Systemic adverse effects of beta-adrenergic blockers: an evidence-based assessment

To present an evidence-based review of the systemic adverse effects of beta-adrenergic blockers and recommend safety guidelines for use of ophthalmic beta-adrenergic blockers.

Literature review of published articles in peer-reviewed journals and medical texts.

Pre-MEDLINE and MEDLINE search of relevant English language articles from 1966 to the present. Cardiovascular, pulmonary, endocrine/metabolic, central nervous system, sexual, exercise, and neuromuscular effects of systemic or ophthalmic beta-adrenergic blockers were reviewed.

Systemic beta-adrenergic antagonists unequivocally reduce mortality in patients with mild, moderate, and even severe congestive heart failure. Development of symptomatic bradycardia on systemic or ophthalmic beta-adrenergic blockers alone likely indicates underlying cardiac conduction disturbances. Beta 2-adrenergic blockade, regardless of route of administration, may exacerbate or trigger bronchospasm in patients with asthma or pulmonary disease associated with hyper-reactive airways. This review identifies no scientific studies supporting the development of worsening claudication, depression, hypoglycemic unawareness, or prolonged hypoglycemia in non-insulin-dependent diabetes, sexual dysfunction, or impaired neuromuscular transmission with systemic or ophthalmic beta-adrenergic blockers.

Many commonly presumed adverse beta-adrenergic blocker effects observed via systemic or ocular administration are not supported by published randomized clinical trials. Wide acceptance of such traditionally purported side effects has been largely due to propagation of isolated case reports and short series as well as personal communication felt to reflect expert opinion. Many more patients may be eligible to use these drugs. Obtaining a careful medical history and checking pulse rate and rhythm in the office should identify the vast majority of patients with potential cardiopulmonary contraindications.