Beta-adrenergic blocking agents, more commonly referred to as beta blockers, are a category of medication primarily used to impede the effects of adrenaline on the heart. By slowing a patient’s heartbeat, beta blockers make it easier for the heart to contract, as well as relax blood vessels in both the heart and brain.
Physicians typically prescribe beta blockers to treat cases of cardiac arrhythmia (irregular heartbeat). 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 work by reducing the amount of oxygen needed by the heart. This allows the heart muscle to pump blood more efficiently and eliminates symptoms such as angina (chest pain), shortness of breath, nausea, and fatigue.
There are other applications for beta blockers aside from treatment of heart-related illnesses. For example, 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 vision loss.
What are the side effects of beta blockers?
Despite their many beneficial applications, beta blockers can present complications when combined with other drugs. Being used with clonidine, for example, may result in low blood pressure (hypotension). NSAID pain relievers, such as aspirin and other anti-inflammatory drugs, can also reduce effectiveness of beta-blocker medications. Additionally, beta blockers can prolong low blood sugar levels (hypoglycemia) and mask hypoglycemia symptoms in patients with diabetes.
What is the most prescribed beta blocker?
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).
When a physician does decide that a beta blocker is necessary, however, they will 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.
Most-prescribed beta blockers in 2019 by number of prescriptions
Number of Prescriptions
Dorzolamide Hydrochloride and Timolol Maleate
Fig. 1 Data pulled from the Definitive Healthcare Medical Claims database for claims year 2019 (most recent available). Commercial claims data sourced from multiple medical claims clearinghouses in the U.S. and updated monthly. Data accessed April 2020.
As seen in the above table, metoprolol succinate and metoprolol tartrate are the two most commonly prescribed beta-blocker medications. While both drugs are used to treat the same standard heart-related issues, their primary differences lay in their execution.
Metoprolol tartrate is a fast-acting medication taken orally twice per day. 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 between these two 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-prescribed beta blockers by days of supply
Days of Supply
Dorzolamide Hydrochloride and Timolol Maleate
Bisoprolol Fumarate and Hydrochlorothiazide
Fig. 2 Data pulled from the Definitive HealthcareMedical Claims database for claims year 2019 (most recent available). Commercial claims data sourced from multiple medical claims clearinghouses in the U.S. and updated monthly. Data accessed April 2020.
Days of supply is a term used in supply chain management to reflect how many days a given item’s inventory would last if sales were to maintain their current rate.
A look at which beta blockers have the highest days of supply paints a very similar picture to figure 1 with its prescription volume rankings — meaning all of the most commonly prescribed beta blockers are also the most well-stocked. Keep this in mind, pharma and biotech organizations.
The only difference between these two figures surrounds the drug Combigan, which ranks second to last in prescription volume rankings, but does not rank at all among most days of supply. This could be due to the higher cost that generally comes with brand name medications.
Combigan is the only brand name on either of these lists. It is also primarily intended to reduce eye pressure for glaucoma treatments or cases of ocular hypertension — making it the only ophthalmic-specific solution in either ranking. This could be related to the fact that essential hypertension is the number one most common diagnosis for primary care physicians. In comparison, glaucoma and ocular hypertension do not even rank in this same list.