Can I take beta blockers and still study/exercise at my normal capacity?
September 12, 2011 7:28 PM   Subscribe

I am a PhD student 6 weeks from my oral exam. I am also an avid runner. I've just been prescribed beta blockers for recurring migraine - will I screw up both/neither of the above if I take them?

I'm in grad school and am currently in the more intense phase of studying for orals. I've been having problems with migraines, which I get, as of recently, up to several times a week. I have a prescription for Sumatriptin, but it makes me tired enough that I usually miss out on close to a day's work when I take it. I recently saw a neurologist who prescribed me 20 mg of Nadolol as a preventative measure. I'm supposed to take it daily for about two months to decrease the frequency of my migraines. Much of the information I've seen online indicates that an intense grogginess is one of the primary side effects of Nadolol. I've also read that it causes an intense sense of weakness, and I'm worried about how it might interfere with running, which I do with some frequency (about 6 miles 3-4x/wk) and is pretty much the single thing keeping me sane while studying.

Both studying and running are important enough to me that just trying the beta blocker to see how it works seems like a pretty big risk. In some ways, the prescription seems fortuitous as I know beta blockers are often prescribed for test anxiety, but I'm really nervous about the aforementioned side effects messing up my life during a time that is already stressful. It doesn't help that I've been reading horrifying accounts of people's experiences with beta blockers online.

I'm wondering whether anyone can confirm or deny these side effects (FWIW, the dose is 20 mg and I weigh about 160), whether anyone has experience attempting to be highly productive on either sumatriptin or beta blockers, or whether anyone has been able to minimize the side effects (i.e. by taking them at night vs. in the AM or vice versa) of beta blockers in order to still be able to work productively and/or exercise the same amount as before.

Thanks, in advance, for any advice/suggestions.
posted by lxs to Health & Fitness (13 answers total)
Not a pharmacist, not your pharmacist...but did study the MOA of these and similar meds as a neuroscience grad student many, many moons ago...I would still defer to your pharmacist

Check out the PI for your med, linked here. At your prescribed dosage (similar to whatit would be for test anxiety, it is below what is prescribed for it's indicated uses,such as hypertension. Note that those people take it daily at 40 to 300 some mg/day (so your dosage is very small in comparison).

If you are worried about adverse events such as fatigue, also check out the PI and they report what patients reported in clinical trials (fatigue is 6 per 1000 patients, which is pretty small). I don't see the placebo group mentioned, but it a lot of clinical trials you will see the placebo groups also cite adverse events it doesn't look that high.

I would really discuss this with your physician, too. Sometimes there are options to select other meds, and they can look at the safety profile and match it to your preference within limits.
posted by Wolfster at 7:40 PM on September 12, 2011

I take Atenolol (50 mg/day, I think), for migraine prevention. My neurologist originally suggested I take it at night to avoid the fatigue side effects (since you're going to sleep anyway). I did for a while, but now take it in the morning with other medicines because it's an easier part of my daily routine. Just a thought.
posted by Sweetie Darling at 7:47 PM on September 12, 2011

I am not a pharmacist or doctor I can only tell you about my experiences.

I take beta blockers but not the ones you do I take 50mg atenolol and I take it for blood pressure. I had problems with them making me sleepy so after discussing it with my doctor I take them just before bedtime and have had no further problems with sleepiness while on them and in fact have found them handy to take as I used to have problems with anxiety insomnia.

I have actually found them very handy to take during stressful times eg for things like studying and test taking as I find the anti anxiety side effect great for stopping me stressing out. My doctor even joked that he took them in medschool to help him study for and take tests. So I wouldn't worry about them causing problems with your studying or tests too much

I don't exercise a lot, I suppose that because they regulate heart beat they might somehow effect fitness or running theoretically but in the 10 years of taking them I have never noticed any side effects of that sort. Though I mostly hike/walk and swim not run so YMMV.

I've been lucky and only had a few migraines in the past, any side effects of beta blockers are well known as they have been used for years and IMO way better than a migraine attack or the effects of some of the other medicines I was prescribed.
posted by wwax at 7:54 PM on September 12, 2011

If you're anxious about trying them, try them now and get it out of the way. If this turns out to be a bad week, then it's a bad week with five weeks to recover.
posted by thinkingwoman at 7:59 PM on September 12, 2011

I take a beta blocker for blood pressure and it sure as heck did make me tired the first week I took it. I gradually got used to it.

