It is recognised that β-blockers often produce central nervous effects, notably lassitude, depression, poor concentration, nightmares and other sleep disturbances, and occasionally hallucinations and psychosis. Such central effects have been reported most often with propranolol, probably because it is the oldest and most widely used compound. Other lipophilic β-blockers, e.g. oxprenolol, metoprolol and pindolol, seem similarly liable to cause them. Atenolol, which is hydrophilic and enters the brain more slowly and in relatively smaller amounts, can also cause various central affects but is claimed to do so rarely.1The relationship between CNS effects and lipid solubility is however disputed.
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