The NHS is urging thousands of people in the UK to ‘cut down on coffee, tea, and alcohol’ to avoid uncomfortable side effects. The warning is primarily aimed at those who take a common type of medication.
According to the British Heart Foundation, many people in the UK take a beta blocker medicine, which is a type of medication prescribed to people diagnosed with high blood pressure. A recent statement on its website reads: “In 2021 alone, more than 40,000 prescriptions were issued in England.”
Beta blockers, also referred to as beta adrenergic blocking agents, primarily function by decreasing the heart rate, which in turn lessens the strength of blood circulation throughout the body. They achieve this by inhibiting the release of stress hormones like adrenaline and noradrenaline, which typically prompt the heart to beat more vigorously and rapidly.
A normal heart rate and blood pressure are:
- A normal heart rate should be between 60 and 100 beats per minute (bpm) when resting.
- Normal blood pressure should be between 90/60 mmHg and 120/80 mmHg for adults.
However, for people over 80 years old, it’s higher at 150/90 mmHg (or 145/85 mmHg at home). This is because arteries get stiffer as we get older. High blood pressure, or hypertension, poses significant risks as it can harm your heart, brain, kidneys, and eyes. Such damage may result in severe health issues, including heart attacks, strokes, and kidney failure.
Beta blockers are mainly used for various heart and circulatory issues. They are often recommended to manage irregular heartbeats, relieve angina, and assist in reducing blood pressure.
Individuals with heart valve disease, heart failure, or those who have experienced a heart attack may also receive a beta blocker prescription. Doctors may occasionally prescribe beta blockers for conditions unrelated to the heart, such as anxiety. Common beta blockers include:
- atenolol (also called Tenormin)
- bisoprolol (also called Cardicor or Emcor)
- carvedilol
- labetalol (also called Trandate)
- metoprolol (also called Betaloc or Lopresor)
- propranolol (also called Inderal or Angilol)
- sotalol
In particular, the NHS is urging people who take verapamil to limit the amount of caffeine they consume. Too much can cause a side effect known as flushing.
Flushing is the quick reddening of the skin, typically seen on the face, neck, and chest. This occurs due to increased blood flow to those areas and is often accompanied by a warm sensation. Various factors can trigger flushing, including emotions such as embarrassment, high temperatures, alcohol intake, or specific medical conditions like carcinoid syndrome.
A statement on the NHS website reads: “Flushing – try cutting down on coffee, tea and alcohol. It might help to keep the room cool and use a fan. You could also spray your face with cool water or sip cold or iced drinks. The flushing should go away after a few days. If it does not go away or it’s causing you problems, contact your doctor.
“You can usually drink alcohol with verapamil. However, it’s best to not drink alcohol for the first few days when you start taking verapamil or if your doctor increases your dose. Wait until you know how the medicine affects you. This is because drinking alcohol can increase the effects of verapamil. It can make your blood pressure too low and you may feel dizzy or lightheaded.
“Do not eat grapefruit or drink grapefruit juice while taking verapamil. This is because grapefruit can make the side effects of verapamil worse. Otherwise, you can eat and drink normally while taking verapamil. Eating a healthy balanced diet can help if you have high blood pressure.”
Experts at Harvard Health say: “Drinking coffee at the same time you take certain blood pressure medications, including the calcium-channel blocker verapamil (Verelan), can temporarily hamper their ability to relax blood vessels.”
What is verapamil?
Verapamil helps reduce blood pressure and assists the heart in pumping blood more efficiently throughout the body. It is commonly prescribed to help manage chest pain associated with angina and to regulate irregular heartbeats.
Additionally, it is effective in treating high blood pressure (hypertension). For those with hypertension, taking verapamil can help reduce the risk of developing heart disease, experiencing heart attacks, and having strokes.
Doctors may also recommend verapamil for individuals suffering from cluster headaches, as it can help decrease the frequency of these headaches. Verapamil is available only with a prescription and can be found in tablet form or as a liquid to swallow. Sometimes, it may be administered via injection, typically in a hospital setting.
Verapamil begins to take effect on the day you start using it, but it might take about one to two weeks to experience its full benefits. One of the most frequently reported side effects of verapamil is constipation.
Avoid consuming grapefruit or its juice while on verapamil, as it can intensify side effects. Continuing to take verapamil is crucial unless your doctor tells you otherwise. Stopping the medication could lead to an increase in blood pressure, which may heighten your risk of a heart attack or stroke.
Common side effects happen in more than one in 100 people. They are usually mild and do not last long. Talk to your doctor or pharmacist if these side effects bother you or do not go away:
- constipation
- feeling or being sick (nausea or vomiting)
- flushing of the face and neck
- headaches
- feeling dizzy or tired
- swollen hands, ankles or feet
Serious side effects are rare and happen in less than one in 10,000 people. Stop taking verapamil and tell your doctor straight away if:
- the whites of your eyes or your skin turn yellow, although this may be less obvious on brown or black skin, or you have dark pee – these can be signs of liver problems
Who can take beta blockers?
Beta blockers are not suitable for everyone. Tell your doctor if you have:
- uncontrolled heart failure
- had an allergic reaction to a beta blocker or any other medicine in the past
- low blood pressure or certain conditions that affect the rhythm of your heart
- metabolic acidosis – when there’s too much acid in your blood
- lung disease or asthma
Make sure to inform your doctor if you are planning to become pregnant, are currently pregnant, or are breastfeeding. It’s crucial to consult your doctor before discontinuing beta blockers, as stopping them abruptly could potentially worsen your health condition.
Cautions with other medicines
The NHS adds: “There are some medicines that may interfere with the way that beta blockers work, including beta blocker eyedrops. Tell your doctor or pharmacist if you’re taking any other medicines, including herbal remedies, vitamins or supplements.”
Speak to your GP if you’re taking:
- other medicines for high blood pressure. The combination with beta blockers can sometimes lower your blood pressure too much. This may make you feel dizzy or faint
- other medicines for an irregular heartbeat such as amiodarone or flecainide
- other medicines that can lower your blood pressure. These include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), medicines for an enlarged prostate gland like tamsulosin, or Parkinson’s disease medicines such as levodopa
- medicines for asthma or chronic obstructive pulmonary disease (COPD)
- medicines for diabetes, particularly insulin – beta blockers may make it more difficult to recognise the warning signs of low blood sugar
- medicines to treat nose or sinus congestion, or other cold remedies (including those you can buy in the pharmacy)
- medicines for allergies, such as ephedrine, noradrenaline or adrenaline
- non-steroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen. These medicines may increase your blood pressure, so it’s best to keep them to a minimum