A scoping review of adverse events associated with concomitant beta-adrenoreceptor blockers and selective serotonin reuptake inhibitors.

Authors

Ziyi Cai, James Sutton, Charlotte Archer, Caroline S Copeland, Joseph Hayes, Charles E Leonard, Nicky Lidbetter, Kenneth K C Man, Faraz Mughal, Ian C K Wong, Hayley C Gorton

Published in

British journal of clinical pharmacology. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

Beta-adrenoreceptor blockers (beta-blockers) and selective serotonin reuptake inhibitors (SSRIs) are commonly used medications and often used together, such as for the treatment of anxiety. However, there is no recent review of any potential adverse events related to concomitant use of medicines from each group. This scoping review therefore aimed to provide this narrative synthesis. Key databases were searched for articles published in English from 1 January 1990 to 24 November 2025 reporting any adverse event due to the concomitant use of beta-blockers and SSRIs in people aged 18 or over. Any study design was permitted. From 2211 distinct records, 117 articles were eligible for full-text screening, and 48 articles were included. Eight of these were review articles referring to otherwise-included empirical studies. Most were interventional (n = 19, 36.9%) or case reports (n = 14, 29.2%). Bradycardia was the most frequently reported adverse event (n = 11) mostly in case reports involving metoprolol-fluoxetine, metoprolol-paroxetine, metoprolol-sertraline or propranolol-fluoxetine. Blood pressure changes (including hypotension) were observed in half of studies which explored them. Neurocognitive-related symptoms were heterogeneous and there were four case reports/series of self-poisoning suicide or self-harm. The adverse events discussed in this review could be signals for drug-drug interactions. Where mechanism was postulated, authors mostly proposed pharmacokinetically mediated effects via Cytochrome P450 2D6. Signals described in this review of potential adverse events should be examined in robust observational studies of specific beta-blocker-SSRI combinations. This will enable precise estimation of the magnitude of any associated risks and provide insight into the potential mechanism.

PMID:
42844901
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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