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A lot of people have contacted me and asked me as to how to safely stop Beta blockers and therefore I thought I would do a quick blog on this subject.
I would like to stress that you should only alter the dosage or stop Beta-blocker usage with the explicit consent of your usual healthcare provider as they will know about your unique clinical situation and all I am doing in this vlog is just giving general information.
Beta Blockers are one of the most commonest classes of medications that we use in cardiology and often serve as a ‘jack of all trades’. They basically blunt sympathetic activity and by doing so, have a multitude of potentially beneficial effects such as reducing heart rate, reducing blood pressure, making the heart less irritable, reducing the demands on the heart and increasing the time for the heart to fill with blood so that the heart is able to contract more effectively by pushing more blood out with each heartbeat. In some situations they make people feel better i.e improve quality of life. In other situations, they may actually have a prognosis-modifying role.
Let me give you some examples.
Beta blockers can be used to control blood pressure. Here they don’t necessarily make patients feel better but may have a prognosis-modifying role (albeit a weak one).
Beta blockers can be used as a treatment for heart failure. Here they make people feel better and have a very significant impact on improving lifespan
Beta blockers can be used for heart rhythm disturbances (ectopics/AF/SVT/VT) and her they may make the patient feel better and in some heart rhythm disturbances may also have a prognosis-modifying role
Beta blockers can be used to treat angina and prolong life after a heart attack so they may improve quality and quantity of life.
Sometimes beta blockers are used in a purely symptom control role such as for controlling anxiety or benign ectopics in people with normal hearts
So if you are taking beta blockers it is always worth asking why you take them. Is it because they are being given to make you feel better or is it because they in some way are being used for their prognosis-modifying effects? This is important because if they have a prognosis-modifying role then you may decide you just want to remain on them. If on the other hand they are being given purely for symptomatic relief then sometimes the only way to know how much they are benefitting you is by discontinuing them and seeing whether general quality of life deteriorates or improves.
Acute, abrupt withdrawal of beta blockers has been shown in many case reports to be associated with an increased risk of morbidity and mortality. This is mainly seen in patients who were taking the beta blocker for angina due to significant coronary disease and in a few of these patients, stopping the beta blocker was associated with more angina and even development of heart attacks. Similarly, there have been case reports of patients who were taking beta blockers to control dangerous heart rhythm disturbances and when the beta blocker was abruptly stopped it led to precipitation of ventricular dysrhythmias and even in some cases death. There have also been reports of heart failure status worsening and blood pressure going up excessively. This is termed as ‘Acute beta blocker withdrawal syndrome’.
Why does it happen?
It is believed that withdrawal effects happen because of increased sympathetic activity which is probably because of Beta receptor upregulation during the period of beta blockade. Upregulation is a well-recognised phenomenon where the receptors that are being blocked become more sensitive and responsive to circulating adrenaline. It is believed that receptors take 24-36 hours to down-regulate when the blockade is removed. So if you stop the beta blocker abruptly and it doesn’t stay in the body long (and how long it hangs around in the body depends on that beta blockers half-life) then there may be a period where you have receptors which are significantly more sensitive to the effects of the adrenaline and this can then trigger this withdrawal syndrome. What this means is that the withdrawal syndrome is far more likely with short-acting beta blockers or those beta blockers where you have to take 2 or 3 doses in a day because they will have a much shorter half-life. Beta blockers that have a long half-life will stay in the body for much longer and therefore will allow the time that is needed for the beta receptors to downregulate.
So if you are taking a short-acting beta blocker e.g. propranolol, metoprolol, carvedilol etc, it is best to be more cautious about reducing the dose. In such cases I would suggest taking the usual dose once daily for a week, then every other day for a week and then stop.
If you are taking a long-acting beta blocker e.g. Atenolol, Bisoprolol etc, then take half the usual dose for a week, then half the usual dose every other day for a week and then stop.
As I say it is very important that you only alter your dosages if sanctioned and supervised by your own doctor as it may in some patients have dangerous consequences.
I hope you found this useful.
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This was a really helpful and very informative jargon-free article. You explain everything very clearly and in a manner that one can understand and then interpret. A pleasure to read.
Thank you very much.
Fify Watson
How do I safely wean off propranolol 30mg
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This was helpful. Thank you Dr. Gupta
I stopped abruptly because I developed ulcers on my ankles. One on each ankle. I’m going through lower limb vascular treatment. I read a article in NICE which stated beta blockers should not be prescribed for people with lower limb arterial disease.
I love you Dr. Gupta. Thank you for being true to yourself
Dr. Gupta, I have been listening to your channel for many years, and you have benefited your viewers very much by empowering them to understand their heart health. Plus, your approach, friendly attitude, and smoothness of thought make it a pleasure to watch whatever you say.
With the increased use of smartwatches with ECG features, have you posted any videos on ECG basics for two-lead ECG readings shown by these watches?
You are a rock star, Dr Gupta. One in a million. Thank you for really caring about people. Very clear and concise post.
