Beta Adrenergic Receptor Blockers (Class II Antiarrhythmics)

  • Esen Özkaya
  • Kurtuluş Didem Yazganoğlu


Beta-blockers are classified into two major subgroups as cardioselective (β1) (acebutolol, atenolol, metoprolol, betaxolol, bisoprolol, esmolol, nebivolol) and noncardioselective (β1+β2) blockers (propranolol, nadolol, oxprenolol, pindolol, timolol, sotalol, carteolol, penbutolol). Additionally, there are other ones with both α and β receptor blocking activities such as labetalol and carvedilol. While β1 receptors are found mostly in the heart muscle, β2 receptors are located mostly on the vascular and bronchial smooth muscle. β2 receptors are also found in the skin. Practolol is no longer used because of its various side effects.


Beta-blockers Psoriasis/psoriasiform Oculomucocutaneous syndrome Lichenoid Angioedema/urticaria Lupus erythematosus Peyronie’s disease Vasculitis Cold extremity Gangrene Alopecia 


  1. 1.
    Opie LH. Beta-blocking agents. In: Opie LH, Gersh BJ, editors. Drugs for the heart. 8th ed. Philadelphia: Elsevier Saunders; 2013.Google Scholar
  2. 2.
    Gold MH, Holy AK, Roenigk Jr HH. Beta-blocking drugs and psoriasis. A review of cutaneous side effects and retrospective analysis of their effects on psoriasis. J Am Acad Dermatol. 1988;19:837–41.PubMedCrossRefGoogle Scholar
  3. 3.
    Abel EA, DiCicco LM, Orenberg EK, Fraki JE, Farber EM. Drugs in exacerbation of psoriasis. J Am Acad Dermatol. 1986;15:1007–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Jappe U, Uter W, de Padua CA, Herbst RA, Schnuch A. Allergic contact dermatitis due to beta-blockers in eye drops: a retrospective analysis of multicentre surveillance data 1993–2004. Acta Derm Venereol. 2006;86:509–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. Int J Dermatol. 2010;49:1351–61.PubMedCrossRefGoogle Scholar
  6. 6.
    Dika E, Varotti C, Bardazzi F, Maibach HI. Drug-induced psoriasis: an evidence-based overview and the introduction of psoriatic drug eruption probability score. Cutan Ocul Toxicol. 2006;25:1–11.PubMedCrossRefGoogle Scholar
  7. 7.
    White WB, Schulman P, McCabe EJ. Psoriasiform cutaneous eruptions induced by cetamolol hydrochloride. Arch Dermatol. 1986;122:857–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Hu CH, Miller AC, Peppercorn R, Farber EM. Generalized pustular psoriasis provoked by propranolol. Arch Dermatol. 1985;121:1326–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Palatsi R. A skin reaction to pindololum, a beta-blocking drug. Ann Clin Res. 1976;8:239–40.PubMedGoogle Scholar
  10. 10.
    Jensen HA, Mikkelsen HI, Wadskov S, Sondergaard J. Cutaneous reactions to propranolol (Inderal). Acta Med Scand. 1976;199:363–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Wright P. Untoward effects associated with practolol administration: oculomucocutaneous syndrome. Br Med J. 1975;1:595–8.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Holt PJ, Waddington E. Oculocutaneous reaction to oxprenolol. Br Med J. 1975;2:539–40.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Litt JZ. Drug eruption reference manual. 19th ed. Boca Raton: CRC Press (Taylor and Francis Group); 2013.Google Scholar
  14. 14.
    Frishman WH, Brosnan BD, Grossman M, Dasgupta D, Sun AD. Adverse dermatologic effects of cardiovascular drug therapy: part I. Cardiol Rev. 2002;10:230–46.PubMedCrossRefGoogle Scholar
  15. 15.
    Amos HE, Lake BG, Artis J. Possible role of antibody specific for a practolol metabolite in the pathogenesis of oculomucocutaneous syndrome. Br Med J. 1978;1:402–4.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Behan PO, Behan WM, Zacharias FJ, Nicholls JT. Immunological abnormalities in patients who had the oculomucocutaneous syndrome associated with practolol therapy. Lancet. 1976;2:984–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Torpet LA, Kragelund C, Reibel J, Nauntofte B. Oral adverse drug reactions to cardiovascular drugs. Crit Rev Oral Biol Med. 2004;15:28–46.PubMedCrossRefGoogle Scholar
  18. 18.
    Gange RW, Jones EW. Bullous lichen planus caused by labetalol. Br Med J. 1978;1:816–7.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Massa MC, Jason SM, Gradini R, Welykyj S. Lichenoid drug eruption secondary to propranolol. Cutis. 1991;48:41–3.PubMedGoogle Scholar
  20. 20.
