When to Hold Beta Blockers [Metoprolol, Propranolol]

As a healthcare professional, it’s essential to become familiar with the medications commonly prescribed to patients. Beta-blocker is one of the most frequently encountered medication classes in the clinical setting.

Do you suffer from anxiety, blood pressure issues, or heart problems? If so, your doctor may have recommended that you try beta-blockers. But what exactly are they, and how do they work? Beta-blockers are potent drugs that help to treat a variety of cardiovascular conditions.

They can reduce the symptoms of high blood pressure, improve circulation by slowing the heart rate, and reduce stress on the body’s systems. In this blog post, we’ll explore all the ins and outs of using beta-blockers safely and when to hold beta blockers for you to get optimum health benefits.

What are Beta Blockers?

Beta-blockers are medications that block the effects of certain hormones in your body. Beta-blockers reduce the heart rate, lower blood pressure, and reduce anxiety by blocking these hormones- epinephrine and norepinephrine.

They are commonly prescribed to treat high blood pressure, angina (chest pain), arrhythmias (irregular heart rhythms), and prevent migraine headaches. Beta-blockers can also treat anxiety, tremors, glaucoma, and other conditions.

Other names for beta-blockers include:

  • beta-antagonists
  • beta-adrenergic blocking agents
  • beta-adrenergic antagonists.

Types of Beta Receptors in the Human Body

The human body has two main types of beta receptors: Beta 1 and Beta 2.

Beta 1 receptors are mainly found in the heart and other muscles around the body. They control blood pressure and heart rate and regulate how various organs use energy during exercise. Since beta-1 receptors are only present in the heart, when a drug is specific to beta-1 receptors, it is often called “cardioselective”.

Beta 2 receptors are mainly found in the lungs and airways. They play a role in regulating breathing patterns and controlling blood glucose levels. Drugs specific to this receptor type are known as “non-selective.”

How do they Work?

Doctors often prescribe beta-blockers to manage cardiovascular symptoms like angina and hypertension. This type of medication works by blocking the action of certain hormones in the nervous system, like adrenaline.

Doing so helps prevent the body’s “fight or flight” stress response from occurring. Adrenaline and noradrenaline help prepare the muscles for physical activity; when they’re released in large amounts, they may experience a rapid heartbeat, high blood pressure, excessive sweating, anxiety, and other palpitations.

Blocking these hormones lowers stress on the heart and reduces force from its contractions – thus taking pressure off the vessels in the heart, brain, and elsewhere in the body.

Beta-blockers also block the production of angiotensin II, a hormone produced by the kidneys that relaxes and widens the blood vessels, allowing for better flow.

What Conditions are Treated by this Class of Medication?

Because beta receptors are found in several locations throughout the body, beta-blockers can treat a wide range of problems and conditions.

Beta-blockers are mainly used to treat heart and circulatory conditions, including the following:

Angina: Angina is chest pain caused by reduced blood flow to the heart; beta-blockers can help improve this condition.

High Blood Pressure: Beta-blockers reduce the stress on the heart and take pressure off the blood vessels in the body, aiding in lowering high blood pressure.

Hypertrophic Cardiomyopathy: Beta-blockers can help reduce the size and thickness of the heart muscle, improving symptoms associated with HCM.

Arrhythmias: Beta-blockers can help slow down a racing or irregular heartbeat, improving blood flow.

Migraine Headaches: Beta-blockers can help reduce the frequency and intensity of migraine headaches.

Anxiety: Beta-blockers can help reduce the physical symptoms of anxiety, such as trembling and sweating.

Glaucoma: Beta-blockers can help treat glaucoma by reducing the amount of fluid in the eye and lowering intraocular pressure.

Heart failure: Beta-blockers can also treat congestive heart failure (CHF). They work by helping the heart pump more efficiently, reducing strain on the organ, and improving blood flow.

Dysrhythmias: Beta-blockers can help reduce irregular heartbeats and other dysrhythmias.

Beta-blockers are also commonly prescribed for the treatment of following conditions such as:

  • Essential tremor
  • Tremors
  • Hyperthyroidism (overactive thyroid)

By reducing stress on the body, they can help control a wide range of symptoms associated with these conditions.

Overview Of Most Common Beta Blocker Drugs: Metoprolol & Propranolol

About Metoprolol 

Metoprolol is a medication from a group of drugs known as beta blockers. It is prescribed to:

  • Control high blood pressure (hypertension),
  • treat conditions causing irregular heartbeats (arrhythmia),
  • help prevent future cardiovascular diseases,
  • heart attacks and strokes,
  • manage chest pain brought on by angina,
  • reduce migraine symptoms,
  • and decrease the effects of an overactive thyroid gland (thyrotoxicosis).]

Dosage and strength

Metoprolol tablets come in strengths of 50mg and 100mg.

How much you take depends on why you need it:

  • high blood pressure – 50mg to 100mg, taken twice a day
  • chest pain – 50mg to 100mg, taken 2 to 3 times a day
  • an irregular heartbeat – 50mg, taken 2 to 3 times a day
  • preventing migraine – 50mg to 100mg, taken twice a day
  • too much thyroid hormone (thyrotoxicosis) – 50mg, taken 4 times a day

When to Hold Metoprolol?

