Editing Beta blocker (section)

=== Blood–brain barrier permeability ===
Beta blockers vary in their [[lipophilicity]] (fat solubility) and in turn in their ability to cross the [[blood–brain barrier]] and exert effects in the [[central nervous system]].<ref name="pmid33572109">{{cite journal | vauthors = Cojocariu SA, Maștaleru A, Sascău RA, Stătescu C, Mitu F, Leon-Constantin MM | title = Neuropsychiatric Consequences of Lipophilic Beta-Blockers | journal = Medicina | volume = 57 | issue = 2 | date = February 2021 | page = 155 | pmid = 33572109 | pmc = 7914867 | doi = 10.3390/medicina57020155 | doi-access = free }}</ref> Beta blockers with greater blood–brain barrier [[Vascular permeability|permeability]] can have both [[neuropsychiatric]] therapeutic benefits and [[side effect]]s, as well as adverse [[cognition|cognitive]] effects.<ref name="pmid33572109" /> Central nervous system-related side effects and risks of beta blockers may include [[fatigue (medical)|fatigue]], [[depression (mood)|depression]], [[sleep disorder]]s (namely [[insomnia]]) and [[nightmare]]s, [[visual hallucination]]s, [[delirium]], [[psychosis]], [[Parkinson's disease]], and [[falling (accident)|falling]].<ref name="pmid33572109" /> Conversely, central nervous system-related benefits of beta blockers may include prevention and treatment of [[migraine]], [[essential tremor]], [[akathisia]], [[anxiety]], [[post-traumatic stress disorder]], [[aggression]], and [[obsessive–compulsive disorder]].<ref name="pmid33572109" />

Most beta blockers are lipophilic and can cross into the brain, but there are a number of exceptions.<ref name="pmid33572109" /> Highly lipophilic beta blockers include [[penbutolol]], [[pindolol]], [[propranolol]], and [[timolol]], moderately lipophilic beta blockers include [[acebutolol]], [[betaxolol]], [[bisoprolol]], [[carvedilol]], [[metoprolol]], and [[nebivolol]], and low lipophilicity or hydrophilic beta blockers include [[atenolol]], [[carteolol]], [[esmolol]], [[labetalol]], [[nadolol]], and [[sotalol]].<ref name="pmid33572109" /> It is thought that highly lipophilic beta blockers are able to readily cross into the brain, moderately lipophilic beta blockers are able to cross to a lesser degree, and low lipophilicity or hydrophilic beta blockers are minimally able to cross.<ref name="pmid33572109" /> More lipophilic beta-blockers are known to suppress melatonin release by 50-80%.<ref>{{Cite journal |last1=Stoschitzky |first1=K. |last2=Sakotnik |first2=A. |last3=Lercher |first3=P. |last4=Zweiker |first4=R. |last5=Maier |first5=R. |last6=Liebmann |first6=P. |last7=Lindner |first7=W. |date=April 1999 |title=Influence of beta-blockers on melatonin release |url=https://pubmed.ncbi.nlm.nih.gov/10335905/ |journal=European Journal of Clinical Pharmacology |volume=55 |issue=2 |pages=111–115 |doi=10.1007/s002280050604 |issn=0031-6970 |pmid=10335905|s2cid=32317760 }}</ref><ref>{{Cite journal |last1=Tikhomirova |first1=O. V. |last2=Zybina |first2=N. N. |last3=Kozhevnikova |first3=V. V. |date=2022-05-01 |title=Effects of Prolonged Use of β-Adrenoblockers on Melatonin Secretion, Sleep Quality, and Vascular Brain Damage |url=https://doi.org/10.1007/s11055-022-01270-y |journal=Neuroscience and Behavioral Physiology |language=en |volume=52 |issue=4 |pages=500–504 |doi=10.1007/s11055-022-01270-y |s2cid=250708105 |issn=1573-899X}}</ref><ref>{{Cite journal |last1=Gehrman |first1=Philip R. |last2=Anafi |first2=Ron C. |date=October 2021 |title=Treatment of a patient with a circadian sleep-wake disorder using a combination of melatonin and metoprolol |journal=Journal of Clinical Sleep Medicine |language=en |volume=17 |issue=10 |pages=2121–2124 |doi=10.5664/jcsm.9410 |issn=1550-9389 |pmc=8494102 |pmid=34032203}}</ref> The preceding beta blockers also vary in their [[intrinsic sympathomimetic activity]] and [[beta-1 adrenergic receptor|β<sub>1</sub>-adrenergic receptor]] [[binding selectivity|selectivity]] (or cardioselectivity), resulting in further differences in pharmacological profiles and suitability in different contexts between them.<ref name="pmid33572109" />