Do beta blockers cause hair thinning?

Question

Hello doctor,

I am 44 years old and have been diagnosed with preliminary hypertension. All my tests, including ECG, TMT, 2D echo, brain CT scan, and chest X-ray, as well as tests for pulmonary embolism (to rule out the cause of sinus tachycardia), 48-hour Holter monitor, lipid profile, and kidney and liver function tests, have been completed. The results for TMT, 2D echo, complete blood profile (CBP), and vitamin levels are normal.

I was prescribed Metoprolol tartrate 50 mg twice a day, Hydralazine hydrochloride 25 mg twice a day, and Amlodipine 5 mg twice a day. As my total cholesterol was slightly high, I was also prescribed Atorvastatin 10 mg. The doctors suggested two changes to my medication regimen: to stop taking Hydralazine hydrochloride and to switch from Metoprolol tartrate (immediate release) to Metoprolol succinate (extended-release).

Currently, I am taking Metoprolol succinate XL 50 mg twice a day, Amlodipine 5 mg twice a day, and Atorvastatin 10 mg once a day. My blood pressure is well-controlled at 110/80 mmHg, and my average heart rate is between 70 and 80 beats per minute, dropping to the 60 to 70 range at night. My cholesterol levels are also under control, with a total of 140 mg/dL, LDL at 73 mg/dL, and HDL at 43 mg/dL.

I have specific questions regarding my treatment: Since switching to Metoprolol succinate, I have noticed that my hair is thinning. Do beta blockers cause hair thinning? Can I switch back to Metoprolol tartrate (immediate release), or is there another beta blocker that is as effective and safe as Metoprolol but does not cause hair thinning? Additionally, Metoprolol is causing my HbA1c levels to rise; it is currently at 5.4%.

Within one month of taking Atorvastatin, my cholesterol levels have improved. I have been on Atorvastatin for the last year—can I stop it now? I also engage in regular exercise, walking for 20 to 30 minutes each day.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

From your description, it appears that you have only hypertension and no other problems. Firstly, beta blockers are not typically prescribed as a first-line treatment for hypertension. They are generally used after calcium channel blockers (like Amlodipine), ACE (angiotensin-converting enzyme) inhibitors (such as Telmisartan), and hydrochlorothiazide have proven ineffective. However, there is no harm in using them as a first-line agent in some cases.

In rare instances (less than one percent of patients), Metoprolol can cause hair loss and may also raise HbA1c levels; however, this increase is generally not clinically significant and does not require treatment. Considering these factors, it might be better to switch to another medication, such as Telmisartan.

You may also switch to Metoprolol tartrate if you prefer, but since it is an immediate-release formulation, blood pressure control may be inadequate later in the dosing period. Additionally, the issue with elevated HbA1c will be present with all beta blockers. An alternative beta blocker you might consider is Nebivolol 5 mg once a day, which we can gradually increase as needed.

Ultimately, the choice will depend on your personal preferences. However, given the circumstances, switching to Telmisartan would be advisable. If you are not concerned about hair loss, you may continue with Metoprolol, but keep in mind that both Metoprolol succinate and tartrate can cause hair loss.

You can stop taking Atorvastatin and maintain a healthy lifestyle, including a balanced diet and regular exercise. Please repeat your lipid profile after six to eight weeks to monitor for sustained control.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, as I mentioned, you can take Nebivolol 5 mg once a day, which can be gradually increased. It is less likely to cause hair loss, but there may still be an issue with HbA1c (glycated hemoglobin). However, this is not significant, as any increase will be slight and is reversible.

Thanks and regards.