adrenergic mediated inhibition of melatonin secretion. It might be useful to discuss the differences in melatonin secretion inhibition between beta blockers. ― Bio chemistry 🙴 ❤   04:11, 18 October 2017 (UTC)

Unsourced
Moved here per WP:PRESERVE as this is almost all unsourced. Per WP:BURDEN please do not restore without finding reliable sources, checking the content against them, and citing the sources.


 * Examples

Nonselective beta blockers display both β1 and β2 antagonism.
 * Nonselective agents
 * Propranolol
 * Bucindolol (has additional α1-blocking activity)
 * Carteolol
 * Carvedilol (has additional α1-blocking activity)
 * Labetalol (has additional α1-blocking activity)
 * Nadolol
 * Oxprenolol (has intrinsic sympathomimetic activity)
 * Penbutolol (has intrinsic sympathomimetic activity)
 * Pindolol (has intrinsic sympathomimetic activity)
 * Sotalol (not considered a "typical beta-blocker")
 * Timolol

β1-selective beta blockers are also known as cardioselective beta blockers.
 * β1-selective agents
 * Acebutolol (has intrinsic sympathomimetic activity, ISA)
 * Atenolol
 * Betaxolol
 * Bisoprolol
 * Celiprolol (has intrinsic sympathomimetic activity)
 * Metoprolol
 * Nebivolol


 * β2-selective agents
 * Butaxamine
 * ICI-118,551


 * β3-selective agents
 * SR 59230A


 * Comparative information


 * Pharmacological differences
 * Agents with intrinsic sympathomimetic action (ISA)
 * Acebutolol, pindolol, labetalol, mepindolol, oxprenolol, celiprolol , penbutolol
 * Agents organized by lipid solubility (lipophilicity)
 * High lipophilicity: propranolol, labetalol
 * Intermediate lipophilicity: metoprolol, bisoprolol, carvedilol, acebutolol, timolol, pindolol
 * Low lipophilicity (also known as hydrophilic beta-blockers): atenolol, nadolol, and sotalol
 * Agents with membrane stabilizing effect
 * Carvedilol, propranolol > oxprenolol > labetalol, metoprolol, timolol


 * Indication differences
 * Agents specifically labeled for cardiac arrhythmia
 * Esmolol, sotalol, landiolol (Japan)
 * Agents specifically labeled for congestive heart failure
 * Carvedilol, sustained-release metoprolol
 * Agents specifically labeled for glaucoma
 * Betaxolol, carteolol, levobunolol, timolol, metipranolol
 * Agents specifically labeled for myocardial infarction
 * Atenolol, metoprolol (immediate release), propranolol (immediate release), timolol, carvedilol (after left ventricular dysfunction)
 * Agents specifically labeled for migraine prophylaxis
 * Timolol, propranolol

Propranolol is the only agent indicated for control of tremor, portal hypertension, and esophageal variceal bleeding, and used in conjunction with α-blocker therapy in phaeochromocytoma.

I've finished the necessary citing and have moved the material over. Thank you for bringing this important issue to our attention.― Bio chemistry 🙴 ❤   04:09, 18 October 2017 (UTC)
 * Thanks for taking care of that! So much work! Jytdog (talk) 05:17, 18 October 2017 (UTC)r

Other Effects, Beta-adrenergic Receptors
Proposed addition: "Because beta-adrenergic receptors are expressed across a diverse group of cancers, researchers are exploring ways to identify tumor types that would be responsive to beta blockers." Citation: 10.18632/oncoscience.357

This section on non-cardiological indications should be supported, although this citation is admittedly primary research. Do you think this adds reliable, valuable information to this article?Cglife.trummler (talk) 23:02, 14 November 2017 (UTC)
 * I couldn't view the citation. Can you give a DOI?
 * I found a review article on the subject here, but I haven't read it. See: Coelho, M., Soares-Silva, C., Brandão, D. et al. J Cancer Res Clin Oncol. 2017;143:275.― Bio chemistry 🙴 ❤   23:43, 14 November 2017 (UTC)
 * Oops, sorry about the bum link. DOI is 10.18632/oncoscience.357 but the direct link is http://impactjournals.com/oncoscience/index.php?pii=357. Thanks for finding the review; I'll see if I can get access and take a look! Cglife.trummler (talk) 21:15, 17 November 2017 (UTC)

Anxiety section US-Centric
Right now the Anxiety section starts with "Officially, beta blockers are not approved for anxiolytic use by the U.S. Food and Drug Administration." and doesn't have much more content than that. However, in many other countries, e.g. UK, Australia, they are occasionally used for this. At present, I don't have time to format that into a update to that paragraph. Oxinabox (talk) 13:50, 20 October 2021 (UTC)

Wiki Education Foundation-supported course assignment
This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 July 2019 and 30 August 2019. Further details are available on the course page. Student editor(s): DJay29, Realcoolchick, Amriya, Inocanreadbrah, Isoniazid.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 15:38, 16 January 2022 (UTC)