Beta Blockers for Migraines

Drug Profiles:
Beta-adrenergic Blocking Agents
AKA Beta-Blockers

CAUTION: Federal law prohibits dispensing without prescription.

Description

This group of medicines is commonly used as a Migraine preventive treatment, they are known as beta-adrenergic blocking agents, beta-blocking agents, or, more commonly, beta-blockers. Beta-blockers are primarily used in the treatment of high blood pressure (hypertension). Some beta-blockers are also used to relieve angina (chest pain) and in heart attack patients to help prevent additional heart attacks. Beta-blockers are also used to correct irregular heartbeat, as stated above, prevent Migraine, and treat tremors. They may also be used for other conditions as determined by your doctor.

Beta-blockers work by affecting the response to some nerve impulses in certain parts of the body. As a result, they decrease the heart's need for blood and oxygen by reducing its workload. They also help the heart to beat more regularly.

Beta-adrenergic blocking agents are available only with your doctor's prescription, in the following dosage forms:

Oral

Acebutolol

Capsules (U.S.)
Tablets (Canada)

Atenolol

Tablets (U.S. and Canada)

Betaxolol

Tablets (U.S.)

Bisoprolol

Tablets (U.S.)

Carteolol

Tablets (U.S.)

Labetalol

Tablets (U.S. and Canada)

Metoprolol

Tablets (U.S. and Canada)
Extended-release tablets (U.S. and Canada)

Nadolol

Tablets (U.S. and Canada)

Oxprenolol

Tablets (Canada)
Extended-release tablets (Canada)

Penbutolol

Tablets (U.S.)

Pindolol

Tablets (U.S. and Canada)

Propranolol

Extended-release capsules (U.S. and Canada)
Oral solution (U.S.)
Tablets (U.S. and Canada)

Sotalol

Tablets (U.S. and Canada)

Timolol

Tablets (U.S. and Canada

Parenteral

Atenolol

Injection (U.S.)

Labetalol

Injection (U.S. and Canada)

Metoprolol

Injection (U.S. and Canada)

Propranolol

Injection (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the beta-blockers, the following should be considered:

Allergies-

Tell your doctor if you have ever had any unusual or allergic reaction to the beta-blocker medicine prescribed. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy-

Use of some beta-blockers during pregnancy has been associated with low blood sugar, breathing problems, a lower heart rate, and low blood pressure in the newborn infant. Other reports have not shown unwanted effects on the newborn infant. Animal studies have shown some beta-blockers to cause problems in pregnancy when used in doses many times the usual human dose. Before taking any of these medicines, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding-

It is not known whether bisoprolol, carteolol, or penbutolol passes into breast milk. All other beta-blockers pass into breast milk. Problems such as slow heartbeat, low blood pressure, and trouble in breathing have been reported in nursing babies. Mothers who are taking beta-blockers and who wish to breast-feed should discuss this with their doctor.

Children-

Some of these medicines have been used in children and, in effective doses, have not been shown to cause different side effects or problems in children than they do in adults.

Older adults-

Some side effects are more likely to occur in the elderly, who are usually more sensitive to the effects of beta-blockers. Also, beta-blockers may reduce tolerance to cold temperatures in elderly patients.

Other medicines-

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving a beta-blocker it is especially important that your health care professional know if you are taking any of the following:

Allergen immunotherapy (allergy shots) or
Allergen extracts for skin testing-Beta-blockers may increase the risk of serious allergic reaction to these medicines
Aminophylline (e.g., Somophyllin) or
Caffeine (e.g., NoDoz) or
Dyphylline (e.g., Lufyllin) or
Oxtriphylline (e.g., Choledyl) or
Theophylline (e.g., Somophyllin-T)-The effects of both these medicines and beta-blockers may be blocked; in addition, theophylline levels in the body may be increased, especially in patients who smoke
Antidiabetics, oral (diabetes medicine you take by mouth) or
Insulin-There is an increased risk of hyperglycemia (high blood sugar); beta-blockers may cover up certain symptoms of hypoglycemia (low blood sugar) such as increases in pulse rate and blood pressure, and may make the hypoglycemia last longer
Calcium channel blockers (bepridil [e.g., Bepadin], diltiazem [e.g., Cardizem], felodipine [e.g., Plendil], flunarizine [e.g., Sibelium], isradipine [e.g., DynaCirc], nicardipine [e.g., Cardene], nifedipine [e.g., Procardia], nimodipine [e.g., Nimotop], verapamil [e.g., Calan]) or
Clonidine (e.g., Catapres) or
Guanabenz (e.g., Wytensin)-Effects on blood pressure may be increased. In addition, unwanted effects may occur if clonidine, guanabenz, or a beta-blocker is stopped suddenly after use together. Unwanted effects on the heart may occur when beta-blockers are used with calcium channel blockers
Cocaine-Cocaine may block the effects of beta-blockers; in addition, there is an increased risk of high blood pressure, fast heartbeat, and possibly heart problems if you use cocaine while taking a beta-blocker
Monoamine oxidase (MAO) inhibitors (furazolidone [e.g., Furoxone], isocarboxazid [e.g., Marplan], phenelzine [e.g., Nardil], procarbazine [e.g., Matulane], selegiline [e.g., Eldepryl], tranylcypromine [e.g., Parnate])-Taking beta-blockers while you are taking or within 2 weeks of taking monoamine oxidase (MAO) inhibitors may cause severe high blood pressure

Other medical problems-

The presence of other medical problems may affect the use of the beta blockers. Make sure you tell your doctor if you have any other medical problems, especially:

Allergy, history of (asthma, eczema, hay fever, hives), or
Bronchitis or
Emphysema-Severity and duration of allergic reactions to other substances may be increased; in addition, beta-blockers can increase trouble in breathing
Bradycardia (unusually slow heartbeat) or
Heart or blood vessel disease-There is a risk of further decreased heart function; also, if treatment is stopped suddenly, unwanted effects may occur
Diabetes mellitus (sugar diabetes)-Beta-blockers may cause hyperglycemia (high blood sugar) and circulation problems; in addition, if your diabetes medicine causes your blood sugar to be too low, beta-blockers may cover up some of the symptoms (fast heartbeat), although they will not cover up other symptoms such as dizziness or sweating
Kidney disease or
Liver disease-Effects of beta-blockers may be increased because of slower removal from the body
Mental depression (or history of)-May be increased by beta-blockers
Myasthenia gravis or
Psoriasis-Beta-blockers may make these conditions worse
Overactive thyroid-Stopping beta-blockers suddenly may increase symptoms; beta-blockers may cover up fast heartbeat, which is a sign of overactive thyroid

Proper Use of This Medicine

For patients taking the extended-release capsule or tablet form of this medicine:

Swallow the capsule or tablet whole.

Do not crush, break (except metoprolol succinate extended-release tablets, which may be broken in half), or chew before swallowing.

For patients taking the concentrated oral solution form of propranolol:

This medicine is to be taken by mouth even though it comes in a dropper bottle. The amount you should take is to be measured only with the specially marked dropper.

Mix the medicine with some water, juice, or a carbonated drink. After drinking all the liquid containing the medicine, rinse the glass with a little more liquid and drink that also, to make sure you get all the medicine.

If you prefer, you may mix this medicine with applesauce or pudding instead.

Mix the medicine immediately before you are going to take it. Throw away any mixed medicine that you do not take immediately. Do not save medicine that has been mixed.

Ask your doctor about checking your pulse rate before and after taking beta-blocking agents. If your doctor tells you to check your pulse regularly while you are taking this medicine, and it is much slower than the rate your doctor has designated, check with your doctor. A pulse rate that is too slow may cause circulation problems.

To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking this medicine for high blood pressure:

In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.

Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. However, if high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.
Remember that this medicine will not cure your high blood pressure but it does help control it. It is very important that you take your medicine exactly as directed, even if you feel well. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life. Also, it is very important to keep your appointments with your doctor, even if you feel well.

Dosing-

The dose of beta-blocker will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses. If your dose is different, do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of solution that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are taking the beta-blocker.

For acebutolol

For oral dosage forms (capsules and tablets):

For angina (chest pain) or irregular heartbeat:

Adults-200 milligrams (mg) two times a day. The dose may be increased up to a total of 1200 mg a day.
Children-Dose must be determined by your doctor.

For high blood pressure:

Adults-200 to 800 mg a day as a single dose or divided into two daily doses.
Children-Dose must be determined by your doctor.

