Beta-Blockers and Alcohol: Interactions and Risks

Picture this: you're enjoying a night out with friends, ready to unwind and let loose, but suddenly you remember you just started a new medication this week — propranolol. Is it still safe to throw back a few drinks?

In this post, you will learn how beta-blockers like propranolol work, how alcohol affects our cardiovascular health, how alcohol interacts with beta-blockers, and how to manage your relationship with alcohol while on beta-blockers. 

What Are Beta-Blockers?

Beta-blockers are a class of medication typically used to treat heart- and circulatory-related problems. However, because beta receptors are found in multiple locations throughout the body, beta-blockers can treat a wide range of problems: 

• Heart arrhythmias
• Chest pain (angina) 
• Coronary artery disease
• Heart attack or congestive heart failure
• High blood pressure (hypertension)
• Enlarged heart
• Migraines
• Glaucoma
• Overactive thyroid (hyperthyroidism) 
• Anxiety 

These are just some conditions that beta-blockers are used for. But how do beta-blockers work? 

How Do Beta-Blockers Work?

Beta-blockers work by blocking certain hormones from activating beta receptors, also called adrenergic receptors. There are three types of beta receptors: 

• Beta-1 receptors. When activated, these receptors increase cardiac activity and activate the release of an enzyme found in our kidneys called renin. 
• Beta-2 receptors. When activated, these relax our airways and lower blood pressure, but they may also cause muscle tremors.
• Beta-3 receptors. When these are activated, they cause fat cells to break down, increase bladder capacity, and cause tremors. 

Since there are different beta receptors, beta-blockers often selectively target a specific type of beta receptor. Generally, beta-blockers fall into two categories based on whether they are cardioselective (beta-1 receptors) or not. Common cardioselective beta-blockers are atenolol, betaxolol, bisoprolol, esmolol, acebutolol, metoprolol, and nebivolol. Popular nonselective beta-blockers include propranolol, nadolol, pindolol, labetalol, trandate, penbutolol, or sotalol. 

Someone struggling with high blood pressure or anxiety, for example, might be prescribed propranolol, which blocks adrenaline (a stress hormone) from beta-1 receptors. The result is a decreased heart rate, making it easier for the heart to pump blood throughout your body.

While they are usually short-lived and mild, there are some side effects to be aware of: 

• Feeling tired, dizzy, or lightheaded
• Having cold fingers or toes 
• Weight gain
• Depression
• Shortness of breath 
• Difficulties sleeping or having nightmares

Not everyone will experience all the side effects associated with beta-blockers, but it’s good to be aware of them in case you do.

Alcohol’s Effects on the Heart

As we drink alcohol, it gets absorbed through the small intestines to the bloodstream. Once in our bloodstream, it has multiple effects on our cardiovascular system. Let’s take a look at how alcohol consumption affects our heart in the short and long term. 

In the short term, alcohol increases our heart rate and blood pressure and potentially leads to heart palpitations. Heart palpitations are a feeling of having a fast-beating, fluttering, or pounding heart that can feel worrisome, but they are harmless most of the time. After we are done drinking and the alcohol leaves our bloodstream, our blood pressure and heart rate go back to normal. 

When we drink heavily for a long time, we can damage our heart. Heavy drinking can result in tachycardia (when the heart beats too fast), high blood pressure, weakened heart muscles, irregular heartbeat, atrial fibrillation (the heart quivers instead of beats), or an enlarged heart. Many of these long-term effects on the heart can increase the chances of having a heart attack or stroke. Research shows us that heavy drinkers have more strokes and a greater chance of dying from strokes.

Alcohol and Beta-Blockers

Interactions

Alcohol’s impact on beta-blockers ranges based on the type of beta-blocker. Alcohol and beta-blockers can be a dangerous mix. Alcohol may decrease the effectiveness of beta-blockers by changing how they are released into the body or the speed at which the body metabolizes them. Mixing metoprolol and alcohol, for example, can speed up the release of the drug into our body and decrease its effectiveness. On the other hand, mixing propranolol and alcohol or flecainide and alcohol might not reduce the effectiveness of the drugs but may enhance the effects of alcohol. 

Side Effects

In general, drinking while on beta-blockers can enhance the side effects associated with both alcohol and beta-blockers. Let’s review some side effects associated with drinking alcohol while on beta-blockers: 

• Excessive sedation and dizziness. Alcohol use and beta-blockers can both cause dizziness and drowsiness. Combining the two can intensify the feelings and lead to more accidents and injuries. 
• Hypotension. Hypotension is when our blood pressure gets below the normal level. When our blood pressure is too low, we don’t get enough blood to essential areas in our body such as the heart and brain. Beta-blockers and alcohol can lower blood pressure, so having them both can excessively lower our blood pressure and lead to fainting, dizziness, or shock. 
• Tachycardia. Tachycardia is when our heart rate exceeds 100 beats per minute. Beta-blockers tend to slow our heart rate, and alcohol has the opposite effect. These conflicting actions can lead to tachycardia, irregular heartbeat, or heart palpitations. 
• Worsened heart conditions. If we are on beta-blockers, we are likely prescribed them to manage issues of the heart. Alcohol consumption can make our heart conditions worse and interferes with the progress we made with the medication. 
• Liver function. Alcohol is toxic to our liver and can cause long-term damage. Beta-blockers can also negatively impact our liver function, so mixing the two can compound the risks. 

If the associated risks haven’t deterred you, the question remains: can you drink on beta-blockers? While it is likely not life-threatening, most physicians won’t recommend it; however, it will largely depend on the type of beta-blocker in question. If we are using it for heart-related problems, alcohol probably isn’t safe. It’s always best to seek medical advice before we drink alcohol while on beta-blockers. 

Managing Our Relationship With Alcohol While on Beta-Blockers

Even if we know the associated risks, it may be hard to quit our current drinking habits. Let’s go through some tips on how we can have a healthy relationship with alcohol while we are on beta-blockers: 

• Drink in moderation. Having one or two drinks while on beta-blockers is likely not life-threatening. However, make sure you consult with your prescribing physician before you drink any alcohol. 
• Don’t skip your beta-blocker! You should never skip a dose of your beta-blocker to drink alcohol. Abruptly stopping beta-blockers can result in a thyroid storm, heart attack, anxiety, or hypertension. A thyroid storm can increase your heart rate, blood pressure, and body temperature to abnormally high levels and be life-threatening. 
• Skip the alcohol. Instead of drinking alcohol, try alcohol-free alternatives such as mocktails or non-alcoholic beer. 
• Plan ahead. If you are going to drink while on beta-blockers, make sure you prepare in advance. You can expect a stronger reaction to alcohol and may become extremely dizzy or drowsy. Make sure you have a trusted person to help you if you need it. 

Remember to consult your doctor before you drink alcohol while on beta-blockers.

The Bottom Line

Although not immediately life-threatening, it’s safest not to drink alcohol while taking beta-blockers. The mix of beta-blockers and alcohol can enhance the effects of alcohol and the side effects of the medication. Never skip a dose of your beta-blockers to drink alcohol, but drink in moderation if you want to drink while on beta-blockers.