    O’Brien TJ, Lyall IG, Reid SS. Lichenoid eruption induced by sotalol. Australas J Dermatol. 1994;35:93–4.PubMedCrossRefGoogle Scholar
  21. 21.
    Hawk JL. Lichenoid drug eruption induced by propranolol. Clin Exp Dermatol. 1980;5:93–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Nguyen DL, Wittich CM. Metoprolol-induced lichenoid dermatitis. J Gen Intern Med. 2011;26:1379–80.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Bodmer M, Egger SS, Hohenstein E, Beltraminelli H, Krähenbühl S. Lichenoid eruption associated with the use of nebivolol. Ann Pharmacother. 2006;40:1688–90.PubMedCrossRefGoogle Scholar
  24. 24.
    Fessa C, Lim P, Kossard S, Richards S, Peñas PF. Lichen planus-like drug eruptions due to β-blockers: a case report and literature review. Am J Clin Dermatol. 2012;13:417–21.PubMedCrossRefGoogle Scholar
  25. 25.
    Clayton R, Chaudhry S, Ali I, Cooper S, Hodgson T, Wojnarowska F. Mucosal (oral and vulval) lichen planus in women: are angiotensin-converting enzyme inhibitors protective, and beta-blockers and non-steroidal anti-inflammatory drugs associated with the condition? Clin Exp Dermatol. 2010;35:384–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Krikorian RK, Quick A, Tal A. Angioedema following the intravenous administration of metoprolol. Chest. 1994;106:1922–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Seides SF, Ruskin JN, Damato AN. Propranolol-induced urticaria: successful therapy with tolamolol. Chest. 1975;67:496–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Ferree CE. Apparent anaphylaxis from labetalol. Ann Intern Med. 1986;104:729–30.PubMedCrossRefGoogle Scholar
  29. 29.
    Hannaway PJ, Hopper GD. Severe anaphylaxis and drug-induced beta-blockade. N Engl J Med. 1983;308:1536.PubMedGoogle Scholar
  30. 30.
    Bause GS, Kugelman LC. Contact anaphylactoid response to labetalol. Contact Dermatitis. 1990;23:51.PubMedCrossRefGoogle Scholar
  31. 31.
    Toogood JH. Beta-blocker therapy and the risk of anaphylaxis. CMAJ. 1987;136:929–33.PubMedCentralPubMedGoogle Scholar
  32. 32.
    Goddet NS, Descatha A, Liberge O, Dolveck F, Boutet J, Baer M, et al. Paradoxical reaction to epinephrine induced by beta-blockers in an anaphylactic shock induced by penicillin. Eur J Emerg Med. 2006;13:358–60.PubMedCrossRefGoogle Scholar
  33. 33.
    Record Jr NB. Acebutolol-induced pleuropulmonary lupus syndrome. Ann Intern Med. 1981;95:326–7.PubMedCrossRefGoogle Scholar
  34. 34.
    McGuiness M, Frye RA, Deng JS. Atenolol induced systemic lupus erythematosus syndrome. J Am Acad Dermatol. 1997;37:298–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Gouet D, Marechaud R, Aucouturier P, Touchard G, Sudre Y, Preud’homme JL. Atenolol-induced lupus erythematosus. J Rheumatol. 1986;13:446–7.PubMedGoogle Scholar
  36. 36.
    Hardee JT, Roldan CA, Du Clos TW. Betaxolol and drug-induced lupus complicated by pericarditis and large pericardial effusion. West J Med. 1997;167:106–9.PubMedCentralPubMedGoogle Scholar
  37. 37.
    Paladini G. Peyronie’s disease and systemic lupus erythematosus syndrome associated with metoprolol administration: a case report. Int J Tissue React. 1981;3:95–8.PubMedGoogle Scholar
  38. 38.
    Bensaid J, Aldigier JC, Gualde N. Systemic lupus erythematosus syndrome induced by pindolol. Br Med J. 1979;1:1603–4.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Harrison T, Sisca TS, Wood WH. Case report. Propranolol-induced lupus syndrome? Postgrad Med. 1976;59:241–4.PubMedGoogle Scholar
  40. 40.
    Brown RC, Cooke J, Losowsky MS. SLE syndrome, probably induced by labetalol. Postgrad Med J. 1981;57:189–90.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Raftery EB, Denman AM. Systemic lupus erythematosus syndrome induced by practolol. Br Med J. 1973;2:452–5.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Fenniche S, Dhaoui A, Ammar FB, Benmously R, Marrak H, Mokhtar I. Acebutolol-induced subacute cutaneous lupus erythematosus. Skin Pharmacol Physiol. 2005;18:230–3.PubMedCrossRefGoogle Scholar
  43. 43.