For atenbolol

For oral dosage form (tablets):

For angina (chest pain):

Adults-50 to 100 mg once a day.

For high blood pressure:

Adults-25 to 100 mg once a day.
Children-Dose must be determined by your doctor.

For treatment after a heart attack:

Adults-50 mg ten minutes after the last intravenous dose, followed by another 50 mg twelve hours later. Then 100 mg once a day or 50 mg two times a day for six to nine days or until discharge from hospital.

For injection dosage form:

For treatment of heart attacks:

Adults-5 mg given over 5 minutes. The dose is repeated ten minutes later.

For betaxolol

For oral dosage form (tablets):

For high blood pressure:

Adults-10 mg once a day. Your doctor may double your dose after seven to fourteen days.
Children-Dose must be determined by your doctor.

For bisoprolol

For oral dosage form (tablets):

For high blood pressure:

Adults-5 to 10 mg once a day.
Children-Dose must be determined by your doctor.

For carteolol

For oral dosage form (tablets):

For high blood pressure:

Adults-2.5 to 10 mg once a day.
Children-Dose must be determined by your doctor.

For labetalol

For oral dosage form (tablets):

For high blood pressure:

Adults-100 to 400 mg two times a day.
Children-Dose must be determined by your doctor.

For injection dosage form:

For high blood pressure:

Adults-20 mg injected slowly over two minutes with additional injections of 40 and 80 mg given every ten minutes if needed, up to a total of 300 mg; may be given instead as an infusion at a rate of 2 mg per minute to a total dose of 50 to 300 mg.
Children-Dose must be determined by your doctor.

For metoprolol

For regular (short-acting) oral dosage form (tablets):

For high blood pressure or angina (chest pain):

Adults-100 to 450 mg a day, taken as a single dose or in divided doses.
Children-Dose must be determined by your doctor.

For treatment after a heart attack:

Adults-50 mg every six hours starting fifteen minutes after last intravenous dose. Then 100 mg two times a day for three months to 1 to 3 years .

For long-acting oral dosage forms (extended-release tablets):

For high blood pressure or angina (chest pain):

Adults-Up to 400 mg once a day.
Children-Dose must be determined by your doctor.

For injection dosage form:

For treatment of a heart attack:

Adults-5 mg every two minutes for three doses.

For nadolol

For oral dosage form (tablets):

For angina (chest pain):

Adults-40 to 240 mg once a day.

For high blood pressure:

Adults-40 to 320 mg once a day.
Children-Dose must be determined by your doctor.

For oxprenolol

For regular (short-acting) oral dosage form (tablets):

For high blood pressure:

Adults-20 mg three times a day. Your doctor may increase your dose up to 480 mg a day.
Children-Dose must be determined by your doctor.

For long-acting oral dosage form (extended-release tablets):

For high blood pressure:

Adults-120 to 320 mg once a day.
Children-Dose must be determined by your doctor.

For penbutolol

For oral dosage form (tablets):
For high blood pressure:
- Adults-20 mg once a day.
- Children-Dose must be determined by your doctor.

For pindolol

For oral dosage form (tablets):

For high blood pressure:

Adults-5 mg two times a day. Your doctor may increase your dose up to 60 mg a day.
Children-Dose must be determined by your doctor.

For propranolol

For regular (short-acting) oral dosage forms (tablets and oral solution):

For angina (chest pain):

Adults-80 to 320 mg a day taken in two, three, or four divided doses.

For irregular heartbeat:

Adults-10 to 30 mg three or four times a day.
Children-500 micrograms (0.5 mg) to 4 mg per kilogram of body weight a day taken in divided doses.

For high blood pressure:

Adults-40 mg two times a day. Your doctor may increase your dose up to 640 mg a day.
Children-500 micrograms (0.5 mg) to 4 mg per kilogram of body weight a day taken in divided doses.

For diseased heart muscle (cardiomyopathy):

Adults-20 to 40 mg three or four times a day.

For treatment after a heart attack:

Adults-180 to 240 mg a day taken in divided doses.

For treating pheochromocytoma:

Adults-30 to 160 mg a day taken in divided doses.

For preventing Migraine :

Adults-20 mg four times a day. Your doctor may increase your dose up to 240 mg a day.

