summary
A 71-year-old man had had visual hallucinations and vivid dreams for two years after starting to take metoprolol. When metoprolol was replaced by atenolol the patient's symptoms disappeared within five days. Side-effects of beta-blockers on the central nervous system are relatively uncommon. The mechanisms underlying these side-effects are not fully understood. Lipophilic beta-blockers can cross the blood-brain barrier, whereas hydrophilic beta-blockers cannot. Doctors need to be alerted to the varying side-effects of specific beta-blockers.