Devastating Hair Loss Side Effect from Beta Blockers Rarely Mentioned

Most medications come with a long list of potential adverse reactions. When a health professional prescribes a medicine, such as a beta blocker for high blood pressure, the chances are that she will focus on the drug complications that seem serious such as slow heart rate, insomnia, digestive distress, sexual difficulties or dizziness. Many doctors may consider a hair loss side effect as a minor complication…hardly worth mentioning. But for some people, this is a very big deal.

A Hair Loss Side Effect Story:

Q. My doctor prescribed 100 mg of metoprolol to control my blood pressure. After taking it for some time, I noticed that my once-thick blond hair had thinned considerably. I saw it on my hairbrush every morning when I styled my hair.

When I complained to my primary care provider, she suggested hair products like Rogaine! I was furious because she didn’t seem to be taking my concern seriously.

Research online suggested that the metoprolol was responsible. I cut the pills in half and took 50 mg for about six months. Voila! My hair grew back.

At my next check-up, I told my PCP how disappointed I was that she did not come forward with the information when I first complained. She professed surprise. How could doctors not know about the hair loss side effect? My BP was still fine at 50 mg, and so my PCP changed my prescription.

Now, even at that dose, my hair has again started thinning. I am at my wits’ end. Is there any treatment for high blood pressure that doesn’t cause hair loss?

A. Beta blockers such as atenolol, metoprolol and propranolol used to be first line prescriptions for hypertension. That is no longer true. And such drugs have been associated with hair loss in some people.

Your doctor has many other options for blood pressure control. Our eGuide to Blood Pressure Solutions discusses non-drug approaches along with a variety of prescription drugs. Hair loss appears less likely with angiotensin receptor blockers (ARBs) such as losartan or valsartan. Your doctor can determine whether such a drug would be appropriate for you.

You might think this problem is rare. If you search “metoprolol side effects” online you will get AI referrals to Drugs.com and MayoClinic.org for starters. If you are persistent and scan through a lot of adverse drug reactions you will eventually discover a “rare side effects” category. And there you will discover words such as “hair loss or thinning of the hair.”

Ask AI: “How common is hair loss with metoprolol?“

The answer you are likely to get is “rare.”

Adverse Reaction Information is Woefully Inadequate!

I positively despise side effect categories such as

• Common or More Common Side Effects or Reactions
• Serious Side Effects or Reactions
• Less Common Reactions or Side Effects
• Rare Side Effects or Reactions

Words such as common, rare or even serious are hard to evaluate. If hair loss is rare, does that mean 1 person in 10 will experience hair thinning or is it 1 person in a 1,000? Is it a “minor” complication or a “serious” reaction? So much depends upon individual interpretation. Words like rare or serious are often in the eye of the beholder. What might be “minor” to a physician could be “devastating” for a patient.

Another Reader Complains About the Hair Loss Side Effect:

Q. I am very upset about a side effect of beta blockers. These drugs are widely prescribed for blood pressure and other problems and a huge number of people are taking them. But they make our hair fall out! This is devastating for a woman.

I have appealed to my cardiologist to help me with this problem and she has offered to switch me from carvedilol (Coreg) to metoprolol (Toprol). If this doesn’t work, what’ll I do?

A. Beta blockers like atenolol, carvedilol, metoprolol and propranolol can lead to hair loss. No one knows how common this complication is because it has not been considered a serious side effect (by researchers and doctors). Patients have a very different perspective!).

Another reader reported her experience with a different beta blocker:

“I started drastically losing my hair soon after starting on atenolol. My doctor was reluctant to take me off of it since it was working so well in lowering my blood pressure. But there are many meds to take for hypertension, so don’t let your doctor keep you on any one medication if you are experiencing side effects that bother you.

“Hair loss from atenolol IS reversible. My hair grew back completely in less than six months. It’s taken me a few years of trial and error to find the drugs that work best for my blood pressure without side effects.”

Hair Loss Side Effect Research?

We have been disappointed with the amount and quality of the research into this issue. Most everyone knows that certain chemotherapeutic drugs for cancer treatment cause baldness. Surprisingly little attention has been paid to hair thinning brought on by common medicines.