For trembling:

Adults-40 mg two times a day. Your doctor may increase your dose up to 320 mg a day.

For long-acting oral dosage form (extended-release capsules):

For high blood pressure:

Adults-80 to 160 mg once a day. Doses up to 640 mg once a day may be needed in some patients.

For angina (chest pain):

Adults-80 to 320 mg once a day.

For preventing Migraine:

Adults-80 to 240 mg once a day.

For injection dosage form:

For irregular heartbeat:

Adults-1 to 3 mg given at a rate not greater than 1 mg per minute. Dose may be repeated after two minutes and again after four hours if needed.
Children-10 to 100 micrograms (0.01 to 0.1 mg) per kilogram of body weight given intravenously every six to eight hours.

For sotalol

For oral dosage form (tablets):

For irregular heartbeat:

Adults-80 mg two times a day. Your doctor may increase your dose up to 320 mg per day taken in two or three divided doses.
Children-Dose must be determined by your doctor.

For timolol

For oral dosage form (tablets):

For high blood pressure:

Adults-10 mg two times a day. Your doctor may increase your dose up 60 mg per day taken as a single dose or in divided doses.
Children-Dose must be determined by your doctor.

For treatment after a heart attack:

Adults-10 mg two times a day.

For preventing Migraine :

Adults-10 mg two times a day. Your doctor may increase your dose up to 30 mg once a day or in divided doses.

Missed dose-

Do not miss any doses. This is especially important when you are taking only one dose per day. Some conditions may become worse if this medicine is not taken regularly.

If you do miss a dose of this medicine, take it as soon as possible. However, if it is within 4 hours of your next dose (8 hours when using atenolol, betaxolol, bisoprolol, carteolol, labetalol, nadolol, penbutolol, sotalol, or extended-release [long-acting] metoprolol, oxprenolol, or propranolol), skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage-

To store this medicine:

Keep out of the reach of children.
Store away from heat and direct light.
Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

It is important that your doctor check your progress at regular visits. This is to make sure the medicine is working for you and to allow the dosage to be changed if needed.

Do not stop taking this medicine without first checking with your doctor. Your doctor may want you to reduce gradually the amount you are taking before stopping completely. Some conditions may become worse when the medicine is stopped suddenly, and the danger of heart attack is increased in some patients.

Make sure that you have enough medicine on hand to last through weekends, holidays, or vacations. You may want to carry an extra written prescription in your billfold or purse in case of an emergency. You can then have it filled if you run out of medicine while you are away from home.

Your doctor may want you to carry medical identification stating that you are taking this medicine.

Before having any kind of surgery (including dental surgery) or emergency treatment, tell the medical doctor or dentist in charge that you are taking this medicine.

For diabetic patients:

This medicine may cause your blood sugar levels to rise. Also, this medicine may cover up signs of hypoglycemia (low blood sugar), such as change in pulse rate.
This medicine may cause some people to become dizzy, drowsy, or lightheaded. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy or are not alert. If the problem continues or gets worse, check with your doctor.

Beta-blockers may make you more sensitive to cold temperatures, especially if you have blood circulation problems. Beta-blockers tend to decrease blood circulation in the skin, fingers, and toes. Dress warmly during cold weather and be careful during prolonged exposure to cold, such as in winter sports.

Chest pain resulting from exercise or physical exertion is usually reduced or prevented by this medicine. This may tempt a patient to be overly active. Make sure you discuss with your doctor a safe amount of exercise for your medical problem.

Before you have any medical tests, tell the doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.

Before you have any allergy shots, tell the doctor in charge that you are taking a beta-blocker. Beta-blockers may cause you to have a serious reaction to the allergy shot.

For patients with allergies to foods, medicines, or insect stings:

There is a chance that this medicine will cause allergic reactions to be worse and harder to treat. If you have a severe allergic reaction while you are being treated with this medicine, check with a doctor right away so that it can be treated. Be sure to tell the doctor that you are taking a beta-blocker.

For patients taking this medicine for high blood pressure:

Do not take other medicines unless they have been discussed with your doctor. This especially includes over-the-counter (nonprescription) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems since they may tend to increase your blood pressure.

