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peter01729

Can Beta Blockers cause Autonomic Dysfunction?

I was perfectly fit and well until end of last December when they put me on a small dosage of the Beta Blocker Bisoprolol due to ectopic heart beats that developed into Ventricular Tachycardia.

As soon as I started taking them, I described myself as being turned into an old man overnight who could no longer feel my lungs working, like a drunk zombie.

When they found me in a state of near collapse at work with a heart beat after oxygen given, of only 42bpm, they declared I was allergic to beta blockers and I have not taken any since March.

The symptoms however remain to this day and all the doctors, GPs, cardiologists, they refuse to even consider that beta blockers are to blame and so attribute my illness to anxiety from an abused childhood.

I do not feel anxious, I have worked for over 40 years with no symptoms of anxiety until the day they put me on beta blockers which seems to be a bit too much of a co-incidence.

Beta blockers however, they block adrenaline receptors in your Autonomic Nervous System, so I have symptoms of disruption to my ANS following taking medicine that not only disrupts your ANS, but that I reacted badly too. This seems rather more a logical reason for my current sickness, but how can I get anybody to even investigate the possibility?, they have all told each other it is anxiety so of course I cannot get past this presupposition.

I have found a detailed description of Autonomic Dysfunction on the Dantest site, they make medical machinery for the study of such. they list causes of Autonomic Neuropathy including medications that include " Drugs that decrease sympathetic activity (sympatholytics): alpha and beta blockers (i.e. metoprolol), barbiturates, anesthetics", but of course I would simply be told to not believe things I read on the web!

In addition, I possibly have a genetic predisposition to this as I have a Maternal cousin with Fibroid-Mialgia and Paternal half-sister with the same symptoms as POTs.

My current symptoms are ectopic beats and palpitations that occur mainly later in the day when I get tired, and after eating that can get so that every other heart beat is an ectopic.

My heart rate is around 30bpm faster than it used to be in any given situation, it also seems to fluctuate wildly doing the same activity.

Horrendous heartburn and the feeling that my esophagus is closed so that if I eat half what I used to, it feels painful, I feel full up with just a few mouthfuls.

My sense of hunger and thirst are diminished, a few weeks back I did a little experiment, I didn't eat a single thing for 42 hours and still didn't feel hungry.  

Breathlessness and the feeling my lungs do not work automatically. When I talk to people now I sometimes forget to breath and they suddenly see me stop to take a gasp, when I fall asleep I keep waking with a gasp as I forget to breath.

My cardiologist did arrange a lung function test, but this only measured the capacity of my lungs, it didn't measure the lungs gaseous diffusion efficiency.

I had noticed when in hospital that the machine kept beeping because even awake, my blood oxygen level would fall to 87%

So I bought my own Oximeter, sometimes it can be as high as 98%, so there is obviously nothing mechanically wrong with my lungs, but generally it is in the low 90s when relaxing, when I go to sleep however, it spends half the night at 85%

I read that the ANS detects a low oxygen level in your blood and automatically adjusts your breathing.

An eighth month old cough. They tried me on a different beta blocker, Salotolol, this right away put me into a coughing frenzy so my GP told me to come off which I did, the bad cough went right away, but I have been left with a permanent dry cough that gets worst when I talk of when I have a shower it gets so I am nearly vomiting. 

Exhaustion, utter exhaustion, I had to go to work to see O/H and chatted to a few friends, so I was there for about four hours, then I had a meal there, that must have used the last of my energy as I could muster up just enough energy to draw breath, had to sit down for a couple of hours before I could get up again. All my symptoms are worst when tired, so I have to spend the following day in bed after doing anything as strenuous as going out. I don't even have the mental energy to pass my time with computer games, often it is hard to force myself to do anything more than just sit and look at the floor.

Brain Fog, when I get exhausted my speech becomes slurred, I cannot walk straight and feel drunk, I have this all the time to a lesser extent.

Tingling in my feet, often when lying in my bed this expands to a quivering I feel throughout my whole body.

I now find myself waking in the night in order to urinate, as much as four times, full loads not a prostate trouble load.

