β-Blockers and risk of neuropsychiatric disorders: A systematic review and meta-analysis

Lujain Ez Eddin; Rebecca Preyra; Fatemeh Ahmadi; Atefeh Jafari; Mohammad Ali Omrani; Flory T Muanda

doi:10.1111/bcp.16361

β-Blockers and risk of neuropsychiatric disorders: A systematic review and meta-analysis

Br J Clin Pharmacol. 2024 Dec 10. doi: 10.1111/bcp.16361. Online ahead of print.

Authors

Lujain Ez Eddin^{1

2}, Rebecca Preyra², Fatemeh Ahmadi^{1

3}, Atefeh Jafari^{1

3}, Mohammad Ali Omrani^{1

2}, Flory T Muanda^{1

2

3

4}

Affiliations

¹ ICES Western, London, ON, Canada.
² Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.
³ Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.
⁴ Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada.

PMID: 39658346
DOI: 10.1111/bcp.16361

Abstract

Aims: This systematic review and meta-analysis aimed to evaluate the association between β-blocker use and neuropsychiatric adverse events, specifically focusing on short-term outcomes.

Methods: A comprehensive literature search identified studies reporting neuropsychiatric outcomes in patients using β-blockers, including randomized controlled trials and observational studies. Relative risks (RR) and 95% confidence intervals (CIs) were calculated for outcomes such as dizziness, insomnia, nightmares, drowsiness and delirium.

Results: Our analysis revealed that β-blocker use was significantly associated with an increased risk of dizziness (RR 1.72, 95% CI [1.39-2.14]; I² = 1%, 14 studies) compared to placebo. Lipophilic β-blockers, especially propranolol, showed an even greater risk of dizziness (RR 3.13, 95% CI [1.44-6.84]; I² = 0%, three studies). Propranolol was also associated with increased insomnia risk compared to placebo (RR 1.13, 95% CI [1.00-1.28]; I² = 0%, five studies). Our data did not show statistically significant increases in the reports of nightmares and somnolence. Other adverse effects, including drowsiness, sleep disturbances, hallucinations and delirium, were noted.

Conclusions: Our findings suggest a significant association between β-blocker use and an increased risk of neuropsychiatric adverse events, particularly insomnia and dizziness with higher risks associated with lipophilic β-blocker use. Given the ambiguity surrounding dizziness and its classification as a neuropsychiatric effect, our findings are exploratory, and we cannot exclude a potential cardiovascular origin for dizziness. Most studies (75%) were published before the CONSORT statement in 1996, indicating potential reporting limitations and a lack of recent research. Additionally, 60% of studies had a high risk of bias, underscoring the need for more rigorous and contemporary investigations into the neuropsychiatric implications of β-blocker use.

Keywords: hydrophilic; insomnia; lipophilic; meta‐analysis; neuropsychiatric adverse effect.

Publication types

Review