When should you hold metoprolol, paying attention to your body and being aware of any changes is essential? If you experience any of the following symptoms, stop taking the medication and contact your healthcare provider:

  • a sudden drop in blood pressure
  • dizziness or lightheadedness
  • an irregular heartbeat
  • chest pain or difficulty breathing
  • wheezing, hives, or swelling of the face, lips, tongue or throat.

These are hold parameters for Metoprolol and many other Beta Blocker Drugs. It is also essential to be aware of any other potential side effects when taking metoprolol and to contact your doctor if you experience any unusual symptoms.

Additionally, if you are taking any other medications, make sure to inform your healthcare provider so they can determine if any drug interactions may occur.

By following these guidelines and communicating with your doctor regularly, you can maximize the benefits of metoprolol while minimizing potential risks.

About Propranolol

Propranolol is a medication from a group of drugs known as beta blockers. It is used to:

  • treat high blood pressure (hypertension),
  • lower the risk of recurrent heart attacks, strokes, and other cardiovascular events,
  • prevent migraine headaches,
  • manage chest pain caused by angina,
  • reduce tremors,
  • treat an overactive thyroid gland (hyperthyroidism),
  • and to avoid amnesia caused by general anesthesia in specific surgical procedures.

Dosage and strength

Propranolol tablets come in strengths of 10mg, 40mg, 80mg, or 160mg. The slow-release capsules are 80mg or 160mg. The liquid comes in strengths of 5mg, 10mg, 40mg, or 50mg in 5 ml.

How much you take depends on why you need propranolol.

The usual doses for adults are:

  • high blood pressure – 80mg to 320mg a day in divided doses
  • migraine prevention – 10mg to 60mg a day
  • angina (chest pain) – 40mg or 80mg twice a day
  • hyperthyroidism (overactive thyroid gland) – 10mg to 30mg a day.

These are hold parameters for Propranolol and many other Beta Blocker Drugs. It is also essential to be aware of any other potential side effects when taking propranolol and to contact your doctor if you experience any unusual symptoms. Additionally, if you are taking any other medications, make sure to inform your healthcare provider so they can determine if any drug interactions may occur.

When to Hold Propranolol Blood Pressure Medicine?

Propranolol is a medication that can be used to treat high blood pressure. However, knowing when to take it can be crucial for managing your condition. It is essential to follow the instructions provided by your healthcare provider, especially regarding dosage and timing.

Propranolol is available in two varieties: standard release and slow release.

  • Standard-release propranolol enters your body quickly, so it may be necessary to take several doses a day, depending on the dosage prescribed.
  • On the other hand, slow-release propranolol works slowly over time; usually, just one dose per day is enough. If you take propranolol once daily, your doctor may suggest you take the first dose before bedtime, as it can cause lightheadedness.

After the initial dose, if no dizziness is experienced, you should continue taking propranolol in the mornings.

Do not double up on your next dose if you miss a dose. Instead, continue with your regular dosing schedule. Always consult your healthcare provider before making any changes to your medication regimen. Taking propranolol as directed can help keep your blood pressure under control and improve your overall health and well-being.

How will you Monitor your Patient?

When monitoring a patient taking propranolol or other beta blockers, it is essential to regularly measure blood pressure and pulse. These readings will help your doctor determine if the medication is working correctly and if any adjustments need to be made.

It is also essential to monitor for any changes in mood or behavior that could indicate side effects of propranolol, such as depression, insomnia, or confusion.

Finally, tracking any other medications being taken is essential, and inform your doctor if changes should be made. This will help ensure that there are no adverse drug interactions.

What will you Teach the Patient as Nurse?

1– Teach patients how to count their pulse daily, preferably before taking their dose.

2– Explain to the patient the proper way to take their medication, including what happens if they miss a dose.

3– Advise patients on the potential side effects of propranolol and instruct them to notify their doctor or seek medical attention if any of these occur.

4– Inform patients about the importance of taking their medication as prescribed, even if they do not feel any side effects.

5– Instruct patients to contact their doctor immediately if they take any other medications, as there could be potential drug interactions.

6– Advise patients to keep a list of all their medications and bring this to each doctor’s appointment.

7– Remind the patient that sudden discontinuation of propranolol can be dangerous, so it is essential to follow their doctor’s instructions carefully when stopping or changing doses.

8– Inform patients about the importance of regular checkups with their doctor while on propranolol. This will help ensure that the medication is working effectively and no adjustments need to be made.

Final Words

It is important to remember that beta blockers like propranolol can effectively treat high blood pressure, but they must be used correctly and monitored closely. Always follow your doctor’s instructions and keep an open dialogue with them if any changes occur or you have questions or concerns. Following these steps can help ensure that propranolol is being used safely and effectively.


  • https://www.nhs.uk/medicines/metoprolol/how-and-when-to-take-metoprolol/#:~
  • https://en.wikipedia.org/wiki/Metoprolol
  • https://www.nhs.uk/conditions/beta-blockers/#:~:text=Uses%20for%20beta%20blockers&text=heart%20failure%20%E2%80%93%20failure%20of%20the,in%20addition%20to%20other%20medicines
  • https://www.drugs.com/mtm/metoprolol-succinate-er.html

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