Bisosten Adverse Reactions

Bronchospasm, shortness of breath, and dyspnea may be precipitated, particularly in patients with a history of obstructive airways disease, due to blockade of beta₂ receptors in bronchial smooth muscle. Drugs with selectivity for beta₁-receptors or with intrinsic sympathomimetic activity at beta₂-receptors may be less likely to induce bronchospasm. Pneumonitis, pulmonary fibrosis and pleurisy have also been reported.
CNS effects include headache, depression, dizziness, hallucinations, confusion, amnesia and sleep disturbances including nightmares. Coma and convulsions have been reported after beta-blocker overdosage. Beta blockers that are lipid soluble are more likely to enter the brain and would be expected to be associated with a higher incidence of CNS adverse effects, although this is not proven.
Fatigue is a common adverse-effect of beta blockers. Paresthesia, arthralgia, and myopathies, including muscle cramps, have been reported. Reduced peripheral circulation can produce coldness of the extremities and may exacerbate peripheral vascular disease such as Raynaud's syndrome.
Adverse gastrointestinal effects include nausea and vomiting, diarrhea, constipation and abdominal cramping.