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 video around this subject.
My name is sanjay gupta i’m a consultant cardiologist in york as you can see i’m currently stuck in quarantine uh so it was my plan that i would try and do a video every day whilst i’ve been quarantined um i’m not doing anything else so i thought it’d be a good idea so today i wanted to talk to you about the beta blocker withdrawal syndrome okay and now a lot of
People have contacted me and said look how do i safely come off beta blockers and therefore i thought i would quickly do a video around the subject before i before i start it’s important to say that please do not try and alter your medications your dosages without speaking to your health care provider as he or she will know more about your unique situation than me
And all i’m really trying to do in this video is just giving general information because it’s a subject that not a lot of people know too much about so always speak to your doctor armed with the information i’m providing and see what they say and see whether it’s even safe for you to come off your beta blockers or reduce the dose now beta blockers are one of the
Commonest classes of medications that we use in cardiology and often serve as a bit of a jack of all trades they basically blunt sympathetic activity the effects of adrenaline in our system and by doing so they 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 uh so that the heart is able to then contract more effectively and push more blood out in some situations they make people feel better i.e they improve the quality of life in other situations they may actually have a prognosis modifying role which means that they can actually prolong life let
Me give you some examples of this okay beta blockers can be used to control blood pressure here they don’t necessarily make people feel better but they may have a prognosis modifying role meaning that if they lower the blood pressure they reduce the risk of bad things happening to you in the future the prognosis modifying role is a very weak role but that’s why
They’re used with blood pressure sometimes often they’re used as a treatment for heart failure in fact in heart failure they are very effective and they make people feel better but can also have a very significant impact on improving lifespan or prognosis they can be used in heart rhythm disturbances ectopics atrial fibrillation vt svt and here they make patients
Feel better they suppress the arrhythmia but they can also have a prognosis modifying role i even if they don’t make you feel better they may prevent bad things from happening to you in the future they can be used to treat angina and they can also be used in a prognosis modifying role after a heart attack so again here they may improve both quality and quantity
Of life and sometimes they can be used purely for symptom control such as as an anti-anxiolytic or to suppress benign ectopic beats in patients with normal heart so if you’re taking a beta blocker it’s always worth asking why you take them is it because they make you feel better or is it because they are in some way being used for a prognosis modifying role or
Effect and that’s really important because if it’s just about making you feel better then maybe reducing them may not necessarily be harmful as such yes you may not feel as good but you can then decide that and go up back up to the dose you were taking if they’re being used in a prognosis modifying role then you’re not going to realize those benefits uh yourself
Uh but they may prevent bad things happening to you in the future and therefore in that setting you may say well okay i don’t necessarily want to come off a medication which has been proven to say prolong life or stop bad things happening to me in the future now 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 has mainly been described in patients who take beta blockers for angina due to significant coronary disease and in a few of these patients when they’ve stopped the beta blocker suddenly patients have had more angina and even had heart attacks similarly they’ve been case reports of patients who take beta blockers to
Control dangerous heart rhythm disturbances and the beta block was abruptly stopped it led to precipitation of ventricular dystrophy and even in some cases death they’ve also been reports of heart failure status worsening and blood pressure going up excessively high when people have stopped the beta blocker abruptly and that is why you know everywhere you look
People say do not stop the beta blocker abruptly this phenomena is termed as an acute as acute beta blocker withdrawal syndrome where something bad happens when you suddenly stop the beta blocker why does it happen why does this happen it is believed that the withdrawal effects happen because of increased sympathetic activity this is probably due to something
Called beta receptor upregulation which occurs during the period of beta blockade now what this means is that when you have a receptors the beta receptors and you’re blocking them with a beta blocker in some way you’re sensitizing those receptors those receptors become more sensitized to the effects of adrenaline they’re they’re being blocked so they’re not
Acting they’re you know the adrenaline isn’t getting to them but they become more sensitized this is called up regulation it’s a well-recognized phenomena where the receptors that are being blocked become more sensitive and responsive to circulating adrenaline it is believed that receptors take 24 to 36 hours to down regulate when the beta blockade is removed
Right so when you take away the block with the the the blocking agent the beta blocker these are more sensitized receptors but the receptors will then down regulate by themselves in 24 to 36 hours so the problem is if you stop the beta blocker abruptly and there is no beta blocker left in your blood for a particularly long time then there is a period where you
Have more sensitized receptors which are not being blocked which are going to be more responsive to the effects of adrenaline and this is where you may get this sudden kind of upsurge or overreaction to adrenaline beta blocker withdrawal syndrome is far more likely to happen with short acting beta blockers okay those are beta blockers where you have to take
Two or three doses in a day because they have a much shorter half-life if you have one of these medications which has a short half-life you take it away it doesn’t stain your body very long so there’s a much longer period of time when the beta blocker when the beta receptors are upregulated and are taking time to down regulate so you go a longer period of time
With more hypersensitive beta receptors if you have take a beta blocker with a long half-life then even after discontinuing the beta blocker the beta blocker will stay in your body for much longer and therefore there will still be some beta recep beta blocking action and this will give your body enough time for those beta receptors to down regulate so beta
Blocker withdrawal syndrome is more of a worry with short acting beta blockers such as propranolol metoprolol cavital it is best to be cautious about reducing the dose carefully in such patients before stopping so in such cases most people would say that you should take perhaps the usual dose but once daily for a week and then every other day for a week and
Then eventually stop if on the other hand you’re taking a long-acting beta blocker 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’s very important that you only alter the dosages if sanctioned and supervised by your own doctor but i hope this information is useful to those people as to what
This effect is with the beta blockers and coming off them once again thank you so much for everything you do for me and i really appreciate you more than you will ever realize all the best take care bye
Transcribed from video
How to safely come off beta blockers By York Cardiology
