Off-Label Explorations: Beta Blockers Misuse among University Students in Jordan

Authors

DOI:

https://doi.org/10.71164/socialmedicine.v18i2.2025.1829

Keywords:

propranolol, jordan, university students, beta blockers

Abstract

Background and purpose. The off-label use of beta-blockers among university students for cognitive enhancement and stress
reduction has raised concerns due to potential health risks and implications for educational institutions. This study aims to
explore the prevalence, patterns, and perceptions of the use of beta-blockers among university students in Jordan, and to examine
the associated demographic factors and health outcomes.Methods. A cross-sectional survey was conducted in Jordan, involving
students from seven public and private universities. The survey included demographic questions and detailed inquiries about the
use of beta-blockers. A total of 1,248 students participated in the study.Results. Of the participants, 4.29% reported using betablockers,
with Propranolol being the most common. Usage was occasional, primarily before stressful academic events. While
75.7% of users reported achieving their desired outcomes, there was a significant trend of self-adjusting doses without medical
consultation. Side effects were reported by 25.6% of users, and a substantial portion relied on informal networks for information
about beta-blockers.Conclusions. The study underscores a modest but significant engagement in use of beta-blockers among
university students in Jordan for non-medical purposes, primarily driven by academic stress. The findings highlightthe need for
increased awareness of the risks of unsupervised use, the importance of reliable information sources, and alternative stress
management strategies. Educational institutions, in collaboration with healthcare providers, should promote healthier coping
mechanisms and implement policies to regulate and monitor prescription medication distribution among students, emphasizing
the importance of professional medical advice.

Author Biographies

Layla Nazzal, The University of Jordan, Jordan.

Layla Nazzal

Toqa Awaisheh, The University of Jordan, Jordan



Raneem Alzu'bi, The University of Jordan, Jordan.



References

Almasdy, D., &Sharrif, A. (2011). Self-Medication Practice with Nonprescription Medication among University Students: a review of the literature. Archives of Pharmacy Practice, 2(3-2011), 95-100

Petkova V, Georgieva D, Dimitrov M, Nikolova I. Off-Label Prescribing in Pediatric Population—Literature Review for 2012–2022. Pharmaceutics 2023, Vol 15, Page 2652 [Internet]. 2023 Nov 21 [cited 2024 Mar 7];15(12):2652. Available from: https://www.mdpi.com/1999-4923/15/12/2652/htm DOI: https://doi.org/10.3390/pharmaceutics15122652

Allen HC, Garbe MC, Lees J, Aziz N, Chaaban H, Miller JL, et al. Off-Label Medication use in Children, More Common than We Think: A Systematic Review of the Literature. J Okla State Med Assoc [Internet]. 2018 Oct [cited 2024 Mar 7];111(8):776. Available from: /pmc/articles/PMC6677268/

Cavaco AM, Ribeiro J, Nørgaard LS. Exploring the use of cognitive enhancement substances among Portuguese university students. Exploratory Research in Clinical and Social Pharmacy. 2022 Mar 1; 5:100097. DOI: https://doi.org/10.1016/j.rcsop.2021.100097

Sharif S, Guirguis A, Fergus S, Schifano F. The Use and Impact of Cognitive Enhancers among University Students: A Systematic Review. Brain Sciences 2021, Vol 11, Page 355 [Internet]. 2021 Mar 10 [cited 2024 Mar 7];11(3):355. Available from: https://www.mdpi.com/2076-3425/11/3/355/htm DOI: https://doi.org/10.3390/brainsci11030355

Abdelnasser A, Hamad R, Raju AB, Nasser AA, Mohammed H, Akondi BR. Prevalence of B-Blockers Misuse for Exam Stress and Anxiety Management among Health Professions Students in Jeddah, Saudi Arabia. Article in Journal of Ecophysiology and Occupational Health [Internet]. 2020 [cited 2024 Mar 7];20(2):1–8. Available from: https://www.researchgate.net/publication/340941423 DOI: https://doi.org/10.18311/jeoh/2020/24971

Bornand D, Reinau D, Jick SS, Meier CR. β-Blockers and the Risk of Depression: A Matched Case–Control Study. Drug Saf [Internet]. 2022 Feb 1 [cited 2024 Mar 7];45(2):181–9. Available from: https://link.springer.com/article/10.1007/s40264-021-01140-5 DOI: https://doi.org/10.1007/s40264-021-01140-5

van der Zanden TM, Smeets NJL, de Hoop‐Sommen M, Schwerzel MFT, Huang HJ, Barten LJC, et al. Off‐Label, but on‐Evidence? A Review of the Level of Evidence for Pediatric Pharmacotherapy. ClinPharmacolTher. 2022 Dec 25;112(6):1243–53. DOI: https://doi.org/10.1002/cpt.2736

Pokan R, Huonker M, Lehmann M, Dickhuth HH, Keul J. [Effect of beta blockade on hemodynamics in physical exertion]. Wien Med Wochenschr [Internet]. 1990 Apr 1 [cited 2024 Mar 7];140(6–7):178–84. Available from: https://europepmc.org/article/med/1971981

