Beta-Adrenergic Blocking Agent

Generic and Trade Names:

Acebutolol		Sectral
Atenolol		Tenormin
Betapace			Sotalol
Bisoprolol			Zebeta
Carvedilol			Coreg
Esmolol			Brevibloc
Metoprolol	Lopressor, Toprol XL
Nadolol			Corgard
Penbutolol		Levatol
Propranolol		Inderal
Timolol Maleate		Blocadren
Timolol			Timoptic

Description:

Beta-adrenergic blocking agents "Beta-Blockers" form a class of drugs used to treat angina and hypertension. These drugs reduce the oxygen demand of the heart muscle, slow the heart rate, reduce blood pressure (see under hypotension and hypertension), and diminish cardiac contraction velocity, thus helping to prevent attacks of angina pectoris.

Propranolol, a beta-adrenergic blocker, is used to reduce angina attacks and migraine headaches, it stabilizes irregular heartbeat, and lowers blood pressure.

Nutritional Considerations:

A low sodium and low calorie diet may be recommended. (Pronsky 1999)

Possible mineral deficiencies include: Chromium, Silicon, Zinc, Calcium, Magnesium, Potassium (Reyes, Kishi, Mountokalakis).

Calcium supplements may interfere with absorption. (Pronsky 1999)

Caution in diabetics because these drugs can prolong or mask the symptoms of hypoglycemia. (Pronsky 1999)

Avoid caffeine. (Brinker 1998)

Avoid alcohol. (Facts and Comparisons 1999)

Herbal Considerations:

Avoid natural licorice products (Pronsky, Farese, Shintani).

Black cohosh, poplar, sweet birch, and wintergreen and willow bark all have salicylate properties which may interfere with beta blockers. (Brinker 1998)

These herbs may possess cardioactive properties, and should therefore not be taken with antihypertensive drugs: Blue Cohosh, Broom, Calamus, Cereus, Cola, Coltsfoot, Devil's Claw, Fenugreek, Figwort, Fumitory, Ginger, Ginseng, Panax, Goldenseal, Hawthorn, Horehound, White, Lime Flower, Mate, Mistletoe, Motherwort, Parsley, Pleurisy Root, Prickly Ash, Quassia, Shepherd's Purse, Squill, and Wild Carrot. (Blumenthal 1998)(Newall 1996)(PDR Herbal 1998)

Some herbs possess diuretic properties that may intensify the action of antihypertensive drugs. This could result in an excessive lowering of blood pressure. Such herbs include: Black Radish, Blue Cohosh, Cleavers, Cornsilk, Couchgrass, Elder, Hops, Horsetail, Juniper, Pleurisy Root, Prickly Ash, Pulsatilla, Black Safflower, Sassafras, Saw Palmetto, or Yerba Mate. (Brinker 1998)(Blumenthal 1998)(Newall 1996)(PDR Herbal 1998)

Ephedra should not be taken together with other CNS stimulants or circulatory agents (digitoxin, beta-blockers, etc.). Theoretically, a single high dose could result in irregular heartbeats. (Brinker 1998)

Cola, Guarana, and Mate are some caffeine containing herbs that should be avoided with beta blockers. (Brinker 1998)

Melatonin can reverse the sleep effects of propranolol and Atenolol. (Stoschitzky 1999)(Van den Huevel 1997)

Beta Blockers can help to prevent Yohimbe toxicity. (Brinker 1998)

Several herbs with cardioactive ingredients have been listed by Newall:

Herb
                                
Broom                                
Calamus                                
Cereus                                
Cola                                
Coltsfoot                                
Devil's Claw                        
Fenugreek                                
Figwort                                
Fumitory                                
Ginger                                

References

Angel, J.E. 1983. Physicians Desk Reference. Medical Economics Company, Inc. Oradell, New Jersey.

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Brinker, Francis, N.D. Herb Contraindications and Drug Interactions. 1998.

Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 1999.

Farese, RV et al., Licorice-induced hypermineralcorticoidism. NEJM. 1991, 325:1,1223-1,227.

Griffith, H. W. 1983. Complete Guide to Prescription and Non-Prescription. Fisher Publishing, Inc., Tucson.

Kishi H, Kishi T, Folkers K: Bioenergetics in clinical medicine III - inhibition of coenzyme Q10-enzymes by clinically used antihypertensive drugs, Res Commun Chem Pathol Pharmacol, 1975, 12(3):533-40.

Mountokalakis T, Dourakis S, Karatzas N, et al: Zinc deficiency in mild hypertensive patients treated with diuretics, J Hypertens Suppl, 1984, 2(3):S571-2.

Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996

Osol, Arthur. 1980. Remington's Pharmaceutical Sciences. Mack Publishing Company, Pennsylvania.

PDR For Herbal Medicines, First Edition. Medical Economics Co. Montvale, NJ. 1998.

Product Information: Inderal, propranolol hydrochloride. Wyeth-Ayesrt Laboratories, PA. 1993.

Pronsky, Zaneta. Food Medication Interactions. 11th edition. 1999.

Reyes AJ, Leary WP, Lockett CJ, et al. Diuretics and zinc. S Afr Med J 1982;62:373-75.

Shand, D.G.: Clinical pharmacology of the beta-blocking drugs: implications for the postinfarction patient. Circulation, 1983, 67(Supp 1): 12-15.

Shintani S, Murase H, Tsukagoshi H, Shiigai T. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol 1992;32:44-51.

Stoschitzky K, Sakotnik A, Lercher P, et al. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol 1999;55(2):111-115

Van Den Heuvel CJ, Reid KJ, Dawson D. "Effect of atenolol on nocturnal sleep and temperature in young men: reversal by pharmacological doses of melatonin." Physiol Behav, Jun. 1997; 61(6):795-802.