For patients taking labetalol by mouth:

Dizziness, lightheadedness, or fainting may occur, especially when you get up from a lying or sitting position. This is more likely to occur when you first start taking labetalol or when the dose is increased. Getting up slowly may help. When you get up from lying down, sit on the edge of the bed with your feet dangling for 1 to 2 minutes. Then stand up slowly. If the problem continues or gets worse, check with your doctor.
The dizziness, lightheadedness, or fainting is also more likely to occur if you drink alcohol, stand for long periods of time, or exercise, or if the weather is hot. While you are taking this medicine, be careful to limit the amount of alcohol you drink. Also, use extra care during exercise or hot weather or if you must stand for long periods of time.

For patients receiving labetalol by injection:

It is very important that you lie down flat while receiving labetalol and for up to 3 hours afterward. If you try to get up too soon, you may become dizzy or faint. Do not try to sit or stand until your doctor or nursetells you to do so.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common

Breathing difficulty and/or wheezing; cold hands and feet; mental depression; shortness of breath; slow heartbeat (especially less than 50 beats per minute); swelling of ankles, feet, and/or lower legs

Rare

Back pain or joint pain; chest pain; confusion (especially in elderly patients); dark urine-for acebutolol, bisoprolol, or labetalol; dizziness or lightheadedness when getting up from a lying or sitting position; fever and sore throat; hallucinations (seeing, hearing, or feeling things that are not there); irregular heartbeat; red, scaling, or crusted skin; skin rash; unusual bleeding and bruising; yellow eyes or skin-for acebutolol, bisoprolol, or labetalol

Signs and symptoms of overdose (in the order in which they may occur)

Slow heartbeat; dizziness (severe) or fainting; fast or irregular heartbeat; difficulty in breathing; bluish-colored fingernails or palms of hands; convulsions (seizures)

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

More common

Decreased sexual ability; dizziness or lightheadedness; drowsiness (slight); trouble in sleeping; unusual tiredness or weakness

Less common or rare

Anxiety and/or nervousness; changes in taste-for labetalol only; constipation; diarrhea; dry, sore eyes; frequent urination-for acebutolol and carteolol only; itching of skin; nausea or vomiting; nightmares and vivid dreams; numbness and/or tingling of fingers and/or toes; numbness and/or tingling of skin, especially on scalp-for labetalol only; stomach discomfort; stuffy nose

Although not all of the side effects listed above have been reported for all of these medicines, they have been reported for at least one of them. Since all of the beta-adrenergic blocking agents are very similar, any of the above side effects may occur with any of these medicines. However, they may be more or less common with some agents than with others.

After you have been taking a beta-blocker for a while, it may cause unpleasant or even harmful effects if you stop taking it too suddenly. After you stop taking this medicine or while you are gradually reducing the amount you are taking, check with your doctor right away if any of the following occur:

Chest pain; fast or irregular heartbeat; general feeling of discomfort or illness or weakness; headache; shortness of breath (sudden); sweating; trembling

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

Some commonly used brand names are:

In the U.S.-

Betapace
Blocadren
Cartrol
Corgard
Inderal LA
Inderal
Kerlone
Levatol
Lopressor
Normodyne
Sectral
Tenormin
Toprol-XL
Trandate
Visken
Zebeta

In Canada-

Apo-Atenolol
Apo-Metoprolol
Apo-Metoprolol (Type L)
Apo-Propranolol
Apo-Timol
Betaloc
Betaloc Durules
Blocadren
Corgard
Detensol
Inderal
Inderal LA
Lopresor
Lopresor SR
Monitan
Novo-Atenol
Novometoprol
Novo-Pindol
Novo-Timol
Novopranol
Nu-Metop
pms Propranolol
Sectral
Slow-Trasicor
Sotacor
Syn-Nadolol
Syn-Pindolo
Tenormin
Trandate
Trasicor
Visken

Other generic names-

Acebutolol
Atenolol
Betaxolol
Bisoprolol
Carteolol
Labetalol
Metoprolol
Nadolol
Oxprenolol
Penbutolol
Pindolol
Propranolol
Sotalol
Timolol

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Information offered at this Web site by either a lay person or a health professional should not be interpreted as giving a diagnosis or a treatment recommendation. These can only be provided by a physician who has had an opportunity to interact with a patient in person and at length, with access to the patient's previous records and appropriate follow-up.

Oral

Tablets (U.S. and Canada

Parenteral