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Beta-Blockers: Drugs That Can Influence Athletic Performance 

I recently found myself at an event called the “Salute to Seniors” at our downtown Denver Convention Center.  Not that I’m THAT old – I do take advantage of my senior discount at Einstein Bagels, but I won’t qualify for Medicare until next year. I volunteered with the 9HealthFair team to offer osteoporosis screening and to answer questions under the “Ask A Pharmacist” sign.

A young woman – in her 70s in the Salute to Seniors group –  stopped by to ask about her medications. She was taking propranolol – one of the “beta-blockers” – for an arrhythmia and noticed that she was having trouble with activities like climbing stairs.

Just as many serious athletes (is there another kind?) are looking for an edge, many seniors who exercise to improve their health sometimes find themselves wondering if their medications are working for them or against them. The answer is that it depends; medicines are almost always a tradeoff favoring one response at the expense of another, so the drug that helps in one area can hinder in another.


Beta-Blockers and Athletic Performance

Drugs called beta-blockers are a nice example of this. Propranolol, the first of “beta-blockers” was developed in the 1960s by Sir James Black, a British pharmacologist who went on to develop histamine H2-blockers as well and win the Nobel Prize for Medicine in 1988. Sorry, I’m a history buff.

The normal human response to stress or fear is to activate the sympathetic nervous system. This part of our physiology uses epinephrine (“adrenaline”) and norepinephrine to produce a series of automatic responses that you are probably familiar with:  your heart beats stronger and faster, you start to breath more deeply, muscles receive more blood supply and your metabolism changes to get you ready for action. That action is often referred to as “fight or flight” because sympathetic responses prepare you to fight or to run away from danger.  

Activation of the sympathetic nervous system occurs when you see a scary movie, when you are anxious about speaking or performing in public, and when you exercise.

Propranolol and the other members of the beta-blocker family have generic names that end in –olol.  Beta Blockers inhibit responses to epinephrine and norepinephrine throughout the body. This slows your heart and for some patients can make it harder to breath. Newer beta blockers were developed to selectively act at the heart and rarely influence breathing. New beta-blockers include atenolol, carvedilol, metoprolol and others; they are less likely to affect breathing, but this can still happen in some patients.

Beta blockers are commonly used in patients with heart failure, and also for hypertension and some arrhythmias. By inhibiting the heart from responding too vigorously, they prevent the normal response to exercise. This can make it more difficult to perform vigorous aerobic exercise – like running or climbing stairs – as the heart is not “allowed” to keep up with your exercise.

But here’s the tradeoff.  Beta-blockers are also used for performance anxiety.  

Around ¼ of professional performers have used beta blockers to help them remain calm for a show. These medications can also help if your sport requires calmness and a slower heart rate – if you’re shooting they can improve your marksmanship.

It’s often a matter of making sure that your medications are the best ones for you based on your pharmacological individuality and your lifestyle. Good decisions about medications require individual medical information and patient history, and prescription medication changes should only be made with the approval of your prescriber. Your community pharmacist or prescriber can help you make the best medication choices.  Talk to them. 


About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.