I do not have the POTs symptom, I measured my heart rate as only going up by 20bpm when standing from lying down.

     

27 Replies

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  • peter01729

    Hello Peter01729,

    Thanks for sharing your situation. I found it very interesting. I too, quickly developed a list of first-ever symptoms after taking Methyldopa, for extreme, uncontrollable blood pressure surges. I’ve also taken metoprolol in the past and am currently taking Bisoprolol every morning. However, my new symptoms didn’t begin until I took Methyldopa. The symptoms were extreme and debilitating. They hit me with a bang, out of the blue, for no other reason at all, except that I had been placed on Methyldopa by a well-known physician at Vanderbilt. I had been faithfully taking the medication several times a day, just as he prescribed. Each day I took 125 mg every “two” hours and “750” mg at bedtime. Not long afterwards, the symptoms began and with a vengeance. Most obvious was repetitive, involuntary, uncontrollable, fast, and ballistic limb jerking  (arms and legs) that would last for hours. Most times, my arms would ballistically jerk inwardly, crossing over each other, while both feet banged (outward to inward) together at the same time. I could not make them stop. This would last for hours nonstop. It would continue even if I tried to stand up. My head would also bob up and downward and my feet became entangled when I tried to take a step. There was no coordination. I could not walk. It was a huge struggle to try to put one foot forward. Sometimes the entanglement of my feet caused my right leg/foot to involuntarily cross completely over my left leg/foot. I had NO control over any of these movements! It was so severe that I could not function. This lasted for several years! Today, I have jerking of my arms, but not as much.  Yes, I also experienced severe brain fog and still do. I especially experienced it the most when I stood up from a sitting and/or lying position, but at times it would just happen, even when sitting. It was if my brain instantly stopped. I can’t think -to think.  During the brain fog, I can’t think of anything. I don’t know anything. I can hear but can’t respond. I innately learned that I feel better if I place my head downward on a countertop or furniture, to let blood go back to my head, about 3-4 minutes, so that my brain would begin to work again. This was/is how I cope with the brain fog. If I didn’t lean (head downward) on top of countertops and furniture, then I would fall, as I can not talk, walk or coordinate during the brain fog.  This happens countless times each day. I also have extreme spells of slurred, unintelligible speech. It is worst when I’m tired and stressed. I can hear myself speak with no clarity, and I know what I want to say, but I have no control over what I’m trying to say. As you mentioned, exhaustion is a very common symptom. Sometimes, I’m so exhausted that I feel I’m going to collapse. Many times, both my arms drop into my lap from exhaustion. I’ve not measured my oxygen level but I wouldn’t be surprised if that explains the extreme feeling of weakness and exhaustion. I’ll have to measure it. Yes, I’ve had tingling in my feet and even a very uncomfortable sensation  best described as an electrical charge that flashes throughout my entire body, after I lay down. It is very strange and uncomfortable, like I’ve touched a live wire. There are times, my legs feel so uncomfortable/restless that I have to stand up to ease the odd feeling in them. I also have 24/7 nonstop shrill ringing tinnitus and even occasional  “electrical base-thumping” sounds mixed in. I’m 58 now and have never been an anxious person. I have been battling these symptoms since I began the Methyldopa in 2012.  When my older sister came to visit me and saw how sick I was while trying to raise my young son, she stayed with me to help me. My sister video tapped me with the limb jerking and inability to walk or talk and emailed it to the doctor who had prescribed the Methyldopa to me. With no response, we also called the doctor and my sister described the severity of  my limb jerking, brain fog, etc. The doctor immediately denied Methyldopa could cause such and told me “I needed to see a different kind of doctor” and that he “could not see me any longer”. That was the last I heard of him.  He dropped me like a hot potato. This was a doctor that I had spent many years, driving several hours one-way, to see, while placing my faith in him that he would help me with my severe and extreme blood pressure surges. Dealing with my wild blood pressure was hard enough, but compounding that with all the additional new symptoms became more than I could bear. Like you, I have been told the symptoms are a result of anxiety and childhood abuse-even if I can’t recall such!  I don’t believe it for a minute! I feel there has been damage to my nervous system.  Did they give you a name for the condition that was caused by childhood abuse? What is the link to where you read certain medications can affect the ANS?  Did you experience any significant medical concern prior to your symptoms? Which doctor(s) told you it was due to anxiety from childhood abuse? Please keep in touch. Thanks!

