Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Atrial fibrillation - Management
What are the adverse effects of beta-blockers, and how can they be managed?

  • Cold extremities, paraesthesiae, and numbness can occur and are more common in people with peripheral vascular disease. If troublesome, beta-blockers might need to be stopped — this is most likely in people with severe peripheral vascular disease.
  • 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.
  • Fatigue: an incidence of approximately 18 per 1000 people treated with a beta-blocker has been reported, but in clinical trials, only 0.4% of people stopped taking their beta-blocker for this reason.
  • Sexual dysfunction (impotence and loss of libido) occurs in approximately 5 per 1000 people on treatment, leading to discontinuation of treatment in 2 people per 1000 person-years. 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 recent meta-analysis found no significant increased risk of depressive symptoms in people taking beta-blockers.
  • Warning signs of hypoglycaemia (such as tremor and tachycardia) can be masked by non-selective beta-blockers. A selective beta-blocker is therefore preferred in people with diabetes. Avoid beta-blockers in people who experience frequent hypoglycaemia.
Basis for recommendation

© NHS Institute for Innovation and Improvement