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Selective Vs. Non-Selective Beta-Blockers: What's The Difference?

Selective Vs. Non-Selective Beta-Blockers: What's The Difference?

Beta-blockers are one of the most common medications and are prescribed by doctors to help with an irregular heartbeat (arrhythmias), chest pain (angina), and high blood pressure (hypertension).

They’re also often prescribed for quite a few off-label uses including migraines, glaucoma, essential tremor, and performance anxiety.

This class of medication works by blocking the hormones norepinephrine and epinephrine (more commonly known as adrenaline) from binding to beta receptors.

Beta receptors live on the surface of your cells and when activated, cause a response like increased heart rate or trembling.

When adrenaline doesn’t connect to beta receptors, the fight-or-flight response isn’t activated.

Think of it like this:

Adrenaline is like an electrical plug, a device that brings energy. Beta receptors are the electrical outlet, the thing that activates that energy.

If a plug and outlet don’t connect, nothing happens.

If adrenaline doesn’t bind to beta receptors, there’s no effect on your body. Your pulse doesn’t race, your palms don’t sweat, your stomach doesn’t turn.

Your physical body simply remains calm.

There Are Different Types Of Beta-Blockers?

There are indeed. And while they generally work the same way, different types of this kind of medication prevent adrenaline from binding to different beta receptors.

And by binding to different beta receptors, they affect different areas of the body.

The two main types of beta-blockers are called selective and non-selective.

Selective Beta-Blockers

Selective beta-blockers are cardioselective. In other words, they “select” the beta receptors located in the heart tissue, known as your beta1 receptors.

This type of beta-blocker decreases activity around the heart and can help reduce your heart rate and your systolic pressure, the pressure your blood vessels experience when your heart beats.

They’re often used to help people experiencing conditions like chest pain, irregular heart rate, and high blood pressure.

Common selective beta-blockers include atenolol, metoprolol, nebivolol, and bisoprolol.

Non-Selective Beta-Blockers

Non-selective beta-blockers, on the other hand, block the beta1, beta2, and beta3 receptors, helping to address even more physical symptoms of performance anxiety.

So instead of only targeting the beta receptors in your heart, they also target those in your blood vessels, GI, and lungs as well.

This kind of medication can help slow your breathing, prevent your hands from trembling, or your palms from sweating.

Common non-selective beta-blockers include nadolol, pindolol, among others.

And Propranolol Is What Type Of Beta-Blocker?

Propranolol is a type of non-selective beta-blocker.

Performance anxiety can cause uncomfortable side effects throughout your entire body, including:

  • Shaky hands
  • Headaches
  • Muscle tension
  • Chest pains
  • Sweaty palms
  • Rapid heartbeat
  • Shallow breathing
  • Sweating
  • Blushing

Propranolol blocks the effects of adrenaline, preventing these physical symptoms from happening when you’re under intense pressure.

It’s important to note that beta-blockers don’t address the psychological symptoms of anxiety. You may still feel nervous before your big moment even with your prescription.

But minimizing the physical symptoms and getting your body back on your side can help you stay focused and ultimately feel more in control.

While Propranolol is generally considered to be a safe medication, it isn’t right for everyone. Some might experience some adverse effects while others should avoid the medication altogether due to their medical history.

Consult with a doctor to find out if it’s the right option for you.

Reviewed by Dr. Alex Dimitriu

Dr. Alex Dimitriu is a Stanford-trained physician with dual board certification in psychiatry and sleep medicine. The included content is not intended to replace medical advice. Always be sure to discuss any prescription medications with your doctor.