    • LongJourney

      Hi, your symptoms almost sound like Parkinsons which I understand is a disorder that is related. The needing to lie down bit sounds like POTs.

      Prior to my ANS symptoms, I felt perfectly well apart from the occasional ectopic beats that developed into Ventricular Tachycardia, I wasnt at all concerned about my health, I had the ectopic beats for a year before I even bothered seeing a GP about them in 2014.

      It was my cardiologist who said it was from anxiety, he decided to share this unfounded opinion with my GPs and with work so now I am totally disregarded.

      If I post the link, you wont get this message for a few days whilst the site checks it out, so, in a Google search engine type :- Autonomic system overview-dan test

      The first link should be along the lines of Dantest dtr ans overview.

  • peter01729

    Hi Peter,

    ​I've moved over to your thread.

    ​It looks as though we've been doing the same things particularly after suggesting to the medical profession that a prescribed medication has caused an adverse reaction.

    ​I proved to myself that the right thing to do was to withdraw from two different treatments due to adverse reactions. On the first withdrawal I just had to stop and found that the reaction was likely to be encountered sporadically for years afterwards and it did. My GP's surgery insisted that I was mistaken and was obliged to be put on an anxiety medication.

    ​However this began a second round of treatment for which I was already prepared and I started monitoring my blood oxygen levels. These started going down, but reporting my observations was treated with ridicule.

    I got to the stage where I was feeling so out of it with nocturnal breathing difficulties that I made overnight recordings.

    ​The resulted in the composite SpO2 graph I copied to you which clearly showed that my SpO2 profile was linked to certain drug combinations in a complex manner.  I sent an adverse reaction Yellow Card report to MHRA with full supporting evidence. They contacted my GP and suggested that he and I discussed what had happened but he had already declined to treat me and has never contacted me about these adverse reactions since.

    ​The only good thing about reporting my adverse reactions to MHRA was that they appeared on my electronic patient record and when, sometime later, I was hospitalised for SVT, I was fitted with the Red Wrist Band - i.e. take more care over this patient.

    ​I've attached one of my SpO2 printouts which shows how my oxygen levels change during a recent 40 minute mild exertive walk.  My bottom graphing option shows event frequency at specific O2 levels (left) and time spent below specific O2 levels (right).  My earlier adverse reaction SpO2 printouts were more like yours are now.

    ​I think you've done enough to prove to yourself that there is a good reason why you are experiencing intolerable adverse reactions and that you have the evidence - which I reckon is more demonstrable in your SpO2 records than your ecg.

    ​I think you are definitely experiencing an excessive number of events and at too low a level of SpO2.

    ​The only thing I can think of is to find a medical professional who can interpret SpO2 recordings and conclude that your intolerable symptoms are consistent with your observations. If this a long term effect from withdrawal from bisoprolol there must be something on the internet somewhere that has addressed its treatment but it may be in medical journals which are sometimes difficult to access.

    Regards

    ​Bob

    • Bob37393

      I cannot believe health professionals have never encountered this when there are two of us right here, with the same experience and "anxiety" fob off.

      I did manage to get one of my GPs to address my low oxygen level before the "its anxiety" letter cane from my cardiologist, so hoping I can get them to consider further, although it is my experience they just do what has been referred to them by the GP, and nothing more.

      Tomorrow I see this Cardiologist and will give him a print of my post here to consider, and ask if he can refer me to the one specialist in England re Autonomic Neuropathy.

      Wednesday I have to go back to work as a result of that "its anxiety" letter, I anticipate that it will be a very short time before they call an ambulance from across the river at St Thomas', as they are paranoid about people dying where I work and call ambulances at the drop of a hat. But inconvenient as it is for me, at least it would give me access to more doctors that might take me seriously. 

