Skip to main content
SpringerLink
Log in

Beta Adrenergic Receptor Blockers (Class II Antiarrhythmics)

  • Chapter
  • First Online:
Adverse Cutaneous Drug Reactions to Cardiovascular Drugs

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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. 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.

    Article  CAS  PubMed  Google Scholar 

  3. Abel EA, DiCicco LM, Orenberg EK, Fraki JE, Farber EM. Drugs in exacerbation of psoriasis. J Am Acad Dermatol. 1986;15:1007–22.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  7. White WB, Schulman P, McCabe EJ. Psoriasiform cutaneous eruptions induced by cetamolol hydrochloride. Arch Dermatol. 1986;122:857–8.

    Article  CAS  PubMed  Google Scholar 

  8. Hu CH, Miller AC, Peppercorn R, Farber EM. Generalized pustular psoriasis provoked by propranolol. Arch Dermatol. 1985;121:1326–7.

    Article  CAS  PubMed  Google Scholar 

  9. Palatsi R. A skin reaction to pindololum, a beta-blocking drug. Ann Clin Res. 1976;8:239–40.

    CAS  PubMed  Google Scholar 

  10. Jensen HA, Mikkelsen HI, Wadskov S, Sondergaard J. Cutaneous reactions to propranolol (Inderal). Acta Med Scand. 1976;199:363–7.

    Article  CAS  PubMed  Google Scholar 

  11. Wright P. Untoward effects associated with practolol administration: oculomucocutaneous syndrome. Br Med J. 1975;1:595–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Holt PJ, Waddington E. Oculocutaneous reaction to oxprenolol. Br Med J. 1975;2:539–40.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Litt JZ. Drug eruption reference manual. 19th ed. Boca Raton: CRC Press (Taylor and Francis Group); 2013.

    Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  18. Gange RW, Jones EW. Bullous lichen planus caused by labetalol. Br Med J. 1978;1:816–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Massa MC, Jason SM, Gradini R, Welykyj S. Lichenoid drug eruption secondary to propranolol. Cutis. 1991;48:41–3.

    CAS  PubMed  Google Scholar 

  20. O’Brien TJ, Lyall IG, Reid SS. Lichenoid eruption induced by sotalol. Australas J Dermatol. 1994;35:93–4.

    Article  PubMed  Google Scholar 

  21. Hawk JL. Lichenoid drug eruption induced by propranolol. Clin Exp Dermatol. 1980;5:93–6.

    Article  CAS  PubMed  Google Scholar 

  22. Nguyen DL, Wittich CM. Metoprolol-induced lichenoid dermatitis. J Gen Intern Med. 2011;26:1379–80.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  26. Krikorian RK, Quick A, Tal A. Angioedema following the intravenous administration of metoprolol. Chest. 1994;106:1922–3.

    Article  CAS  PubMed  Google Scholar 

  27. Seides SF, Ruskin JN, Damato AN. Propranolol-induced urticaria: successful therapy with tolamolol. Chest. 1975;67:496–7.

    Article  CAS  PubMed  Google Scholar 

  28. Ferree CE. Apparent anaphylaxis from labetalol. Ann Intern Med. 1986;104:729–30.

    Article  CAS  PubMed  Google Scholar 

  29. Hannaway PJ, Hopper GD. Severe anaphylaxis and drug-induced beta-blockade. N Engl J Med. 1983;308:1536.

    CAS  PubMed  Google Scholar 

  30. Bause GS, Kugelman LC. Contact anaphylactoid response to labetalol. Contact Dermatitis. 1990;23:51.

    Article  CAS  PubMed  Google Scholar 

  31. Toogood JH. Beta-blocker therapy and the risk of anaphylaxis. CMAJ. 1987;136:929–33.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  33. Record Jr NB. Acebutolol-induced pleuropulmonary lupus syndrome. Ann Intern Med. 1981;95:326–7.

