Key takeaways:
Beta blockers are used to treat many health conditions. They’re best known for treating heart-related health problems.
Beta blockers are classified into two types: selective or non-selective. Selective beta blockers mainly affect the heart. Non-selective beta blockers have effects on the heart and other areas of the body.
One beta blocker may be preferred over another in certain situations. For example, carvedilol (Coreg), metoprolol succinate (Toprol XL), and bisoprolol are preferred for people with heart failure.
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Beta blockers are a group of medications used to manage hypertension (high blood pressure), heart failure, and other heart-related conditions. Some are also used for migraine prevention, glaucoma, and essential tremor. They come in various forms, such as pills, injections, and eye drops. Most are available as generic medications.
But what beta blockers are available? And what’s the difference between them?
Types of beta blockers
Beta blockers fall into two categories: selective or non-selective.
Selective beta blockers (also called cardioselective beta blockers) mainly target beta-1 receptors (chemical binding sites). These receptors affect your heart rate and how hard your heart works to pump blood.
Non-selective beta blockers attach to beta-1, beta-2, and sometimes alpha receptors. These types of beta blockers affect blood vessels throughout the body, not just the heart.
With so many types of beta blockers available, it can be hard to tell them apart. The table below provides some basic info about the most commonly prescribed beta blockers.
| Beta blocker name | Type | Dosage forms | FDA-approved uses |
|---|---|---|---|
| Metoprolol tartrate (Lopressor) | Selective |
|
|
| Metoprolol succinate (Toprol XL, Kapspargo Sprinkle) | Selective |
|
|
| Carvedilol (Coreg, Coreg CR) | Non-selective |
|
|
| Atenolol (Tenormin) | Selective |
|
|
| Propranolol (Inderal LA, InnoPran XL, Hemangeol) | Non-selective |
|
IR tablets and generic oral solution:
Hemangeol solution:
InnoPran XL capsules:
Other ER capsules:
IV injection:
|
| Labetalol | Non-selective |
|
|
| Bisoprolol | Selective |
|
|
| Timolol (Betimol, Istalol, Timoptic, Timoptic-XE, Timoptic in Ocudose) | Non-selective |
|
IR tablets:
Eye drops:
|
| Nadolol | Non-selective |
|
|
Below are more details about eight notable beta blockers.
1. Metoprolol
Metoprolol is a selective beta blocker. It’s available in two forms: metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol XL, Kapspargo Sprinkle).
Metoprolol tartrate is an IR tablet that’s typically taken twice a day. It’s also available as an IV injection that can be used in hospital settings. Metoprolol succinate is an ER tablet or capsule that’s taken once a day. Regardless of which form of metoprolol you take, it’s best to take your doses with food. This helps limit digestive side effects, such as diarrhea.
Both forms of metoprolol are FDA approved to manage high blood pressure and chest pain. Metoprolol tartrate is also approved to lower the risk of death after a heart attack. And metoprolol succinate is approved to lower the risk of hospitalization and death for some people with heart failure.
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.
Can you take beta blockers with coffee? Pharmacists discuss what medications, foods, and substances interact with beta blockers.
Good to know: It’s worth noting that metoprolol succinate is a first-choice medication for people with heart failure with reduced ejection fraction (HFrEF). So if you have this condition, your prescriber would likely recommend metoprolol succinate over metoprolol tartrate.
2. Carvedilol
Carvedilol (Coreg, Coreg, CR) is a non-selective beta blocker. As mentioned, this means it blocks beta-1, beta-2, and alpha-1 receptors. Blocking alpha-1 receptors helps widen your blood vessels, which can help lower blood pressure. In theory, beta blockers that block alpha-1 receptors should have greater blood pressure-lowering abilities. But in real life, this isn’t always true.
Carvedilol is FDA approved to treat high blood pressure and heart failure. It’s also used to lower the risk of death after a heart attack. Similar to metoprolol succinate, carvedilol is a first-choice medication for people living with HFrEF.
Carvedilol comes as IR tablets and ER capsules. The IR tablets are taken twice a day. The ER capsules are only taken once a day.
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Carvedilol can cause a sudden drop in blood pressure when you sit up or stand quickly. This is known as orthostatic hypotension, and it can make you feel dizzy. Taking carvedilol with food helps slow down its absorption and lower your risk for this problem.
3. Atenolol
Atenolol (Tenormin) is a selective beta blocker. It’s FDA approved to treat high blood pressure and chest pain. It can also lower your risk of death after a heart attack.
Atenolol only comes in IR tablet form and is usually taken once a day. Unlike some of the other beta blockers, atenolol isn’t broken down by the liver. So if you have liver problems, you may still be able to take atenolol. However, the kidneys remove most of the medication from your body. So people with kidney problems may need to take a lower dose.
4. Propranolol
Propranolol (Inderal LA, InnoPran XL, Hemangeol) is a non-selective beta blocker. Oral forms of propranolol include an IR tablet, ER capsule, and liquid solution. It also comes as an IV injection that can be used in hospitals. The IR tablets and oral solution are usually taken 2 to 3 times daily. The ER capsules are generally taken once a day.
There are differences when it comes to FDA approvals for each dosage form. The table below highlights these differences.
| Propranolol dosage form | FDA-approved uses |
|---|---|
| IR tablets and generic oral solution |
|
| Hemangeol (a brand-name oral propranolol solution) |
|
| InnoPran XL (a brand-name version of the ER capsules) |
|
| Other propranolol ER capsules |
|
| IV injection |
|
5. Labetalol
Labetalol is a non-selective beta blocker that also blocks alpha-1 receptors. Labetalol used to be sold under the brand names Trandate and Normodyne. But these brand names are no longer available in the U.S. Labetalol now only comes as a generic medication.
