Can Beta Blockers cause Autonomic Dysfunction?

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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.


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  • Posted

    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.



    • Posted


      ?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.


    • Posted

      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. 

  • Posted

    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.


    • Posted

      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.

    • Posted


      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.

    • Posted

      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.      

    • Posted

      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.


    • Posted

      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.

  • Posted

    Hi Peter,

    I'm sorry for all the difficulty you are experiencing. It's been a 'long journey' for me too. Many times, dealing with the medical community was as frustrating as my medical symptoms. At times, it was hard to know which was worse - the doctors or my symptoms! I just thought that I would share with you that I also have taken Bisoprolol, and lot of combinations of hypertension medications for the past 15 years. The doctors bounced me from one specialist to another, one expensive scan/test after another, and randomly giving me trial-and-error hypertension medications that never resolved my frequent (daily in the beginning) hypertensive crises (250/190) that would last for hours each time. Before I could even adequately try a new combination of medications, I would be bounced to a new specialist, who ordered new scans/tests, and new medications. It left me never knowing what medications could work. For years, I was on a "treadmill", going no where, and paying a lot of medical bills! 

    I can attest that taking Bisoprolol made me "extremely" fatigued/exhausted, to the point that I felt I was going to collapse every day. I had no strength and was hugely out of breath from just normal walking. Many times, I would have to stop walking so I could try to catch my breath. I'm 58 years old, but I felt like 90! I did not feel so weak until I took Bisoprolol. I learned my unbelievable fatigue was due to the Bisoprolol slowing down my heart rate. A slow heart beat can cause insufficient oxygen to reach the brain for normal functioning, resulting in a feeling of confusion and difficulty with memory, and extreme exhaustion. I reached a point in which I could not bear the exhaustion any longer, which left me on the brink of collapsing every day. I called my physician and explained that I can no longer take Bisoprolol, and to replace it with something else. He prescribed Pindolol, which I am still tired, but not anything like with Bisoprolol. I have read Bisoprolol can cause serious side effects. I've concluded that I do not trust the drug and will never take it again. I wish you all the best!

  • Posted

    I was on Bisoprolol for two years. For most of the time I was OK but eventually had to come  off it because of most of the reasons you mention (i.e. extreme tiredness, poor quality of life etc)  and when I stopped I was quite ill, I experienced panic attacks (which I had never had before) headaches, anxiety etc. The doctor put me on Propranolol which also made me ill, even worse headaches etc and I had to take it 3 times a day! I tried various other bp pills including two diuretics which upset me, mainly I think because of the withdrawal effects from Bisoprolol. The last 6 months has been hell, I'm now back on the lightest dose there is of Bisoprolol which I hoped would work but I feel as bad as I did on the double dose before. They tell me it's all anxiety related and I go to CBT therapy once a week. I keep telling them if I didn't have the side effects I would be fine! My head is constantly spinning and I have muscle pain, it's now starting to affect my sleep. I also have Eustachian Tube disfunction in my left ear which causes me a lot of distress and I'm sure the Bisoprolol is making it worse (according to all the doctors, there's nothing wrong!!) But no-one seems to care. I'm booking an appointment with a chiropractor to see if he can help reduce the tenseness in my head and back caused by these horrible tablets.

  • Posted

    Hi Peter. I’m on way to bed but just thought I’d ask if you have ever had a work up for autoimmune diseases? This would initially be ANA and Rheumatoid Factor - then more specifically our ENA panel.

    I only ask because I don’t have PoTS either but share all the symptoms you describe. My neurologist has diagnosed small fibre neuropathy and ganglionopathy with mild ataxia - all relating to a histologically (lip biopsy) confirmed Sjögren’s Syndrome. I’m hypothyroid too and suffer ectopic beats and tachicardia while on many medications. I have recently started a beta blocker called Popranalol at the lowest dose for tremors and to get my hypertension better controlled. It hasn’t really done much at all although I’m having huge night sweats now.

    However I’ve got the flare up in body tremors better controlled when I did some research and found out that renal problems can cause neurological symptoms. They are also common with Sjögren’s so I took a pee sample for testing and it flagged up as extremely mucky on all fronts. I knew I had a kidney infection with early CKD but or some reason my doctors didn’t think of this!? The antibiotic appears to have really helped all thes Parkinsonsonism 

    My neurologist is very dismissive of the impact this has on my life and describes “some heightened health awareness”. But so far I’ve never had symptoms that haven’t eventually been found to have a physiological cause. I have been misdiagnosed many times over a lifetime and have learnt the hard way that my instincts are always spot on. I would trust your instincts and, if you haven't already, get your autoantibodies and kidneys checked just in case there’s an autoimmune disease triggering your autonomic dysfunction. 

    • Posted

      Thanks for this, I haven't had any checks for an autoimmune dysfunction done.

      Back in 1982 however, I was in hospital for breaking my leg badly in a motorcycle accident, and a few times they connected me to multiple leads, when I asked why, I was told I was being checked for Rheumatoid arthritis, I never learnt why though or if they found anything.


  • Posted

    Oops sorry for typos - meant that I’ve never had symptoms where they haven’t eventually found a medical cause. 
  • Posted

    Hi, I hate when doctors and cardiologists blame your problems on anxiety sad I to have been a victim of the drug bisoprolol even after stating to my doctor I was cautious of taking it due to a previous bad episode many years ago, but I was reassured that no harm would come to me due to being a lower dose. This wasnt the case ;( im now left with more frequent episodes of ectopic beats , debilitating pots like symptoms (I am being tested for this soon) and now no medical people want to deal with me sad I complained to direct to the hospital who two months later replied with a bunch of lies about how I dont have abnormalities with my heart even though every ecg I have displays these and I have copies as proof. The NHS have literally screwed me over, even if (and heaven forbid) these arrythmia are benign ive been left with debilitating symptoms and offered no treatment. Im having heart rate issues aswel like standing or moving in general causes it to race ie sitting 65ish standing 90-100 . Again doc who prescribed me bisoprolol sais its anxiety , what a f*****g idiot, so every time I just sit forward or stand up I instantly get anxious lol. All my friends and family tell me they think the docs/hospital are scared because they know they ve screwed up sad but im the one paying the price
    • Posted

      Thanks for this.

      My symptoms too are Pots like, though I dont quite get a heart beat high enough to qualify for POTS, I do get lots of the other Dysautonomia symptoms and I have Orthostatic hypotension.

      I cannot believe the NHS are unaware of this. I see one of my cardiologists on Tuesday, I will tell him about you and please tell yours about me. Its only by people like us qualifying each other, that this issue will be accepted by the medical profession.

      There is a good forum for Dysautonomia called DINET Dysautonomia Information Network.

      Wonder if we could sue them? If they held their hands up and said sorry, these things happen, I would accept that, its a risk you take with medication, but to fob you off an make out its all in your head when ones life has been ruined really makes me angry.

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