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Angina - stable - Management
What adverse effects are associated with beta-blockers, and how can they be managed?

  • Cold extremities, paraesthesiae, and numbness can occur, and beta-blockers can worsen symptoms in people with peripheral vascular disease. This effect is less pronounced with cardioselective beta-blockers (such as atenolol, bisoprolol, and metoprolol) [Lopez-Sendon et al, 2004].
  • Sleep disturbance or nightmares can occur but are less likely with water-soluble beta-blockers, such as atenolol, because these drugs are less likely to cross the blood–brain barrier [Lopez-Sendon et al, 2004].
  • Fatigue: an incidence of approximately 18 per 1000 people per year treated with a beta-blocker has been reported, but in clinical trials, only 4 per 1000 people per year stopped taking their beta-blocker for this reason [Ko et al, 2002].
  • Sexual dysfunction (impotence and loss of libido) occurs in approximately 5 per 1000 people treated with a beta-blocker for one year, leading to discontinuation of treatment in 2 per 1000 people treated with a beta-blocker for one year [Ko et al, 2002]. The person should be directly questioned about whether they are having sexual problems because this adverse effect is often not volunteered owing to embarrassment.
  • Depression has been claimed to be an adverse effect of beta-blockers, but a meta-analysis found no significant increased risk of depressive symptoms in people taking beta-blockers [Ko et al, 2002].
  • Warning signs of hypoglycaemia (such as tremor and tachycardia) can be masked by non-selective beta-blockers. A cardioselective beta-blocker is therefore preferred in people with diabetes [Lopez-Sendon et al, 2004].

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