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Prescription Patterns of Beta Blockers

November 7, 2017 BY Alanna Moriarty

Prescription Patterns of Beta Blockers

*Updated October 2019

Beta-adrenergic blocking agents, more commonly referred to as beta blockers, are a category of medications that can lower blood pressure and reduce the risk of multiple heart attacks. Beta blockers work by impeding the effects of adrenaline on the heart. This slows the patient’s heartbeat, reducing the amount of force with which the heart contracts and relaxing blood vessels in the heart and brain, improving blood flow.

Physicians primarily prescribe beta blockers to treat cardiac arrhythmias, also called abnormal heart rhythm. The drugs are also used to treat patients after a heart attack, improving survival rates and reducing the risk of subsequent heart attacks. Beta blockers are successful because they reduce the amount of oxygen required by the heart muscle, decreasing the amount of strain put on the heart to pump more blood, and eliminating symptoms such as angina (chest pain), shortness of breath, nausea, and weakness.

Most Popular Beta Blockers by Number of Prescriptions (2017)

Generic Drug Name # Prescriptions Drug Cost (M)
Metoprolol Succinate 20,514,978 $626.5
Metoprolol Tartrate 20,190,175 $137.1
Carvedilol 14,338,224 $114.5
Atenolol 9,908,201 $73.6
Propranolol Hcl 1,667,736 $48.5
Bystolic Hcl 1,485,994 $291.1
Labetalol Hcl 879,531 $39.8
Propranolol Hcl ER 612,943 $53.4
Bisoprolol Fumarate 535,835 $14.6
Toprol XL  455,369 $24.5

Fig 1 Data from Definitive Healthcare based on most recent CMS data available (2017)

Though beta blockers are generally effective, physicians usually only prescribe them if another medication, like a diuretic, has proven ineffective in treating high blood pressure (hypertension). Once a physician decides a beta blocker could be the best option, they typically prescribe it in conjunction with another medication, such as an ACE inhibitor. ACE inhibitors relax blood vessels and decrease blood volume, complementing the effects of a beta blocker.

There are several applications for beta blockers in addition to treatment of heart-related illness. These drugs can prevent migraines by increasing the amount of oxygen delivered to the brain. Physicians also prescribe beta blockers for glaucoma patients in order to reduce pressure from fluid in the eyes, lowering the risk of optic nerve damage and loss of vision.

As seen in figure 1, the most commonly prescribed beta-blocker medications are metoprolol succinate and metoprolol tartrate. While both drugs are used to treat heart-related issues, their applications are very different. Metoprolol tartrate is a fast-acting medication taken orally twice per day to treat arrhythmia and angina. It is also very effective in preventing heart attacks and is given to patients in the hospital after their first heart attack to prevent subsequent episodes. In addition to being taken orally, metoprolol tartrate can be given as an injection to treat angina and arrhythmia. Unlike metoprolol tartrate, metoprolol succinate comes in the form of an extended-release pill to be taken orally once per day.

Another significant difference in the medications is cost. Both are available in generic form and are covered by most health insurance plans. However, for patients paying out-of-pocket, metoprolol tartrate is much cheaper. Where metoprolol tartrate usually costs between $4 and $20 for a 30-day supply, metoprolol succinate usually costs between $13 and $45.

Most Popular Beta Blockers by Days of Supply (2017)

Generic Drug Name Days of Supply (M) Drug Cost (M)
Metoprolol Succinate 1,147 B $626.5
Metoprolol Tartrate 1,074 B $137.1
Carvedilol 754.7 $114.5
Atenolol 618.5 $73.6
Propranolol Hcl 71.8 $48.5
Bystolic 68.5 $291.1
Labetalol Hcl 39.6 $39.8
Toprol XL 38.4 $24.5
Bisoprolol Fumarate 29.3 $14.6
Propranolol HCL ER 28.4 $53.4

Fig 2 Data from Definitive Healthcare based on most recent CMS data available (2017)

While beta blockers can be effective in treating issues such as heart arrhythmia, angina, and high blood pressure, the drugs should not be combined with other blood pressure medications such as clonidine, as it may result in low blood pressure (hypotension). NSAID pain relievers, such as aspirin and other anti-inflammatory drugs, can also negatively impact the effect of beta-blocker medications. Beta blockers also have the potential to prolong low blood sugar levels (hypoglycemia) and mask hypoglycemia symptoms in patients with diabetes.

According to Definitive Healthcare data, physicians in California authorized the greatest number of beta blocker prescriptions in 2017 (6.2 million), followed by New York (4.9 million). In contrast, the state prescribed the fewest number of beta blockers in 2017 was Alaska (48,500).

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