Beta-Blockers (metoprolol, bisoprolol, propranolol, carvedilol) is a primary standard of care after a myocardial infarction, also known as a heart attack. Patients tend to be on this medication lifelong thereafter to achieve better control of their heart rate, prevent further problems with irregular heartbeat, and have better restructuring of their heart long term.

Question at hand: I do not see the importance of this medication, nor how effective it is for me. Can I discontinue this?

Answer: No

Especially if you have known history of heart failure and/or an ejection fraction (EF) of < 50%, Beta-Blockers should not be discontinued. There is open debate about patients that just have a heart attack without other risks, but I will talk about a study later analyzing what happens if you do discontinue your beta blocker in these instances.

Rest assured, this medication is taken for treatment and preventative measures, and it can take some time for your body to get used to this medication.

Why might most patients stop taking this medication?

Starting out on Beta-Blocker therapy can be hard. Patients do not tend to see improvement right away when starting a Beta-Blocker, and often, may feel more tired than their previous self. This has to do with the medication lowering your heart rate, and some Beta-Blockers (Ex: metoprolol) having more of an on your brain and the systems connected to it than others (Ex: bisoprolol can cause less fatigue since it does not concentrate as much in the brain area). These side effects are in most cases temporary (last two to four weeks), but this is why doses are started low, then increased weekly or biweekly based on how your heart rate values look. As well, side effects can occur as our body ages (this is a general approach to most drugs we take). Always remember to report these trends to your doctor or pharmacist so that dose changes or medication switches can be made.

What has been studied if you do discontinue this medication?

In a New England Journal of Medicine article named “Beta-Blocker Use After Myocardial Infarction” published in August 2024, they found that stopping a Beta-Blocker can possibly lead to more events associated with death, another heart attack, stroke, and hospitalization. This means continuing to use your Beta-Blocker could be helpful in preventing these events from occurring, while stopping the medication is harmful.

Additionally, they found that discontinuing a Beta-Blocker does not have an effect on quality of life. This means when people stopped taking their Beta-Blocker, their mobility, self-care, daily activity, pain or discomfort, and anxiety or depression did NOT change versus if they continued to take their Beta-Blocker. So, if your main motivation is to stop taking this medication to feel better, this is not a good reason and further conversations can be had to optimize your dose and lifestyle.

What happens if I abruptly stop taking my Beta-Blocker?
  • Your heart rate may increase rapidly. When on this medication, your heart was used to being more relaxed because the Beta-Blocker blocked epinephrine from attaching to your heart (epinephrine causes your heart to beat quicker). Stopping this can lead to chest pain, and an increased risk of another MI.
  • Often when a heart attack occurs, this can be due to blockage in the blood vessels or irregular heartbeat leading to lack of oxygen in your body. Stopping a Beta-Blocker can recreate these problems and lead to hospitalization .
  • Depending on the Beta-Blocker you are taking (more specifically carvedilol), blood pressure can rise, leading to greater risk of diabetes development, kidney problems, and very high blood pressure values that require hospitalization when uncontrolled (greater than 180/120).

In summary, Beta-Blockers should not be discontinued for any reason without consulting with your prescriber. Especially when taking a higher dose and then abruptly discontinuing, these effects listed above are more prevalent. If you ever need to discontinue a Beta-Blocker for any other reason, please let your prescriber know so that the dose can be slowly decreased over a weekly time period.

Prepared by Jared Hebreo, PharmD Candidate 2025

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