This opened my eyes and prompted me to take charge of my health. I doing so, finding the right doctor to support me on my path to wellness.
Thank you for your service. My cardiologist diagnosed me with junctional rhythm, which he said Metropol was counter-indicated, and made the symptoms worse. Once I stopped the beta-blocker, I felt much better.
Hello Doctor Gupta, I’ve seen your videos on YouTube and you are a remarkable compassionate physician. Thank you for all your help
I was placed on a low-dose of carvedilol started with 3.25 two times per day Then two months later, 6.25 twice a day. This was prescribed for situational tachycardia/HTN. My blood pressure is only high when I go to medical appointments and fairly normal at home It has lessened tachycardia events Help with my blood pressure however the side effects have been difficult. I see my cardiologist next month because I really want to come off this medication however on frightened to pieces but now that I was placed on it if I’m taking off something more drastic could happen. Is there truly a safe way to come off it? I wish I never agreed to it. However, I was scared because of the tachycardia event I had that put me in the emergency room at the time. I also have multiple sclerosis My echocardiogram was perfect. I’ve had two in the last two years and my heart monitors were good as well. I just really don’t want to be on a beta blocker this long. The fear of coming off of it because of everything I’ve heard has really given me so much anxiety Thank you for any opinion you can share Awesome thank you for all the information you provide to everyone. ♥️🙏🏻
Hi Taylor. I am recovering from sleep apnea, which I was diagnosed with in 2005. At the time, I refused to wear a mask and sleep “attached to a pump.” However, the next year, I started walking up with severe disabling panic attacks at night which were related to a “rumbling” in my chest. As my fears grew, so the “rumbling” felt worse and I deteriorated so much I considered registering in a mental hospital. At that point, after seeing many doctors and a Cardiologist (who referred me to a Psychiatrist), a kind locum doctor prescribed 120 mg Propranalol. That literally saved my life and I was able to return to a very busy, very functional life where I had no fear of anything. However, it was an illusion. In 2011 my “flutter” returned and again I started experiencing severe anxiety. Again, my Cardiologist and doctor couldn’t really find anything wrong and couldn’t help much. I don’t know why, but I decided to go for a sleep apnea test as I was having severe, narcolepsy-like symptoms. It turned out that, indeed, my diagnosis in 2005 was accurate and the beta blocker had controlled my apnea and it’s consequences for six years; but it was time to treat the cause, not the symptoms! I was finally able to buy a CPAP and start sleep apnea therapy, which was extremely difficult. I did not want to accept that I had this (or any) condition; and I constantly worried about my health. I am grateful my wife stood by me, though she could not understand much about what was happening. After six very long months, I began to respond to the therapy and fully recovered. I was, however, still taking the high-dose Propranalol. Sometime in 2019 or so, I began to taper myself off the beta blocker, as I started getting worried about it’s potential aide effects. I was afraid it might remodel my heart in a negative way (but this is not likely true; if anything, it prevents such remodelling, at least at low doses). Anyway, I managed to get down to 20 mg a day at the end of 2023. However, after doing some very heavy work (floor sanding when I was angry and frustrated with my wife), I felt that my heartbeat was “strange”. What actually was happening was that my heartbeat was normal; but I probably somewhat overworked my heart temporarily, while the protective effect of only 20 mg of beta blocker was probably inadequate: this, together with CPAP or APAP therapy that was not sufficient (most likely due to a leaking mask). My “flutter” returned and I started spiralling as my panic attacks grew worse and worse. In early 2024 I became very dysfunctional (just like I was in the UK in 2006 without any PAP therapy, CBT or Propranalol) and had to go to the hospital in an ambulance. But I am very grateful that after a year, I have recoverd a lot. I don’t drink alcohol much these days (bad for your heart and definitely bad for sleep apnea) and I changed my diet completely to cut out as much sugars, fats and carbs as possible. I also started going to the gym 4-5 times a week. I did increase the beta blocker a little (30-40 mg a day) but, unfortunately, my family doctor sees my issues as almost all psychological (anxiety/GAD/depression) and refuses to accept that sleep apnea, alone, can induce anxiety and other physiological issues that will resolve with appropriate treatment. I just wanted to share this with you so you understand that beta blockers have a place; but, I think, if you’re physically healthy, you can overcome your situational or other anxiety through prayer, the love of friends and family, some beta blocker (though it would probably be better not to be on anything, due to side effects of chronic or high-dosage use), then you can live normally without any medication. But, if your anxiety is very severe or you have real depression or other mental issues, it might be best for you to take a medication specific to your need. Beta blockers are always only prescribed for anxiety as a “secondary” use and probably shouldn’t be used at all for that use, in my opinion, for a long time.
I’ve been trying to get off Bisoprilol due to fatigue and libido issues, but every Calcium Cb or ARB/ACE I try raises my pulse making me anxious and insomnic. Your article makes sense to keep taking a lower dose for a few weeks until possibly quitting the beta blocker altogether. Otherwise you may have the pulse issues I’m experiencing.