Lipworth B, Wedzicha J, Devereux G, Vestbo J, Dransfield MT. Beta-blockers in COPD: time for reappraisal. European Respiratory Journal [Internet]. 2016 Sep 1 [cited 2024 Mar 7];48(3):880–8. Available from: https://erj.ersjournals.com/content/48/3/880 DOI: https://doi.org/10.1183/13993003.01847-2015

Carpenter M, Berry H, Pelletier AL. Clinically Relevant Drug-Drug Interactions in Primary Care. AmFam Physician [Internet]. 2019 May 1 [cited 2024 Mar 7];99(9):558–64. Available from: https://www.aafp.org/pubs/afp/issues/2019/0501/p558.html

Blaufarb I, Pfeifer TM, Frishman WH. β-Blockers: Drug Interactions of Clinical Significance. Drug Saf [Internet]. 1995 Oct 27 [cited 2024 Mar 7];13(6):359–70. Available from: https://link.springer.com/article/10.2165/00002018-199513060-00005 DOI: https://doi.org/10.2165/00002018-199513060-00005

Butt, J. H., Dalsgaard, S., Torp-Pedersen, C., Køber, L., Gislason, G. H., Kruuse, C., &Fosbøl, E. L. (2017). Beta-blockers for exams identify students at high risk of psychiatric morbidity. Journal of child and adolescent psychopharmacology, 27(3), 266-273 DOI: https://doi.org/10.1089/cap.2016.0079

Carracedo-Martínez, E., Pia-Morandeira, A., &Figueiras, A. (2020). Factors associated with off-label drug use in primary care: A systematic review. Journal of Clinical Pharmacy and Therapeutics, 45(2), 270-280. doi:10.1111/jcpt.13077 DOI: https://doi.org/10.1111/jcpt.13077

Jemal, K., Hailu, D., &Mekonen, D. (2018). Self-medication practices and contributing factors among health professionals in Harar, eastern Ethiopia. PLOS ONE, 13(3), e0194318. doi:10.1371/journal.pone.0194318. DOI: https://doi.org/10.1371/journal.pone.0194318

World Health Organization. (2016). Health systems strengthening: Glossary. Geneva: WHO.

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179-211. DOI: https://doi.org/10.1016/0749-5978(91)90020-T

Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40(4), 471-499. DOI: https://doi.org/10.1348/014466601164939

Norman, P., & Conner, M. (2005). Predicting and changing health behaviour: Future directions. In M. Conner & P. Norman (Eds.), Predicting health behaviour: Research and practice with social cognition models (pp. 324-371). Open University Press.

Webb, T. L., &Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132(2), 249-268. DOI: https://doi.org/10.1037/0033-2909.132.2.249

Godin, G., &Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2), 87-98. DOI: https://doi.org/10.4278/0890-1171-11.2.87

Schelle KJ, Olthof BMJ, Reintjes W, Bundt C, Gusman-Vermeer J, van Mil ACCM. A survey of substance use for cognitive enhancement by university students in the Netherlands. Front SystNeurosci. 2015 Feb 17;9. DOI: https://doi.org/10.3389/fnsys.2015.00010

Alsini A, Alkhodaidi I, Alsini Y, Alsseeni S, Alkhodaidi S, Alsini E, et al. A national survey of self-prescription of beta-blockers and their relation to undiscovered anxiety among medical and pharmacological students in Saudi Arabia. Neuropsychiatr Dis Treat. 2021;17:797–807. DOI: https://doi.org/10.2147/NDT.S289833

Tounsi AA, Alnowaiser A, Alsuhibani A, Alsadhan L, Hamdan HM. Dental students’ attitude towards propranolol non‐medical use: A multi‐institutional cross‐sectional study in Riyadh, Saudi Arabia. European Journal of Dental Education. 2022 Nov 2;26(4):787–93. DOI: https://doi.org/10.1111/eje.12761

Alkhatabi R, Alowfi J, Arshad L, Khan MA. The Prevalence of Beta-Blocker Use Among Medical Students at King Saud bin Abdulaziz University for Health Sciences in Jeddah, Saudi Arabia: A Cross-Sectional Study. Cureus. 2020 Nov 11; DOI: https://doi.org/10.7759/cureus.11450

McCabe SE, Teter CJ, Boyd CJ. Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs. Journal of American College Health. 2006 Mar;54(5):269–78. DOI: https://doi.org/10.3200/JACH.54.5.269-278

Rathod P, Sharma S, Ukey U, Sonpimpale B, Ughade S, Narlawar U, et al. Prevalence, Pattern, and Reasons for Self-Medication: A Community-Based Cross-Sectional Study From Central India. Cureus. 2023 Jan;15(1): e33917. DOI: https://doi.org/10.7759/cureus.33917

Published

2025-05-01

Issue

Section

Original Research