ModerateOral hypoglycemic agents. Sulfonylureas×Non-selective beta blocker
Updated · Methodology
Mechanism
Beta-blockers mask adrenergic hypoglycaemia symptoms (tachycardia, tremor), leaving only sweating. Severe unrecognised hypoglycaemia risk rises in sulfonylurea-treated patients, especially older patients.
Symptoms
Sweating, confusion, vision changes, loss of contact. Adrenergic symptoms (tachycardia, tremor) are suppressed — the patient misses the hypoglycaemia.
Management
Do not prescribe propranolol in diabetes. Alternatives: cardioselective beta-blockers (metoprolol, bisoprolol, nebivolol) — minimally mask hypoglycaemia. Replace glibenclamide with modern glucose-lowering agents with lower hypoglycaemia risk: gliclazide MR, metformin, SGLT-2 inhibitors (dapagliflozin, empagliflozin), GLP-1 agonists (semaglutide, liraglutide). If the combination is unavoidable, teach the patient to recognise hypoglycaemia via sweating.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- ADA: Standards of Care in Diabetes 2024 – pharmacologic approaches to glycemic treatment (2024)– Diabetes Care 2024;47(Suppl 1):S158-S178
- AEMPS: Ficha técnica: Propranolol (nº registro 89692), sección 4.4 (2026)– AEMPS, CIMA, nº registro 89692, revisión 05/2026, sección 4.4