7 Beta Blocker Interactions to Be Aware Of

Beta blockers are a group of medications that slow your heart rate and relax your blood vessels. Because of this, they’re a popular choice for managing heart-related conditions, such as high blood pressure and heart failure.

There are several different beta blockers to choose from. Common examples include atenolol (Tenormin), metoprolol (Lopressor, Toprol XL), and carvedilol (Coreg). Your prescriber will determine which one is best for you. But all beta blockers have interactions to be aware of. So be sure to show your prescriber an updated medication list, and take a look at these seven beta blocker interactions you should know about.

Good to know: These are general interactions for beta blockers as a whole, but each individual beta blocker medication has other interactions to be aware of. So be sure to talk to your healthcare team about the specific beta blocker you’re taking.

1. Other medications that affect blood pressure and heart rate

As mentioned, beta blockers slow down the heart rate and relax the blood vessels. If you take a beta blocker with other medications that have similar effects, side effects can happen.

When you take a beta blocker with another medication that lowers blood pressure, your risk of hypotension (very low blood pressure) goes up. This interaction is more likely if you take a beta blocker with a calcium channel blocker, such as verapamil. But it can occur with any blood pressure medication, such as a diuretic (water pill) or an angiotensin-converting enzyme (ACE) inhibitor.

Beta blockers can also interact with medications that affect your heart rate, such as digoxin (Lanoxin) and amiodarone (Pacerone). Taking beta blockers with these medications can lead to bradycardia (very slow heartbeat).

It’s possible that your prescriber may have you taking a beta blocker along with other heart-related medications. But you shouldn’t combine heart medications without their approval. They’ll likely have you check your blood pressure at home to keep an eye out for signs that your blood pressure or heart rate are too low. Be sure to report any signs and symptoms of hypotension or bradycardia, such as

• Blurry vision

• Feeling dizzy or lightheaded

• Feeling weak

• Irregular heartbeat

EXPERT PICKS: WHAT TO READ NEXT

• Starting a beta blocker? Here are some things you should know to help you get the most from your medication.

• Beta blocker side effects: Learn about common and rare side effects of beta blockers, how to manage them, and when to seek medical care.

• Beta blockers and weight gain: Here’s what to know about weight gain while taking beta blockers and steps you can take to help prevent it.

Seek emergency care if any symptoms feel life-threatening. But don’t stop taking your beta blocker unless your prescriber tells you to. It can be dangerous to stop taking them abruptly.

2. Asthma or COPD rescue inhalers

If you’re living with asthma or chronic obstructive pulmonary disease (COPD), beta blockers may interfere with rescue inhalers used to open your airways. They may also worsen your breathing condition.

When beta blockers bind to receptors in your heart, they affect your heart rate and blood pressure. But when they bind to receptors in your lungs, they can narrow your airways and make it harder to breathe. They can also block the effects of rescue inhalers, such as albuterol (ProAir HFA, Proventil HFA), that help open your lungs when you’re having trouble breathing. 

Read more like this

Explore these related articles, suggested for readers like you.

11 Side Effects of Beta Blockers You Should Know About

7 Things You Should Know Before Starting a Beta Blocker

ACE Inhibitors vs. Beta Blockers: How Are They Different?

5 Foods to Avoid When Taking Carvedilol (and Other Beta Blockers)

View more

There are two main types of beta blockers: selective and non-selective. Selective beta blockers only bind to receptors in the heart. Non-selective beta blockers bind to receptors in the heart as well as in other areas of the body, such as the lungs and blood vessels. So non-selective beta blockers are more likely to cause breathing issues. Examples include propranolol (Inderal LA), nadolol, and carvedilol.

Make sure your prescriber is aware of any breathing problems you have before you start taking a beta blocker. They may want to try a different medication first or change the type of beta blocker you’re taking.

3. Diabetes medications

Some beta blockers may raise your blood glucose (sugar) levels. This is concerning for everyone, but especially if you’re living with diabetes. Your insulin or other diabetes medications may not work as well to control your blood glucose once you start taking a beta blocker.

Beta blockers can also mask many symptoms of low blood sugar (hypoglycemia). So it can be harder to tell if your blood glucose is low while you’re taking them. But sweating is one symptom of low blood sugar they don’t affect. So if you notice increased sweating, it’s a good idea to check your blood glucose and consume fast-acting glucose tablets or gel if needed.

If you’re taking diabetes medications and also need a beta blocker, your prescriber will likely have you check your blood glucose levels more often. They’ll adjust your diabetes medications as necessary to help keep your blood glucose under control.

4. Caffeine

Caffeine is a stimulant, meaning it helps wake the body up. This is why many people drink a caffeinated beverage in the morning or when they need a quick pick-me-up.

As a stimulant, caffeine can raise your blood pressure and make your heart beat faster. This is the opposite of what beta blockers do. So large amounts of caffeine while you’re taking a beta blocker may make the medication less effective and raise your risk of a stroke or heart attack.

You don’t have to give up your morning coffee if you’re taking a beta blocker. But it’s best to limit your caffeine intake and avoid energy drinks or other high sources of caffeine. Your prescriber can tell you how much caffeine is safe for you based on your personal medical history.

5. Alcohol

Alcohol interacts with beta blockers in several ways:

• Alcohol can affect how some beta blockers are processed in the body, which can raise or lower medication levels in the body. This can raise your risk of low blood pressure or make the beta blocker less effective.

• Alcohol can also raise your blood pressure and heart rate, which may counteract the intended effect of the beta blocker you’re taking.

• Beta blockers can make you feel dizzy or lightheaded. Drinking alcohol can raise the risk of these side effects or worsen them. This can put you at risk for falls or accidental injury. 

In most cases, it’s best to avoid alcohol if you’re taking a beta blocker. Talk to your prescriber about whether a drink or two on occasion is safe for you based on your medical history.

6. NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are medications that treat pain, fever, and swelling. Examples include ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn).

NSAIDs can raise your blood pressure and increase the risk of heart attacks. This may work against the intended effects of a beta blocker. It’s generally recommended that you avoid NSAIDs if you have a history of high blood pressure or other heart-related conditions.

It may be OK for you to take an NSAID occasionally as needed. But you should check with your prescriber first to make sure it’s safe for you.

7. Pseudoephedrine (Sudafed)

Pseudoephedrine (Sudafed) is an over-the-counter decongestant that’s kept behind the pharmacy counter. It’s also an ingredient in combination allergy or cough and cold products, such as Allegra-D (fexofenadine / pseudoephedrine) and Advil Cold and Sinus (ibuprofen / pseudoephedrine).

Pseudoephedrine can raise your blood pressure and heart rate, which can counteract the effects of a beta blocker. It’s generally recommended that you avoid taking pseudoephedrine if you have high blood pressure or another heart condition. Ask your pharmacist about safer alternatives for congestion. 

Can you take beta blockers with Adderall?

Adderall (mixed amphetamine salts) is a stimulant medication that treats attention deficit-hyperactivity disorder (ADHD). Stimulant medications can increase your blood pressure and heart rate. Because of this, beta blockers may not work as well if you take them with Adderall. But there’s some evidence that this interaction may not be as serious as once thought.

If your prescriber determines you need to take Adderall and a beta blocker, they may want you to check your blood pressure more often at home as a precaution.

Why trust our experts?

Written by:

Emilie White, PharmD

Emilie White is a clinical pharmacist with over a decade of hospital pharmacy experience. Her professional areas of interest include critical care as well as infectious and autoimmune diseases.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Our editorial standards

Meet our experts