Labetalol is available as an IR tablet. It’s FDA approved to manage high blood pressure. For maximum absorption, it’s best to take it with food.
Labetalol is unique because the IV formulation is used in hypertensive crises. This is when there’s a rapid and severe rise in your blood pressure. Labetolol is also one of only a few blood pressure medications (and the only beta blocker) that’s safe to take during pregnancy.
6. Bisoprolol
Bisoprolol (previously sold under the brand name Zebeta) is a selective beta blocker that’s FDA approved to treat high blood pressure. However, it’s a first-choice medication for managing HFrEF. So your healthcare professional may prescribe it off-label for this use.
Bisoprolol only comes as an IR tablet. Because bisoprolol lasts a long time in the body, it’s typically only taken once a day.
7. Timolol
Timolol is a non-selective beta blocker. It’s most commonly prescribed as an eye drop. But it’s also available as an oral IR tablet (previously sold under the brand name Blocadren). Timolol tablets are usually taken twice a day.
There are several brand-name versions of timolol eye drops. Each of them also has a generic form. Different versions of timolol eye drops include:
Timolol eye drops are commonly used to treat glaucoma or high blood pressure in the eye. The tablet form is FDA approved to treat hypertension and prevent migraines. It can also be used after a heart attack to lower the risk of death.
8. Nadolol
Nadolol (previously sold under the brand name Corgard) is a non-selective beta blocker. It’s FDA approved to treat chest pain and high blood pressure. This medication is only available as an IR tablet and is usually taken once a day.
Nadolol stays in the body longer than most other beta blockers. And it’s removed from the body by your kidneys. So those with kidney problems may need to take doses less frequently (every 2 to 3 days instead of every day).
What are the common side effects of beta blockers?
Beta blockers are generally well-tolerated by most people. If you do experience side effects, it’s likely that they’ll go away as your body adjusts to the medication. Some common side effects include:
Slow heart rate
Low blood pressure
Dizziness
Fatigue
Constipation
Nausea
Insomnia
More serious (but rare) side effects include:
Heart block (extremely slow heart rate or skipped heartbeats)
Masking symptoms of hypoglycemia (low blood sugar) such as shaking, irritability, and confusion. Untreated hypoglycemia can lead to serious complications such as coma, seizures, and even death. But sweating is a low blood sugar symptom that’s not masked by beta blockers. So if you have diabetes and take a beta blocker, it’s a good idea to check your blood sugar if you feel sweaty or clammy.
Difficulty breathing due to tightening of the muscles lining your airways. This is more likely with non-selective beta blockers.
Which beta blocker is right for you?
There are many beta blockers, so knowing which one is best for you can be hard to figure out. The two main factors your prescriber will consider when selecting a beta blocker are:
The medical condition you’re taking a beta blocker for
Your personal medical history
If you need a beta blocker, your prescriber will determine if it’s safe to start taking one. And they’ll help determine if one specific beta blocker is best for you. For example, selective beta blockers (like metoprolol, atenolol, and bisoprolol) are often a better choice than non-selective beta blockers if you have asthma.
Below, we’ll cover a few scenarios where one beta blocker from the list above may be preferred over another:
High blood pressure: In general, beta blockers aren’t first-choice options for managing high blood pressure. But if you have other related health conditions (for example, coronary artery disease), you may need a beta blocker. Many beta blockers are good options in this case, except research shows atenolol isn’t as good as other beta blockers at preventing heart-related events.
Heart failure: Current research shows that the best beta blockers for heart failure are carvedilol, metoprolol succinate, and bisoprolol.
Essential tremors: Propranolol is a common first-choice medication for essential tremors. Nadolol and atenolol are also possible treatment options.
Performance anxiety: Propranolol is the most commonly used beta blocker to prevent physical symptoms of performance anxiety. This is an off-label use, and the evidence supporting this use isn’t very strong.
Migraine prevention: Propranolol and metoprolol are two beta blockers that may help prevent migraines.
High blood pressure in pregnancy: Labetalol is a first-choice medication for high blood pressure in pregnancy. There is a lot of evidence to support its safety during pregnancy.
How to save
There are many ways to save on your beta blocker medication. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find beta blocker prices as low as $9 with a free GoodRx discount.
Frequently asked questions
No, beta blockers are available only with a prescription. Because beta blockers work on the heart and affect blood pressure, a healthcare professional needs to make sure it’s safe for you. It’s also important for a healthcare professional to monitor your body’s response to the treatment to make sure it’s working well for you. Beta blockers also have a number of side effects, some of which could be serious.
The most commonly prescribed beta blocker is metoprolol. This includes both forms of the medication (metoprolol tartrate and metoprolol succinate). Carvedilol is the next most prescribed beta blocker.
No, beta blockers are available only with a prescription. Because beta blockers work on the heart and affect blood pressure, a healthcare professional needs to make sure it’s safe for you. It’s also important for a healthcare professional to monitor your body’s response to the treatment to make sure it’s working well for you. Beta blockers also have a number of side effects, some of which could be serious.
The most commonly prescribed beta blocker is metoprolol. This includes both forms of the medication (metoprolol tartrate and metoprolol succinate). Carvedilol is the next most prescribed beta blocker.
The bottom line
Beta blockers are versatile medications, and there are quite a few to choose from. They’re mainly used to treat heart-related health problems. But they can manage other conditions, such as migraines and essential tremors. Most people tolerate beta blockers fairly well, with common side effects fading after a short time.
Not all beta blockers work the same way. Some, such as atenolol (Tenormin) and metoprolol (Lopressor, Toprol XL), mainly target the heart. Others, such as carvedilol (Coreg) and propranolol, can affect other areas of the body as well. Your prescriber can help you choose the beta blocker that’s right for you.
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