Contra-indications

• chronic obstructive airways disease and asthma
  • note however that there is evidence that cardioselective beta blockers are >20 times more selective for ß1 than ß2 receptors and should carry less risk of bronchoconstriction in reactive airways disease (1)
    • there is evidence that, in patients with COPD, cardioselective beta blockers do not change FEV1 or increase respiratory symptoms (2)
    • in a small study on asthmatics, propranolol caused a reduction in lung function, but celiprolol was shown not only to improve spirometry readings, it also inhibits the bronchoconstrictor effects of propranolol (3)
    • in mice studies, initial therapy with beta blockers increased airway hyperresponsiveness, whereas longer therapy decreased hyperresponsiveness and seemed to have an anti-inflammatory effect (4)
• severe peripheral vascular disease
• uncontrolled heart failure
  • however beta-blockers may produce benefit in stable heart failure by blocking sympathetic activity. Treatment with beta blockers in cases of heart failure should be initiated by those with experience in the management of heart failure
• marked bradycardia
• second- or third- degree AV block
• sick sinus syndrome
• cardiogenic shock
• metabolic acidosis
• hypotension
• beta-blockers are used with caution in patients with unstable diabetes mellitus

There is an important interaction of beta-blockers with calcium channel blockers:

• beta-blockers + verapamil may cause heart failure and are a contraindicated combination
• beta-blockers + other calcium channel blockers may cause severe hypotension or heart failure

Reference:

1. Salpeter SR et al. Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis. Ann Intern Med 2002; 137:715-25.
2. Salpeter S et al. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005;(4):CD003566.
3. Pujet JC, et al. Effects of celiprolol, a cardioselective beta-blocker, on respiratory function in asthmatic patients. Eur Respir J. 1992 Feb;5(2):196-200.
4. Callaerts-Vegh Z, Evans KL, Dudekula N, et al. Effects of acute and chronic administration of beta-adrenoceptor ligands on airway function in a murine model of asthma. Proc Natl Acad Sci USA. 2004;101(14):4948-4953.
5. Henderson RA (1993). Angina: medical treatment, coronary arteriography and angioplasty.Medicine International, 21 (10), 389-396