People who take beta blockers may have a higher risk of neuropsychiatric adverse events compared with patients who take other blood pressure medications, a study in the Journal of Psychopharmacology suggests.
Lujain Ez Eddin, B.S., of Western University in Canada, and colleagues used the FDA Adverse Event Reporting System (FAERS) database to compare reported side effects of beta blockers (atenolol, propranolol, carvedilol, metoprolol) with those of lisinopril (an angiotensin-converting enzyme inhibitor) and losartan (an angiotensin II receptor blocker) between 2004 and 2023. The researchers conducted a broad analysis for nervous system and psychiatric events along with a comparison of nine specific adverse events commonly reported in these two categories: dizziness, nightmares, insomnia, confusional state, altered mental status, hallucinations, disorientation, delirium, and somnolence.
Overall, beta blockers were associated with higher reported odds of both nervous system events and psychiatric events compared with lisinopril (2.08 and 1.68 times more likely, respectively) and losartan (1.29 and 1.53 times more likely, respectively). Of the specific events studied, beta blockers had significantly higher reports for dizziness, nightmares, insomnia, hallucinations, disorientation, and somnolence, but not confusion, delirium, and altered mental status.
Among the beta blockers, propranolol—a fat-soluble medication that is sometimes used off-label in the treatment of akathisia and certain anxiety disorders—had the highest reported odds of several of these neuropsychiatric events compared with both lisinopril and losartan.
“Taken together, these findings support prior studies suggesting that lipophilic [beta] blockers, such as propranolol, can more easily cross the blood–brain barrier, increasing the likelihood of neuropsychiatric adverse effects,” the researchers wrote. “In addition, it is possible that beta blockers could increase the risk of neuropsychiatric [events] through mechanisms other than their beta blocker properties, such as by altering neurotransmitter levels or other pathways.”
The researchers noted that FAERS data are subject to underreporting, which could lead to a bias in the findings, especially for milder or less recognized adverse events. On the other hand, notoriety bias, in which certain drugs or events are disproportionately reported due to heightened awareness or publicity, could result in overreporting.
For related information, see the Psychiatric News article “Beta Blockers Associated With Decreased Violence.”
(Image: Getty Images/iStock/Shidlovski)
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