Post-myocardial infarction: initiated in secondary care, but when should they be stopped? The optimal duration of treatment post-myocardial infarction is uncertain There are two reasons why the optimal duration of beta-blocker treatment post-myocardial infarction is uncertain: 16 Reperfusion techniques and the routine use of statins and anti-platelet medicines post-myocardial infarction mean that patients now gain less benefit from the use of beta-blockers than they did decades ago There are no recent prospective randomised studies assessing the long-term benefits of beta-blockers in patients with uncomplicated myocardial infarction A systematic review of sixty trials that divided studies into either the reperfusion era or the pre-reperfusion era, found that beta-blockers reduced mortality in patients post-myocardial infarction in the pre-reperfusion era, but not the reperfusion era.
Minimising the adverse effects of beta-blockers The adverse effect profile varies between beta-blockers according to their properties Table 1.
Initiating beta-blockers: start low and go slow if treating heart failure Beta-blockers should be started at a low dose and slowly titrated to maximum tolerated dose when used to treat patients with heart failure. Beta-blockers are usually not recommended in patients with asthma Beta-blockers should generally be avoided in patients with asthma.
Cardioselective beta-blockers are generally safe and beneficial in patients with COPD There is evidence that beta-blockers are under-prescribed to patients with COPD, yet they provide significant benefit to those with co-existing heart failure; 23 cardioselective beta-blockers are preferred.
Cardioselective beta-blockers may reduce peripheral vasoconstriction and fatigue Cardioselective beta-blockers, e. Water soluble beta-blockers are less likely to cause sleep disturbances Malaise, vivid dreams, nightmares and in rare cases hallucinations may be caused by lipid-soluble beta-blockers crossing the blood brain barrier.
Indication Recommendation Co-morbidities and considerations Angina All beta-blockers are considered to be equally effective although bisprolol or metoprolol may be preferred. Celiprolol and pindolol tend not to be used Cardioselective beta-blockers, e.
Withdrawal of beta-blockers is sometimes appropriate Treatment with beta-blockers is generally long-term, but it should not be regarded as indefinite. Stopping treatment: go slow to get low Beta-blockers should be withdrawn slowly to prevent the onset of a withdrawal syndrome which in serious cases may include ischaemic cardiac symptoms, e.
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Prescriber ;5. Chest ;— Heart ;— Beta-blockers reduced the risk of mortality and exacerbation in patients with COPD: a meta-analysis of observational studies. PloS One ;9:e Discontinuation of beta-blockers and the risk of myocardial infarction in the elderly. Drug Saf ;—9. Expression of beta-adrenergic receptor up-regulation is mediated by two different processes. Brain Res ;— Published: 21 July Updated:.
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Louise Kuegler 5 Aug I read this article hoping to find the answer to my older male patients problem with B blockers- Erectile dysfunction.
Time and time again they come out of hospital post MI on Metoprolol and the ability to maintain an erection seems to have been left at the hospital. Over the last few weeks I have spoken to one of the cardiologists who suggests switching those who need to stay on a B Blocker to Carvediolol as it is more cardioselective I wonder if you can comment on what you would do with these men both in the situation of preserved ejection fraction and those with reduced ejection fraction.
The other piece of advice my friendly cardiologist gave me was post MI, f they can walk up two flights of stairs Viagra was fine. Again not what I had been lead to believe historically. Many thanks. Hi Louise. The initial run-in period of 2 to 6 weeks consisted of therapy with fixed-dose atenolol, mg once daily, a thiazide diuretic drug, and any other agents required to control the hypertension.
Patients were then randomized for 4 weeks to active atenolol plus 2 tablets of labetalol placebo, or active labetalol mg twice daily plus atenolol placebo, then crossed over and then changed back to active atenolol without labetalol placebo; the observers were unblinded in the last period. Labetalol and atenolol were equivalent in control of blood pressure at rest, exercise tolerance and use of nitroglycerin; however, heart rates at rest and during exercise were higher with labetalol p less than 0.
Philippine J Cardiol 4: 47— Br J Clin Pharmacol — Kane J, Gregg I A long-term study of labetalol in general practice. Br J Clin Pharmacol S— Koch G Hemodynamic adaption at rest and during exercise to long-term antihypertensive treatment with combined alpha- and beta-adrenoceptor blockade.
Br Heart J — Lund-Johansen P Hemodynamic changes in long-term diuretic therapy of essential hypertension. Acta Med Scand — Lund-Johansen P Hemodynamic changes at rest and during exercise in long-term prazosin therapy of essential hypertension. In: Evaluation of a new antihypertensive agent.
Lund-Johansen P Hemodynamic consequences of long-term beta-blocker therapy: A 5-year follow-up study of atenolol. J Cardiovasc Pharmacol 1: — J Cardiovasc Pharmacol Suppl 3 2: S— Lund-Johansen P, Bakke OM Haemodynamic effects and plasma concentrations of labetalol during long-term treatment of essential hypertension. Br J Clin Pharmacol 7: — Br Med J — Curr Ther Res 79— J Cardiovasc Pharmacol Suppl 1: S1—7.
Curr Ther Res — Br J Clin Pharmacol 7: 63— Am J Cardiol — Turner AS Prescribing prazosin.
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