    Fragasso G, Ciboddo G, Pagnotta P, Chierchia SL. Septal panniculitis induced by atenolol–a case report. Angiology. 1998;49:499–502.PubMedCrossRefGoogle Scholar
  44. 44.
    Pryor JP, Khan O. Beta blockers and Peyronie’s disease. Lancet. 1979;1:331.PubMedCrossRefGoogle Scholar
  45. 45.
    Kristensen BO. Labetalol-induced Peyronie’s disease? A case report. Acta Med Scand. 1979;206:511–2.PubMedCrossRefGoogle Scholar
  46. 46.
    Wolf R, Ophir J, Elman M, Krakowski A. Atenolol-induced cutaneous vasculitis. Cutis. 1989;43:231–3.PubMedGoogle Scholar
  47. 47.
    Ashford R, Staughton R, Brighton WD. Cutaneous vasculitis due to acebutolol. Lancet. 1977;2:462.PubMedCrossRefGoogle Scholar
  48. 48.
    Rustmann WC, Carpenter MT, Harmon C, Botti CF. Leukocytoclastic vasculitis associated with sotalol therapy. J Am Acad Dermatol. 1998;38:111–2.PubMedCrossRefGoogle Scholar
  49. 49.
    Iliopoulou A, Giannakopoulos G, Synetos A, Georgiou A, Chalkiadaki A. Leukocytoclastic vasculitis: is propranolol implicated? Pharmacotherapy. 2000;20:848–50.PubMedCrossRefGoogle Scholar
  50. 50.
    Pavlović MD, Dragojević Simić V, Zolotarevski L, Zecević RD, Vesić S. Cutaneous vasculitis induced by carvedilol. J Eur Acad Dermatol Venereol. 2007;21:1004–5.PubMedCrossRefGoogle Scholar
  51. 51.
    Gokal R, Dornan TL, Ledingham JG. Peripheral skin necrosis complicating beta-blockage. Br Med J. 1979;1:721–2.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Feleke E, Lyngstam O, Råstam L, Rydén L. Complaints of cold extremities among patients on antihypertensive treatment. Acta Med Scand. 1983;213:381–5.PubMedCrossRefGoogle Scholar
  53. 53.
    Trash D, Grundman M, Cargill J, Christopher K. Letter: Cold extremities and beta-blockers. Br Med J. 1976;2:527–8.PubMedCentralPubMedCrossRefGoogle Scholar
  54. 54.
    Vale JA, Van de Pette SJ, Price TM. Peripheral gangrene complicating beta-blockade. Lancet. 1977;2:412.PubMedCrossRefGoogle Scholar
  55. 55.
    Vale JA, Jefferys DB. Peripheral gangrene complicating beta-blockade. Lancet. 1978;1:1216.PubMedCrossRefGoogle Scholar
  56. 56.
    Hilder RJ. Propranolol and alopecia. Cutis. 1979;24:63–4.PubMedGoogle Scholar
  57. 57.
    Martin CM, Southwick EG, Maibach HI. Propranolol induced alopecia. Am Heart J. 1973;86:236–7.PubMedCrossRefGoogle Scholar
  58. 58.
    Scribner MD. Propranolol therapy. Arch Dermatol. 1977;113:1303.PubMedCrossRefGoogle Scholar
  59. 59.
    Graeber CW, Lapkin RA. Metoprolol and alopecia. Cutis. 1981;28:633–4.PubMedGoogle Scholar
  60. 60.
    Shelley ED, Shelley WB. Alopecia and drug eruption of the scalp associated with a new beta-blocker, nadolol. Cutis. 1985;35:148–9.PubMedGoogle Scholar
  61. 61.
    Hong JA, Bisognano JD. Metoprolol succinate therapy associated with erythema multiforme. Cardiol J. 2009;16:82–3.PubMedGoogle Scholar
  62. 62.
    Kowalski BJ, Cody RJ. Stevens-Johnson syndrome associated with carvedilol therapy. Am J Cardiol. 1997;80:669–70.PubMedCrossRefGoogle Scholar
  63. 63.
    Mukul, Verma G. Propranolol induced Steven-Johnson syndrome. J Assoc Physicians India. 1989;37:797–8.Google Scholar
  64. 64.
    Vlahovic-Palcevski V, Milic S, Hauser G, Protic A, Zupan Z, Reljic M, Stimac D. Toxic epidermal necrolysis associated with carvedilol treatment. Int J Clin Pharmacol Ther. 2010;48:549–51.PubMedCrossRefGoogle Scholar
  65. 65.
