Beta-blockers overdose
Beta-blockers are a type of medicine used to treat high blood pressure and heart rhythm disturbances. They are one of several classes of medicines used to treat the heart and related conditions. Beta-blockers are also used in the treatment of thyroid disease, migraine, and glaucoma. These drugs are a common cause of poisoning.
Beta-blocker overdose occurs when someone takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose.
This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call your local emergency number (such as 911), or your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.
If your doctor told you that you have high blood pressure, you may have wondered, what's the big deal? Well high blood pressure IS a big deal, because it can lead to a heart attack, stroke, vision loss, and kidney disease, sometimes before you even realize you have it. When you have high blood pressure, you'll want to control it before it can lead to these dangerous complications. Let's talk about high blood pressure, otherwise known as hypertension. Blood pressure measures the force at which your blood rushes against the walls of your arteries as your heart pumps it through your body. The higher the force, meaning the higher your blood pressure, the harder your heart has to work. High blood pressure damages not only your heart but also your arteries. When your doctor or nurse measures your blood pressure, you'll see two numbers. The top number is called systolic blood pressure. That's the force of blood in your arteries whenever your heart beats. The bottom number measures diastolic blood pressure, or the force of blood in between heartbeats. You're more likely to have high blood pressure if you don't exercise regularly, you're obese, you eat too much salt, you have diabetes, you smoke, or you have a family history of high blood pressure. Most of the time, you won't know that you have high blood pressure. That's because high blood pressure usually doesn't cause symptoms. Unless you get your blood pressure checked, you may have no idea there's a problem until you develop heart disease or another complication. If your blood pressure is high, a few simple lifestyle changes can help bring it back down, and prevent its complications. Eat a heart-healthy diet that includes plenty of fresh fruits and vegetables, whole grains, and low-fat dairy, avoid fatty, salty, and sugary foods, exercise at least 30 minutes a day, limit salt to 1,500 milligrams or less a day, that's less than a teaspoon per day, and if you smoke, now is the perfect time to quit. Ask your doctor for tips on how to kick the habit. If these measures don't work, your doctor may prescribe one or more medicines to control your blood pressure. Because high blood pressure can sneak in without warning, stop it before it starts. Stay healthy, and your blood pressure checked at least once a year. If you already have high blood pressure, follow your doctor's advice to get it under control.
Poisonous Ingredient
The specific ingredient that can be poisonous in these medicines varies among the different drug makers. The main ingredient is a substance that blocks the effects of a hormone called epinephrine. Epinephrine is also called adrenaline.
Where Found
Prescription beta-blockers are sold under various names, including:
- Acebutolol
- Atenolol
- Betaxolol
- Bisoprolol
- Carvedilol
- Esmolol
- Labetalol
- Metoprolol
- Nadolol
- Sotalol
- Pindolol
- Propranolol
- Timolol
Other medicines may also contain beta-blockers.
Symptoms
Below are symptoms of a beta-blocker overdose in different parts of the body.
AIRWAYS AND LUNGS
- Breathing trouble (shortness of breath, gasping)
- Wheezing (in people who have asthma)
EYES, EARS, NOSE, AND THROAT
HEART AND BLOOD
- Irregular heartbeat
- Lightheadedness
- Low blood pressure
- Rapid or slow heartbeat
- Heart failure (shortness of breath and swelling of the legs)
- Shock (extremely low blood pressure)
NERVOUS SYSTEM
- Weakness
- Nervousness
- Excessive sweating
- Drowsiness
- Confusion
- Convulsions (seizures)
- Fever
- Coma (decreased level of consciousness or unresponsiveness)
Low blood sugar is common in children with this type of overdose, and it can lead to nervous system symptoms.
Home Care
Seek medical help right away. Do NOT make the person throw up unless poison control or a health care provider tells you to do so.
Before Calling Emergency
Have this information ready:
- Person's age, weight, and condition
- Name of medicine (and the ingredients and strength, if known)
- Time it was swallowed
- Amount swallowed
- If the medicine was prescribed for the person
Poison Control
Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.
This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison control. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.
What to Expect at the Emergency Room
Take the container with you to the hospital, if possible.
The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure.
Tests that may be done include:
- Blood and urine tests
- Chest x-ray
- ECG (electrocardiogram, or heart tracing)
Treatment may include:
- Activated charcoal
- Breathing support, which may include oxygen or a ventilator (tube through the mouth into the lungs and breathing machine
- Intravenous fluids (IV, given through a vein)
- Laxatives
- Medicine to treat symptoms and reverse the effect of the drug
- Pacemaker to the heart for serious heart rhythm disturbances
Outlook (Prognosis)
A beta-blocker overdose can be very dangerous. It can cause death. If the person's heart rate and blood pressure can be corrected, survival is likely. Survival depends on how much and what type of this medicine the person took and how quickly they receive treatment.
An overnight hospital stay may be needed even in less serious cases, as some long-acting drugs remain in the body for many hours.
Risk factors for a more severe outcome, including multiple organ failure and death, include:
- Co-ingestion with other drugs which affect the heart; for example, digoxin, calcium channel blockers, tricyclic antidepressants
- People with other health conditions, such as congestive heart failure and heart rhythm disturbances
References
Aronson JK. Beta-adrenoceptor antagonists. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:897-927.
Cole JB. Cardiovascular drugs. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 142.
Version Info
Last reviewed on: 7/1/2023
Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