I’m 71 and was on 50 mg of Metoprolol ER for about two months for anxiety related to insomnia. I had pretty bad side effects from it (Cognitive difficulties, sleep difficulties, balance, ice cold fingers and hands for a big part of the day, feeling cold all the time, excessive sweating etc) Now trying to taper off by reducing 25% of the dose per week. Now on the third day of cutting from .75 of original dose to .50 of original dose. I have been experiencing intense anxiety, significant increase in heart rate, and feet sweating a lot. I’m assuming these things are related to the sympathetic system ramping up from the dosage reduction. Does this reaction happen very often?
Such a truly helpful piece , thankyou. I was only on low dose bisoprolol 3 months and it certainly helped with elevated Blood pressure when paired with nifedipine……but its made me suffer hair loss so consultant has told me to stop taking it, for the last few day been very jittery and anxious but am reckoning this will stop and ny system will feel more normal👍
Hi
Did this stop by going by old turkey?
Thank you I g he Ave been asked to stop atenolol and cardizem for a scheduled cardiac ablation procedure I have been on atenolol 50 bid for years to control blood pressure and breakthrough SVT. The cardixem only for a few weeks I am having anxiety because the cardizem was added after a long episode of SVT that required adenosine and I’ve cardizem to break. I know it’s only a week away but isn’t it safer to just taper off the atenolol
Had call off needed to monitor my heart. I felt better being off out of the doctor. It was given to me for my migraines. I feel better without it and have less dizziness.
Wonderful explanation. I’ve been trying to come off propranolol for the last month which I take for migraine, it’s worked really well for controlling them. However, while hiking in the Alps I felt like I was being suffocated and passed out, my heart rate was around 60bpm. My GP thinks that the betablocker stopped my heart rate from increasing enough to oxygenate what the body required, all it could do was to do was a ‘system reset’ making me pass out. I didn’t have any chest pain at the point of this happening. I’ve had a ECG which is all good. The thing is that I haven’t felt well since this episode and even though I’ve mentioned it to the GP he’s suggested that I reduce the betablocker until I start getting migraines again, but nothing else. Do you have have any suggestions why I still don’t feel normal. My blood pressure is controlled with nighttime 10mg Amlodipine 106/68 morning BP 128/78 evening BP
Dr Gupta, you are a inspiration. I had hyperthyroidism in August 2021 that was left untreated, that had leads me to A&E January 2022 with atrial fibrillations. I was prescribed bisopronol and a blood thinner. The doctor at the emergency advised me to stop both médecine when my thyroid levels were back in range. I now have been in range for a year, withT4 stabilised for 10 months. I am trying desperately to wean off bisopronol , I now take the lowest dose (1.25) every other days for few months, but find impossible to lower the dose further !!
My chest ache, my head feels pressure, sweat, and loud heart beats !! All very scary symptoms ! I follow you on YouTube and stumble on this article. You made me feel so much more relax about my condition as you explain it in detail and leman term. I just wanted to thank you from the bottom of my heart.
This is a magnificent article due to its honesty and clarity. My incompetent cardiologist put me on 5 mg of bisoprolol because my CT calcium scoring result was 118 which I had taken on my own some 4 months earlier. At age 79, I have never had ANY heart concern or event. My blood pressure has always been in control with chlorthalidone. Needless to say, the bisoprilol didn’t work at all controlling my blood pressure since it was now the substitute for chlorthalidone along with many other bad side effects, including, insomnia, nervousness, lack of energy, and gaining weight to name a few. So I tried weening myself off of Bisoprolol by going on one half tablet per day for several days and then reducing more later. Unfortunately I never got to later because at the third day of withdrawal my blood pressure suddenly went to wild high readings running in the 200 to 220 range over 95 to 115. After two days of this, we stopped the bisoprilol completely and went back to chlorthalidone for blood pressure control. After two more days my heart beat rate went totally out of control staying up around 135 to 150 I went to the emergency room of the local hospital and basically laid on a hospital bed for 120 hours well doctors seemingly tried every combination of beta blockers, blood thinners and blood pressure meds to try to get my heart back in control. I was in atrial flutter the entire time in the hospital and now my heart does anything it wants to do relative to pressure and heart rate and medicines seem to have no control to correct the erratic readings. I am now waiting for several more days for the possibility of getting the shock treatment which they do to get the heart. rhythms back to normal. So I am an example of a perfectly healthy 79-year-old male with a perfectly healthy heart that was given this insidious drug called bisoprolol which has now basically destroyed my life. MY ADVICE TO ANYBODY WHO READS THIS IS UNDER NO CONDITIONS SHOULD YOU EVER TAKE BISOPROLOL UNLESS YOU ARE IN EXTREME DIRE CONDITIONS. THIS DRUG CAN KILL YOU OR GIVE YOU A HEART ATTACK OR STROKE AS A MINIMUM or it might work OK. Do you want to take the risk???