The Pharmaceutical Journal
Vol 269 No 7208 p122
27 July 2002

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JAMA (jama.ama-assn.org)

Fear of beta-blocker effects unfounded

Concerns among some clinicians that beta-blockers carry a substantial risk of side effects, such as depressive symptoms, fatigue and sexual dysfunction, are unsubstantiated by clinical trial data, a new study has concluded (JAMA 2002;288:351).

Researchers analysed data from 15 trials, involving over 35,000 patients taking beta-blockers and found that these drugs were not associated with any increase in reported symptoms of depression. However, they did find that approximately one out of every 57 patients treated with beta-blockers each year suffered from fatigue and one out of every 199 patients treated reported suffering some sexual dysfunction.

Previous researchers have suggested that beta-blockers with low lipid solubility could result in fewer central nervous system side effects, such as fatigue, because they are less able to cross the blood-brain barrier. This study found no difference in the risks of fatigue or sexual dysfunction according to the degree of solubility of the beta-blocker in question, but the risk of fatigue was higher with older beta-blockers compared to newer drugs.

However, the researchers believe these drugs remain underused. They conclude: "Concerns about the development of these adverse effects should not deter physicians from initiating long-term treatment when indicated, although surveillance for adverse effects remains prudent."

The National Service Framework for Coronary Heart Disease recommends beta-blockers for patients who have stable angina, heart failure, or who have had a heart attack.