    • peter01729

      https://patient.info/forums/discuss/beta-blocker-bisoprolol-withdrawal-and-breathlessness-493734

      ​I just came across this Patient entry of a few years ago with many reports of longevity of withdrawal adverse reactions.

      ​Sorry if you've come across this already but there are some commenters under this thread who have large databases of extended problems with bisoprolol withdrawal.

      I'm beginning to think that this is in fact a known problem in the medical world.

      ​When I was following up reactions I had to a medications I found leads to medical publications were disappearing whilst I was doing searches.

      ​The only breakthrough I got was from an open publication on recognising early signs of heart failure.

      ​I didn't say I was a patient - you get fobbed off when you do that.

      Good Luck

      ​Bob

  • peter01729

    Hi Peter,

    Just tried comparing our two SpO2 recordings - both nocturnal and about the same length.

    ​Mine was taken in 2012 about 2 weeks after withdrawing from a drug causing intolerable side effects.

    ​It  shows instability of both SpO2 and heart rate but I had much higher SpO2 levels and higher levels of heart rate.

    ​My SpO2 reports showed continuing deterioration at the time and caused me to withdraw from all medication.

    Yours has significantly lower SpO2 and also lower heart rate levels and I gather has been taken some time after beta-blocker withdrawal with no other medication.

    I have recently been observing that changes in my heart rate have been accompanied by compensatory changes in SpO2 when in a resting state in order to maintain steady perfusion. This would suggest that changes in both should correlate and thus events in each should correlate.

    ​Your SpO2/pulse rate event markers show far less correlation than mine - with your heart rate variability being far more in evidence than your SpO2 events.

    This is a bit of a long shot but have you considered the involvement of your carotid baroreceptors​ in failing to maintain your SpO2 levels - they are the only receptors in humans that detect low oxygen partial pressures.

    Regards

    Bob

    • Bob37393

      I was unaware of the technical term, but I did say to my cardiologist today that the Autonomic Nervous System detects blood oxygen levels and gets the breathing mechanism to react accordingly in a working ANS.

  • Great news for me, I saw my cardiologist and he now considers it is worth referring me to the Autonomic Nervous System specialist in London.

    He admitted that apart from the heart side of things, he knows very little about the ANS, my reasoning helped persuade him I believe, such reasoning only being made available to me via forums such as this, and an Internet search.

    Its taken me many long months to finally get somebody in the NHS to go down this investigative road.

     

     

    • peter01729

      Congratulations.

      ​I glad you've managed to break through the medical professional barrier and get an acknowledgment that your symptoms deserve further investigation and not just dismissed as anxiety,

      ​I learned your experience and have gained some knowledge to be prepared for any proposals to change my medication which includes bisoprolol.

      ​I wish you all the best.

      Bob

    • Bob37393

      That’s a big step forward Bob. But just to point out there’s a strong link between autonic dysfunction in Sjögren’s, Vasculitis and Lupus so it would be well to get these tested for. They can be their without being positive bloods and antobodies - theirs callled seronegative. 

  • Latest update, now some nights my blood oxygen average is low 90s, some nights it is mid 80s.

    The sleep apnea clinic gave me a similar machine to wear for an evening, this matched my machine on the low 90s occasions.

    The Doctor said whilst it is low, its not a problem and they only worry when its in the mid 80s.

    So I showed him some of my reports when it was in the mid 80s.

    "Maybe you had a sweaty finger" was the professional and caring response. "Nothing wrong with you", he then started to accuse me of having "health anxiety" having seen the anxiety label on my notes.

    I wonder how my finger, encased in a rubber sleeve goes from being sweaty to dry to sweaty to dry whilst I am asleep?, I also did an experiment and moved a sweaty finger to a dry finger to see the difference, and its actually the opposite to what the doctor claimed, the sweaty finger gave a reading showing 3 or 4% more oxygen than the dry finger. Still, I dare say he will get a bonus having saved the NHS a bit of money rather than investigating me further.

