Can you drink coffee while taking beta blockers?

If you’re one of the nearly 50% of Americans with hypertension, your healthcare provider may prescribe a beta blocker like Lopressor (metoprolol), Inderal (propranolol), or Tenormin (atenolol) to lower your blood pressure. Beta blockers are medications that limit the effects of epinephrine, a hormone that constricts blood vessels and increases the rate and force of heart contractions, according to the Mayo Clinic. These medications allow blood vessels to open, improving blood flow to the heart. They also reduce the speed and force by which the heart beats. Both of these factors result in a reduction in blood pressure. Beta blockers may also be prescribed to individuals with heart arrhythmia (abnormal heart rhythms), chest pain, or heart failure.

If you’re a coffee lover, you may be wondering what happens if you drink caffeine with beta blockers. Is it safe? In short, it depends. Here’s what you need to know about mixing caffeine and beta blockers.

Can you drink coffee while taking beta blockers?

Ideally, it’s best to avoid caffeine while taking beta blockers, says Ahmad Nooristani, MD, an internal medicine physician practicing in San Luis Obispo, California, and founder of the SLO Noor Foundation. Why? There are two reasons:

1. Caffeine increases blood pressure overall when it enters your bloodstream.
2. Caffeine reduces the effectiveness of beta blockers and other types of blood pressure medication. 

“Caffeine is a stimulant, which means that it increases your heart rate and blood pressure. If you are taking a blood pressure medication, caffeine may interact with it in a way that makes your blood pressure rise,” Dr. Nooristani says.

Do you need to give up caffeine completely?

However, caffeine affects everyone differently, and for patients who won’t give up their morning cup of joe, it’s possible to combine beta blockers and coffee safely, says Marc Helzer, MD, a board-certified primary care physician specializing in family medicine at the University of Michigan Health-West in Wyoming, Michigan. In fact, according to a recent study published in the Journal of the American Heart Association, while heavy coffee consumption resulted in an increased risk of cardiovascular disease mortality among individuals with severe hypertension (Stage 2 or 3), this correlation was not found among individuals with blood pressure readings that were normal, elevated, or Stage 1 hypertension.

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Your best bet? Avoid excessive caffeine consumption if you have hypertension, whether you’re on beta blockers or not. “Anyone in the severe range (Stage 2-3) is not meant to have more than one cup per day,” Dr. Helzer says. He adds that if you’re going to drink coffee on beta blockers, stick with one cup in the morning with no more than 200 mg of caffeine, and be sure to stay well-hydrated, drinking two cups of water per cup of coffee. If you’re an all-day coffee drinker, try swapping out most of your regular coffee for decaf, which won’t have the same effect.

And if you are on beta blockers due to a tachyarrhythmia (abnormal heart rhythm marked by a ventricular rate of 100+ beats per minute) such as atrial fibrillation, palpitations, etc., you should limit your caffeine intake—that’s not so much because of the beta blocker, but due to the underlying condition, adds Carlos Ince, MD, a board-certified cardiologist at The Heart Center at Mercy in Baltimore, Maryland.

How coffee affects the body

Coffee and/or caffeine increases alertness and decreases fatigue, says Dr. Nooristani. And while it may help you feel more awake at first, it can also lead to increased anxiety, irritability, difficulty sleeping, and an increase in heart rate and blood pressure—especially when consumed in large quantities or over an extended period of time. 

“When combined with beta blockers, this nervousness and anxiety can cause an increase in your heart rate, even when you aren’t exercising or experiencing any physical exertion,” Dr. Nooristani says.

According to the U.S. National Library of Medicine, caffeine can have the following effects, depending on the individual:

• Makes you feel more awake and provides an energy boost
• Acts as a diuretic, causing you to urinate more frequently (and potentially causing dehydration) 
• Increases acidity levels in the stomach, which can cause digestive upset or heartburn
• Interferes with the absorption of calcium in the body
• Increases your blood pressure

Best practices for taking beta blockers

In order to get the most out of taking beta blockers, Dr. Nooristani recommends taking the medication with food. Dr. Helzer advises staying hydrated, engaging in regular physical activity, and paying attention to concerning symptoms like waves of fatigue, shortness of breath, and swelling in your legs—all of which warrant a conversation with your provider. 

In addition to limiting your caffeine consumption via coffee, tea, and energy drinks, it’s best to avoid the following while on beta blockers:

• Decongestants: Cough and cold meds containing pseudoephedrine or phenylephrine can increase your blood pressure and heart rate, so make sure any products you take do not contain these ingredients as they can counteract the effects of your beta blockers.
• Antacids containing aluminum: Research indicates that taking an aluminum-containing antacid may interfere with the absorption of beta blockers, so these medications should not be taken together.
• Alcohol: The use of alcohol should be limited or avoided altogether when taking beta blockers. That’s because alcohol can make beta blockers less effective or cause your blood pressure to drop.
• Grapefruit juice: Grapefruit juice can interfere with many medications, including certain beta blockers, by reducing the medication’s absorption, says Dr. Helzer. For this reason, check with your healthcare provider or pharmacist before combining the two. 

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As a general rule, any major lifestyle changes you make should be discussed with your healthcare provider in advance, says Dr. Helzer. Maybe you’re on beta blockers and you usually drink two cups of coffee each morning, but you suddenly increase your intake. Or maybe you’re starting to train for a race, and you’ve never exercised before. In either scenario, your healthcare team needs to know so they can monitor the safety and efficacy of your blood pressure medication.