Dutch researchers have reported (Nederlands Tijdschrift Geneeskunde, May 8, 1999):

 “Hairs are produced in hair follicles that have a cyclic activity. The cycles that normal hair follicles go through are the metabolically active anagen phase, the catagen transitional phase and the resting telogen phase. Loss of more than 120 hairs daily is called alopecia. Drugs typically cause a diffuse, reversible alopecia by influencing one of the cycles that hair follicles go through.”

Some of the medications discovered to cause alopecia (hair loss) by the Dutch researchers include:

• ACE inhibitors for high blood pressure
• Anticancer chemo drugs
• Anticoagulants
• Antimalaria medicines
• ARBs for high blood pressure
• Beta Blockers
• Lithium carbonate

An article in publication StatPearls (May 1, 2024) Discusses Hair Loss (Telogen Effluvium):

The authors introduce their review this way:

“Telogen effluvium is a form of nonscarring alopecia [hair loss] characterized by diffuse, often acute, hair shedding.”

They go on to add:

“Many medications have been linked to telogen effluvium, but the most common are beta-blockers; retinoids, including excess vitamin A; anticoagulants; propylthiouracil; carbamazepine; and immunizations.”

An article on “adverse reactions of beta blockers and the skin adds” (Experimental and Therapeutic Medicine (April 18, 2019) offers:

“Alopecia has long been recognized as an adverse effect of β-blockers and the suggested mechanism was described by Fraunfelder et al as ‘probably a direct toxic effect on the hair follicle’. They also discussed an impressive number of cases and reversibility after stopping the treatment.”

More Stories About Hair Loss Side Effect from Beta Blockers:

Marie is feeling frustrated:

“I have been taking metoprolol for 9 yrs. I am female, don’t drink or smoke. I have no energy to walk across the room, my hair has been falling out bad. When I ask why? I get no answers. Don’t know what to do?”

Diane is disappointed:

“I am 55 years old and have been taking a very low dose of metoprolol for the past 7 months. A few months ago I told my doctor I was losing hair, and it seemed like the first time he heard of this. He switched me to bisoprolol, with no change in hair loss. Vitamins/topicals/shampoos weren’t working, and I had chest pain with Rogaine.

“On a follow-up visit I complained of breathing problems on higher doses of the med and said that 50% of my hair was lost. He immediately took me off it and said this isn’t what medication is supposed to do. It was hurting me. We are going to meet again in 2 months.

“This week, for hair growth, I started kefir (antioxidant), collagen powder, peppermint/rosemary oil topical, lots of water and Omega 3. Don’t give up, and find a doctor who cares.”

Barbara was not warned about hair loss:

“Three weeks ago my hair started falling out. I have always had very fine hair, so this is devastating. I will be bald if I stay on this medication. My doctor says that hair loss isn’t a sympton of metoprolol. When I read on line, it absolutely is.”

Bryan wondered what was going on:

“I took metoprolol for 2 years. My hair was thinning and I was tired all the time. Then I discovered these were side effects of the drug. I have been gradually weaning off the medicine, but my heart has been beating extra hard.”

Warning: NEVER Stop a Beta Blocker Without Medical Supervision!

Stopping a drug like metoprolol, atenolol or propranolol suddenly is a terrible idea. There can be serious cardiovascular complications. If discontinuation becomes appropria5te it must always be under medical supervision.

Hair Loss Side Effect from Diuretics like HCTZ is Rarely, if Ever, Mentioned:

This reader reports a problem with HCTZ. She took us by surprise:

Q. Is hair loss a side effect of HCTZ? I had been taking triamterene for edema for over a year. When my doctor added HCTZ, I started having excessive hair loss. My family and my hairdresser both noticed. The only part of my health routine that changed was the addition of HCTZ.

A. You surprised us with this question. Most healthcare professionals perceive hydrochlorothiazide as a very safe diuretic to help lower blood pressure. Hair loss (alopecia) is not generally recognized as a side effect of this old medication.

When we checked the official FDA prescribing information, however, we discovered that alopecia (hair loss) is listed as a possible adverse reaction. Although it may be rare, you should mention this to your physician. A different diuretic or blood pressure medication might not cause the same problem.

Our eGuides to Blood Pressure Solutions and Hair and Nail Care so that you will know which common drugs cause hair loss.

Please share your own experience with medications that might cause hair loss in the comment section below.