    Palungwachira P, Palungwachira P. Fixed drug eruption due to atenolol: a case report. J Med Assoc Thai. 1999;82:1158–61.PubMedGoogle Scholar
  66. 66.
    Belhadjali H, Trimech O, Youssef M, Elhani I, Zili J. Fixed drug eruption induced by atenolol. Clin Cosmet Investig Dermatol. 2009;1:37–9.PubMedCentralPubMedGoogle Scholar
  67. 67.
    Zaccaria E, Gualco F, Drago F, Rebora A. Fixed drug eruption due to propranolol. Acta Derm Venereol. 2006;86:371.PubMedCrossRefGoogle Scholar
  68. 68.
    Giner Esparza MA, Miedes Pitarch E, Miquel Miquel FJ, Palop Larrea V. Fixed drug eruption and bisoprolol. Aten Primaria. 2009;41:351.PubMedCrossRefGoogle Scholar
  69. 69.
    Gin A, Gin D, Sinclair R. Metoprolol-induced psoriatic nail disease. Australas J Dermatol. 2013;54:59–60.PubMedCrossRefGoogle Scholar
  70. 70.
    Greiner D, Schofer H, Milbradt R. Reversible transverse overcurvature of the nails (pincer nails) after treatment with a beta-blocker. J Am Acad Dermatol. 1998;39:486–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Bostanci S, Ekmekci P, Akyol A, Peksari Y, Gurgey E. Pincer nail deformity: inherited and caused by a beta-blocker. Int J Dermatol. 2004;43:316–8.PubMedCrossRefGoogle Scholar
  72. 72.
    Habbab KM, Moles DR, Porter SR. Potential oral manifestations of cardiovascular drugs. Oral Dis. 2010;16:769–73.PubMedCrossRefGoogle Scholar
  73. 73.
    Pradalier A, Dry J, Baron JF. Aphthoid stomatitis induced by labetalol. Therapie. 1982;37:695–7.PubMedGoogle Scholar
  74. 74.
    Boulinguez S, Reix S, Bedane C, Debrock C, Bouyssou-Gauthier ML, Sparsa A, et al. Role of drug exposure in aphthous ulcers: a case-control study. Br J Dermatol. 2000;143:1261–5.Google Scholar
  75. 75.
    Kanjanabuch P, Arporniem S, Thamrat S, Thumasombut P. Mucous membrane pemphigoid in a patient with hypertension treated with atenolol: a case report. J Med Case Rep. 2012;6:373.PubMedCentralPubMedCrossRefGoogle Scholar
  76. 76.
    Stavropoulos PG, Soura E, Antoniou C. Drug-induced pemphigoid: a review of the literature. J Eur Acad Dermatol Venereol. 2014;28:1133–40. doi: 10.1111/jdv.12366.PubMedCrossRefGoogle Scholar
  77. 77.
    Miyauchi H, Horiki S, Horio T. Clinical and experimental photosensitivity reaction to tilisolol hydrochloride. Photodermatol Photoimmunol Photomed. 1994;10:255–8.PubMedGoogle Scholar
  78. 78.
    Bajwa ZH, Sami N, Flory C. Severe acne as a side effect of propranolol and nadolol in a migraineur. Headache. 1999;39:758–60.PubMedCrossRefGoogle Scholar
  79. 79.
    Tcherdakoff P. Side-effects with long-term labetalol: an open study of 251 patients in a single centre. Pharmatherapeutica. 1983;3:342–8.PubMedGoogle Scholar
  80. 80.
    Hua AS, Thomas GW, Kincaid-Smith P. Scalp tingling in patients on labetalol. Lancet. 1977;2:295.PubMedCrossRefGoogle Scholar
  81. 81.
    Bailey RR. Scalp tingling and difficulty in micturition in patients on labetalol. Lancet. 1977;2:720–1.PubMedCrossRefGoogle Scholar
  82. 82.
    Harrower AD, Strong JA. Hyperpigmentation associated with oxprenolol administration. Br Med J. 1977;2:296.PubMedCentralPubMedCrossRefGoogle Scholar
  83. 83.
    Neumark M, Moshe S, Ingber A, Slodownik D. Occupational airborne contact dermatitis to simvastatin, carvedilol, and zolpidem. Contact Dermatitis. 2009;61:51–2.PubMedCrossRefGoogle Scholar
  84. 84.
    Henderson CA, Shamy HK. Atenolol-induced pseudolymphoma. Clin Exp Dermatol. 1990;15:119–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  • Esen Özkaya
    • 1
  • Kurtuluş Didem Yazganoğlu
    • 1
  1. 1.Department of Dermatology and VenereologyIstanbul University Istanbul Medical FacultyIstanbulTurkey

Personalised recommendations