To me, the decision is how bad are the migraines and to what extent are they keeping you from studying? If it were me, and I could bear the migraines for another 6 weeks, I would. I would also wait a week or two after your exam to rule out the pressure of studying as a potential cause of the migraines.

But, I am not a doctor nor a pharmacist. I am just an old Dead head willing to do my own experimenting.
posted by JohnnyGunn at 8:10 PM on September 12, 2011 [1 favorite]

I take a beta blocker (metoprolol) and it helps prevent adrenaline surges, for sure. That can be good or bad...when I perform in a community orchestra, for example, I feel kinda flat, with no excitement at the really difficult parts. However, I can see that being a benefit in a high pressure situation like your defense. I think it made me tired at first, too, and it definitely messes with your heart rate when exercising.
posted by cabingirl at 8:16 PM on September 12, 2011

I take beta blockers occasionally (not on a daily basis), and they do make me a bit tired, but not so much that I can't do work or focus on reading.

However, they make me feel really weird when I run; it's like my heart can't speed up as much as it should, so I feel sort of sluggish and strange. I definitely have gone on runs when using them, but I don't really like doing so and will avoid it if I can. I do find that the more I take them, the less I feel the effects, so perhaps you'll adjust to them after a week or so of use.

Maybe if you run in the morning, you can take your beta blockers after you get back from your run. I've done that before and found it to be a successful way to avoid the side effects and still get my workout in.
posted by LizzyBee at 8:37 PM on September 12, 2011

I'm a pharmacist. The "betas" being blocked are adrenaline receptors. There are beta-1 receptors (mainly in the heart) and beta-2 receptors (mainly in the lungs). Nadolol is a drug that hits both receptors.

It's easy to envision what those receptors are responsible for if you think about the fight-or-flight response. Adrenaline at the receptors in the heart result in a fast heart rate, and at the lungs result in relaxation of smooth muscle to enable you to take big deep breaths. The practical effect of blocking these receptors is a slower heart rate and getting winded quicker.

I think taking it in the evening is a great idea. Also, a lot of people say their exercise capacity does improve over time after they start a beta blocker. Realistically you probably will get winded quicker, but you can still exercise.

Also, keep in mind that trying it for a day or two is pretty low commitment. If you hate it, tell your doctor you want to stop taking it.

Everything in medicine is a risk-benefit analysis. If you take the nadolol, you do risk tiredness and decreased exercise capacity. But the current situation is not great either. How much study time are you losing to migraines? It seems the nadolol won't make you worse off, and might make the situation a lot better.

Honestly, I wouldn't give much credence to internet horror stories. Googling "drug name" + "side effects" to learn about a drug is kind of like googling "crazy ex-boyfriend" to learn about relationships. You're going to get a lot of extreme stories that may have nothing to do with your particular situation.
posted by selfmedicating at 9:49 PM on September 12, 2011 [10 favorites]

Wow. I take a different beta-blocker, and have noticed no particular effects at all. New doctor just halved the dose. It's purpose is to keep my heart from demanding more oxygen than I can supply, due to clogged arteries. From the label, I gather it only effects the receptors in the heart.
posted by Goofyy at 6:49 AM on September 13, 2011

I have used several beta blockers, including this one. It did make me feel more tired, so I always took it at night. The effect did diminish over time (several weeks) so it may be possible to switch to taking in the morning. When exercising (not running though), my heart rate did not increase as much as it used to before the medications.
posted by maxg94 at 7:15 AM on September 13, 2011

I have taken a beta blocker for migraine. It didn't make me groggy - instead, it completely destroyed my ability to sleep and also the quality of my sleep. A few months in I realised that the time since I started taking it was a blur to me because I was in such a state of constant exhaustion. I would really hesitate to start taking it 6 weeks before an exam.
posted by Acheman at 9:33 AM on September 13, 2011

I only have infrequent migraines, so haven't tried beta blockers, but after my first use of sumatriptan (a couple of 50mg pills over the course of a day), I felt exhausted. I told my doctor, and she recommended I try a half dose (25mg). That has been working well for me, it usually makes the headache go away, and has no noticeable side effects.
posted by loop at 10:46 AM on September 13, 2011

I hated my beta blocker. It did its job, but felt like I was trudging through quicksand mud the entire time. It also takes several days or weeks for the side effects to wear off. I'm not sure that I'd be able to take that risk, though migraine pain can

There are other migraine prophylactics. Topamax and nortriptyline are two different types. Talk to your doctor about the beta blockers and your situation.
posted by barnone at 10:56 AM on September 13, 2011

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