    On a more positive note, had my assessment at the Neurology hospital in London.

    a Blood pressure test that took five minutes and a GP could have done saw my blood pressure drop from 145/95 when sitting, to 128/82 when standing after 3 minutes, so I already have an initially diagnosis of Autonomic Instability and await more in-dept tests.

    It hasn't happened quick enough to save my career however, so I am to be medically retired and live alone in isolation. Thanks NHS.

    My health is rapidly deteriorating however, friends ask me if I am drunk as I find it requires a lot of concentration to walk in a straight line now.

     

    • peter01729

      No doctor should say you're OK at SpO2 levels below 88%.

      That's why alarms go off in hospitals and in USA where you claim for oxygen therapy on your health insurance.

      ​Ignoring such alarms is prevalent however because there's something called alarm fatigue.

      ​Your case is problematic as we have discussed before and may be outside the scope of many specialists.

      ​However I have used my pulse oximeter to generate average SpO2 levels overnight which together with the SpO2/pulse rate event markers​ allow me assess the advisability of taking drugs prescribed for me.

      I understand yours doesn't produce this data which I get from a Contec CMS50D+ together with SpO Assistant software.

      ​I am not surprised that you have identified bisoprolol as being implicated in your reactions.

      ​Unfortunately medical professionals seem to be disinclined to accept that there is something called an adverse drug reaction.  My own observations have led me to conclude that I suffered from an adverse drug withdrawal reaction. Even with a detailed and reasoned report on my own clinical observations which I sent to the MHRA I have had replies that I am mistaken that my reactions were drug related.

    • peter01729

      Peter, 

      Explore the appropriateness of increasing your salt intake and fluid intake. I'm not an M.D. but I have had several tilt table tests over the years, as well as doctors manually measure my BP after lying, sitting, and standing. Doctors are shocked when they see my BP quickly plummet 100 points (yes, countless times) and soar 100 points just as quickly (seconds) - called a hypertensive crisis accompanied with a "massive- worse than migraine "headache! Low/falling blood pressure can also make one feel very exhausted and foggy (can't think clearly or walk straight). Can such be contributing to your symptoms. Have you measured your blood pressure, heart rate, oxygen level when you are having difficulty walking? It would be worth knowing.

      I have experienced both "extreme" highs and lows with my BP for many years. It is much easier to identify medications that will either raise or lower one's blood pressure, but very difficult to find a combination of medications that will balance surges and falls in blood pressure. That is why doctors some times will combine an anti-depressant (Sertraline), with a BP medication(s), "not" for depression but for helping to stabilize the blood pressure. 

      Nevertheless, I don't know the details of your case, but increasing your salt, fluid intake, and even compression socks can help the falls in blood pressure. I thought I would share this with you, even though you may already know this.

    • Bob37393

      Hi Bob, my device is the CMS50F.

      So today, following my GPs request for me to attend her to discuss the "health anxiety" the fore-mentioned sleep apnea doctor accused me of, it was less than five minutes before she agreed with me and is to arrange many tests indeed. She wants me to see a different sleep apnea specialist for a second opinion, she wants me to have a brain mri, she has arranged for me to have a complete blood analysis, and she was very sympathetic knowing the rest of her practice has done nothing for me, that I had to buy my own test equipment, not because I am a hypochondriac, but because I had to find out what was wrong with me as nobody else was in order to keep my job, which I have sadly failed to do.

      My identifying bisoprolol as the culprit, or at least the trigger, was easy for me as the symptoms arrived the same day, plus of course I have the following from St Thomas', bisoprolol- anaphylactic shock.

      Looking up the very minor things that can tilt a person into Autonomic Neuropathy, I think it hardly surprising that a drug that disrupts that very system can have such adverse side effects to it, and I cannot believe people as supposedly intelligent as doctors, lack the logic to make the connection.      

    • peter01729

      Just looked up papers on the subject of beta-blocker withdrawal.

      ​Beta-blocker withdrawal syndrome was known about decades ago and where this had been observed it coincided with the body evolving more beta-receptors when on the drug - so the withdrawal dramatically enhanced the response to adrenaline.

