Nightmares and beta-blockers

Q: Which of the following beta-blockers is most prone to cause nightmares? (select one)

A) propranolol

B) sotalol

C) carvedilol

D) labetalol 

E) atenolol

Answer: A

Although many classes of drugs are known to cause nightmares, such as dopamine agonists, antidepressants, antimicrobials, antipsychotics, antiseizures, and ketamine, it is less appreciated with anti-hypertensives, particularly beta-blockers (BB).

Almost one-third of the patients having nightmares report using beta blockers! 

BBs that are lipophilic, have higher serotonin 5HT1A receptor affinity, shorter half-lives, and lacking alpha-blockade are more likely to cause nightmares. These include propranolol, metoprolol, and pindolol. Nightmares are least common with sotalol, carvedilol, and labetalol. Although atenolol is hydrophilic, case reports of nightmares have been reported with its use.

#psychiatry

#pharmacology

References:

1. Thompson DF, Pierce DR. Drug-induced nightmares. Ann Pharmacother 1999; 33:93.

2. Garcia P, Montastruc JL, Rousseau V, et al. β-adrenoceptor antagonists and nightmares: A pharmacoepidemiological-pharmacodynamic study. J Psychopharmacol 2021; 35:1441.

3. Westerlund A. Central nervous system side-effects with hydrophilic and lipophilic beta-blockers. Eur J Clin Pharmacol 1985; 28 Suppl:73.