    Article  PubMed  Google Scholar 

  34. McGuiness M, Frye RA, Deng JS. Atenolol induced systemic lupus erythematosus syndrome. J Am Acad Dermatol. 1997;37:298–9.

    Article  CAS  PubMed  Google Scholar 

  35. Gouet D, Marechaud R, Aucouturier P, Touchard G, Sudre Y, Preud’homme JL. Atenolol-induced lupus erythematosus. J Rheumatol. 1986;13:446–7.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  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.

    CAS  PubMed  Google Scholar 

  38. Bensaid J, Aldigier JC, Gualde N. Systemic lupus erythematosus syndrome induced by pindolol. Br Med J. 1979;1:1603–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Harrison T, Sisca TS, Wood WH. Case report. Propranolol-induced lupus syndrome? Postgrad Med. 1976;59:241–4.

    CAS  PubMed  Google Scholar 

  40. Brown RC, Cooke J, Losowsky MS. SLE syndrome, probably induced by labetalol. Postgrad Med J. 1981;57:189–90.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Raftery EB, Denman AM. Systemic lupus erythematosus syndrome induced by practolol. Br Med J. 1973;2:452–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  43. Fragasso G, Ciboddo G, Pagnotta P, Chierchia SL. Septal panniculitis induced by atenolol–a case report. Angiology. 1998;49:499–502.

    Article  CAS  PubMed  Google Scholar 

  44. Pryor JP, Khan O. Beta blockers and Peyronie’s disease. Lancet. 1979;1:331.

    Article  CAS  PubMed  Google Scholar 

  45. Kristensen BO. Labetalol-induced Peyronie’s disease? A case report. Acta Med Scand. 1979;206:511–2.

    Article  CAS  PubMed  Google Scholar 

  46. Wolf R, Ophir J, Elman M, Krakowski A. Atenolol-induced cutaneous vasculitis. Cutis. 1989;43:231–3.

    CAS  PubMed  Google Scholar 

  47. Ashford R, Staughton R, Brighton WD. Cutaneous vasculitis due to acebutolol. Lancet. 1977;2:462.

    Article  CAS  PubMed  Google Scholar 

  48. Rustmann WC, Carpenter MT, Harmon C, Botti CF. Leukocytoclastic vasculitis associated with sotalol therapy. J Am Acad Dermatol. 1998;38:111–2.

    Article  CAS  PubMed  Google Scholar 

  49. Iliopoulou A, Giannakopoulos G, Synetos A, Georgiou A, Chalkiadaki A. Leukocytoclastic vasculitis: is propranolol implicated? Pharmacotherapy. 2000;20:848–50.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  51. Gokal R, Dornan TL, Ledingham JG. Peripheral skin necrosis complicating beta-blockage. Br Med J. 1979;1:721–2.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  53. Trash D, Grundman M, Cargill J, Christopher K. Letter: Cold extremities and beta-blockers. Br Med J. 1976;2:527–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Vale JA, Van de Pette SJ, Price TM. Peripheral gangrene complicating beta-blockade. Lancet. 1977;2:412.

    Article  CAS  PubMed  Google Scholar 

  55. Vale JA, Jefferys DB. Peripheral gangrene complicating beta-blockade. Lancet. 1978;1:1216.

    Article  CAS  PubMed  Google Scholar 

  56. Hilder RJ. Propranolol and alopecia. Cutis. 1979;24:63–4.

    CAS  PubMed  Google Scholar 

  57. Martin CM, Southwick EG, Maibach HI. Propranolol induced alopecia. Am Heart J. 1973;86:236–7.

    Article  CAS  PubMed  Google Scholar 

  58. Scribner MD. Propranolol therapy. Arch Dermatol. 1977;113:1303.

    Article  CAS  PubMed  Google Scholar 

  59. Graeber CW, Lapkin RA. Metoprolol and alopecia. Cutis. 1981;28:633–4.

    CAS  PubMed  Google Scholar 

  60. Shelley ED, Shelley WB. Alopecia and drug eruption of the scalp associated with a new beta-blocker, nadolol. Cutis. 1985;35:148–9.