      ​The shock effect of adrenaline naturally constricts the peripheral arteries to conserve blood supply to essential organs but an over-reaction will cause constrictions in places where you don't want them e.g. coronary arteries. This seems to be why beta-blocker withdrawal is associated with an exascerbated  ischemic response which you are observing.

      ​Unfortunately I don't think specialists using pulse oximeters to diagnose ischemic influences induced through airway constrictions are going to throw much light on this long known phenomenon which may affect only a small susceptible population with certain genotypes.

      ​I'm on five co-administered drugs one of which is a beta-blocker.

      ​It is the only one which specifically labelled as requiring a doctor's advice if patient requires termination.

      ​Together with the fact that beta-blockers have been withdrawn from routine treatment for blood pressure I suspect there is something in the medical world that is not being made public.

      ​I would suggest self monitoring with an ecg monitor.

      ​I use a Prince 180D which gives an on-screen real time display which can be uploaded to a PC.

      ​It allows you to check both rhythm  and rate and will display any irregularities on a printout.

      ​Whilst electrodes are supplied it is worth getting new ones off the internet.

      ​I aim to record no irregularities over a period of five minutes.

      ​This is not as detailed as a 12-lead ecg but gives acceptable recordings if limb leads I, II and III.

      ​(P.S. My pulse rate has come down from about 80 bpm to 55 bpm due to bisoprolol and is reported as 'suspected low beat' as it is technically bradycardia.)

      ​We may be at the forefront of medical observations.

       

    • Bob37393

      Hi Bob, yes the Prince 180B was the best thing I ever bought.

      The NHS sent me home for two years finding nothing so I had to do their job for them by purchasing one of these.

      As for coming off beta blockers, I was told to stop cold turkey in order to have an EP study, trouble is I went into such sustained Ventricular Tachycardia they pumped me full of Bisoprolol to stop it, I then had to go cold turkey again but there wasnt enough time for the EP study.

      Maybe its this that then brought on my allergic reaction and near collapse, so cold turkey a third time. They then tried the drug of last resort, Solotolol, gave me such a horrendous cough, my GP told me to come off right away, so that's four times.

      When I mention to my cardiologist all my remaining symptoms and that it is stated to never come off cold turkey, he claimed its perfectly alright to just stop taking them.

      My fight and flight side of my ANS is certainly now dominant, my hunger seems to have gone and my stomach turned off, hense I get full very easily now but still feel full six hours later.

      Now its interesting when you say:- "but an over-reaction will cause constrictions in places where you don't want them e.g. coronary arteries." because have a look at one of my ECGs below. You probably know the main spike is called the "R" wave and is followed by a little bump called the "T" wave which isn't supposed to be more than a third of the proceeding "R" wave.

      I was feeling very ill indeed when I took this, mucas streaming from my nose and horrendous heart-burn. You will notice my "T" waves are huge. When I showed this to my cardiologist he tried to claim it was perfectly normal and that his T waves would probably look the same if he exerted himself.

      Frankly, I do not belive him, I find nothing on the net to say this is normal.

      Whats more, in lie with your comment, I find a top ECG specialist saying " this is an obvious LAD occlusion because of the enormous T-waves" and "Be suspicious of coronary occlusion when the T-wave towers over the R-wave", when commenting on an ecg that didnt look as bad as mine.

      As you know, coronary occlusion is blockage of these very arteries you mention.

      I have also discovered something called Prinzmetals angina where a coronary artery muscle consticts to cause a reduction in blood supply.

      I also read that Coronary artery spasm can be induced by anaphylactic shock brought on by medical drugs which is exactly what my reaction to Bisoprolol was named.

      So I am wondering if this painful heartburn I now get that throbs is actually angina caused by a reduction in blood flow to the heart as demonstrated by my ECG and our reactions to beta blockers constricting our arteries!

      No wonder I get accused of having "health anxiety" by professionals who appear rather less read than us. No wonder the profession doesn't like Dr Google.

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