    CAS  PubMed  Google Scholar 

  61. Hong JA, Bisognano JD. Metoprolol succinate therapy associated with erythema multiforme. Cardiol J. 2009;16:82–3.

    PubMed  Google Scholar 

  62. Kowalski BJ, Cody RJ. Stevens-Johnson syndrome associated with carvedilol therapy. Am J Cardiol. 1997;80:669–70.

    Article  CAS  PubMed  Google Scholar 

  63. Mukul, Verma G. Propranolol induced Steven-Johnson syndrome. J Assoc Physicians India. 1989;37:797–8.

    Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  65. Palungwachira P, Palungwachira P. Fixed drug eruption due to atenolol: a case report. J Med Assoc Thai. 1999;82:1158–61.

    CAS  PubMed  Google Scholar 

  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.

    CAS  PubMed Central  PubMed  Google Scholar 

  67. Zaccaria E, Gualco F, Drago F, Rebora A. Fixed drug eruption due to propranolol. Acta Derm Venereol. 2006;86:371.

    Article  PubMed  Google Scholar 

  68. Giner Esparza MA, Miedes Pitarch E, Miquel Miquel FJ, Palop Larrea V. Fixed drug eruption and bisoprolol. Aten Primaria. 2009;41:351.

    Article  PubMed  Google Scholar 

  69. Gin A, Gin D, Sinclair R. Metoprolol-induced psoriatic nail disease. Australas J Dermatol. 2013;54:59–60.

    Article  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  72. Habbab KM, Moles DR, Porter SR. Potential oral manifestations of cardiovascular drugs. Oral Dis. 2010;16:769–73.

    Article  CAS  PubMed  Google Scholar 

  73. Pradalier A, Dry J, Baron JF. Aphthoid stomatitis induced by labetalol. Therapie. 1982;37:695–7.

    CAS  PubMed  Google Scholar 

  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. 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.

    Article  PubMed Central  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  77. Miyauchi H, Horiki S, Horio T. Clinical and experimental photosensitivity reaction to tilisolol hydrochloride. Photodermatol Photoimmunol Photomed. 1994;10:255–8.

    CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  79. Tcherdakoff P. Side-effects with long-term labetalol: an open study of 251 patients in a single centre. Pharmatherapeutica. 1983;3:342–8.

    CAS  PubMed  Google Scholar 

  80. Hua AS, Thomas GW, Kincaid-Smith P. Scalp tingling in patients on labetalol. Lancet. 1977;2:295.

    Article  CAS  PubMed  Google Scholar 

  81. Bailey RR. Scalp tingling and difficulty in micturition in patients on labetalol. Lancet. 1977;2:720–1.

    Article  CAS  PubMed  Google Scholar 

  82. Harrower AD, Strong JA. Hyperpigmentation associated with oxprenolol administration. Br Med J. 1977;2:296.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  83. Neumark M, Moshe S, Ingber A, Slodownik D. Occupational airborne contact dermatitis to simvastatin, carvedilol, and zolpidem. Contact Dermatitis. 2009;61:51–2.

    Article  PubMed  Google Scholar 

  84. Henderson CA, Shamy HK. Atenolol-induced pseudolymphoma. Clin Exp Dermatol. 1990;15:119–20.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology and Venereology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Esen Özkaya & Kurtuluş Didem Yazganoğlu

Authors
  1. Esen Özkaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kurtuluş Didem Yazganoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this chapter

Cite this chapter

Özkaya, E., Yazganoğlu, K.D. (2014). Beta Adrenergic Receptor Blockers (Class II Antiarrhythmics). In: Adverse Cutaneous Drug Reactions to Cardiovascular Drugs. Springer, London. https://doi.org/10.1007/978-1-4471-6536-1_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-6536-1_6

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-6535-4

  • Online ISBN: 978-1-4471-6536-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation