How does metoprolol affect energy levels. What are the common side effects of beta-blockers. Can metoprolol make you feel tired or drowsy. How to manage fatigue caused by blood pressure medications.

The Link Between Metoprolol and Fatigue: Exploring Beta-Blocker Side Effects

Metoprolol, a commonly prescribed beta-blocker medication, is known to potentially cause fatigue in some patients. This side effect is not unique to metoprolol but is characteristic of many medications in the beta-blocker class. Understanding the relationship between metoprolol and fatigue is crucial for patients and healthcare providers alike.

Is fatigue a common side effect of metoprolol? Indeed, fatigue is one of the more frequently reported side effects of metoprolol and other beta-blockers. The mechanism behind this fatigue is related to how beta-blockers work in the body. By slowing down the heart rate and reducing blood pressure, these medications can sometimes lead to a feeling of tiredness or lack of energy.

How Metoprolol Affects the Body

Metoprolol belongs to a class of drugs called beta-blockers. These medications work by blocking the effects of the hormone epinephrine, also known as adrenaline. By doing so, they help the heart beat more slowly and with less force, which in turn lowers blood pressure. This action is beneficial for treating various cardiovascular conditions, but it can also lead to side effects like fatigue.

• Slows heart rate
• Reduces blood pressure
• Decreases cardiac output
• Affects energy metabolism

Does metoprolol affect everyone the same way? No, the effects of metoprolol can vary from person to person. While some individuals may experience significant fatigue, others might have minimal or no fatigue at all. Factors such as dosage, individual physiology, and concurrent medications can all influence how a person responds to metoprolol.

Common Side Effects of Metoprolol: Beyond Fatigue

While fatigue is a notable side effect of metoprolol, it’s not the only one patients should be aware of. Understanding the full spectrum of potential side effects can help patients better manage their health and communicate effectively with their healthcare providers.

Cardiovascular Side Effects

Metoprolol’s primary action on the cardiovascular system can lead to several related side effects:

• Bradycardia (slowed heart rate)
• Hypotension (low blood pressure)
• Dizziness or lightheadedness
• Cold hands and feet

Are these cardiovascular side effects dangerous? While these side effects are generally not dangerous, they can be uncomfortable and may require medical attention if severe or persistent. It’s important for patients to monitor their symptoms and report any concerns to their healthcare provider.

Gastrointestinal Side Effects

Some patients may experience gastrointestinal issues while taking metoprolol:

• Nausea
• Stomach pain
• Constipation or diarrhea
• Loss of appetite

Neurological and Psychological Side Effects

Metoprolol can also affect the nervous system, leading to various neurological and psychological side effects:

• Headaches
• Depression
• Memory problems
• Confusion
• Nightmares or vivid dreams

Can metoprolol cause mood changes? Yes, some patients report experiencing mood changes, including depression, while taking metoprolol. These psychological side effects should be taken seriously and discussed with a healthcare provider if they occur.

Fatigue Management Strategies for Metoprolol Users

For patients experiencing fatigue while taking metoprolol, there are several strategies that can help manage this side effect without compromising the medication’s therapeutic benefits.

Lifestyle Modifications

Making certain lifestyle changes can help combat fatigue:

• Regular exercise (with doctor’s approval)
• Improved sleep hygiene
• Balanced diet
• Stress reduction techniques

How can exercise help with metoprolol-induced fatigue? Regular physical activity can improve overall energy levels and cardiovascular fitness. However, it’s crucial to consult with a healthcare provider before starting any new exercise regimen while on metoprolol.

Dosage Adjustment

In some cases, adjusting the dosage of metoprolol can help alleviate fatigue:

• Splitting the dose
• Changing the timing of doses
• Gradual dose reduction (under medical supervision)

Is it safe to adjust metoprolol dosage on your own? No, patients should never adjust their metoprolol dosage without consulting their healthcare provider. Abrupt changes in dosage can lead to serious side effects.

Alternative Medications

If fatigue persists and significantly impacts quality of life, healthcare providers might consider alternative medications:

• Different beta-blockers
• ACE inhibitors
• Calcium channel blockers
• Angiotensin II receptor blockers

Comparing Metoprolol to Other Beta-Blockers: Fatigue Profiles

While all beta-blockers can potentially cause fatigue, the extent and frequency of this side effect can vary among different medications within this class.

Cardioselective vs. Non-Cardioselective Beta-Blockers

Metoprolol is a cardioselective beta-blocker, meaning it primarily affects the heart. Other beta-blockers may have different selectivity profiles:

• Atenolol (cardioselective)
• Propranolol (non-cardioselective)
• Carvedilol (non-cardioselective)

Do cardioselective beta-blockers cause less fatigue? Generally, cardioselective beta-blockers like metoprolol may cause less fatigue compared to non-cardioselective ones. However, individual responses can vary, and some patients may experience fatigue regardless of the type of beta-blocker used.

Comparative Studies on Beta-Blocker Fatigue

Research has been conducted to compare the fatigue profiles of different beta-blockers:

• Metoprolol vs. Atenolol
• Metoprolol vs. Propranolol
• Metoprolol vs. Nebivolol

What do these comparative studies reveal? While results can vary, some studies suggest that newer beta-blockers like nebivolol may have a more favorable side effect profile, including less fatigue, compared to older medications like metoprolol. However, more research is needed to fully understand these differences.

Long-Term Effects of Metoprolol Use: Fatigue Considerations

For patients prescribed metoprolol for chronic conditions, understanding the long-term implications of its use, particularly regarding fatigue, is crucial.

Adaptation and Tolerance

Some patients may experience a reduction in fatigue over time:

• Initial adjustment period
• Potential for decreased fatigue with continued use
• Individual variability in adaptation

Does fatigue from metoprolol always persist long-term? Not necessarily. Some patients report that fatigue symptoms improve over time as their body adjusts to the medication. However, this is not universal, and some individuals may continue to experience fatigue throughout their treatment.

Monitoring and Follow-Up

Regular monitoring is essential for long-term metoprolol use:

• Periodic assessments of fatigue levels
• Regular blood pressure and heart rate checks
• Evaluation of overall quality of life

Metoprolol and Exercise: Balancing Cardiovascular Benefits and Fatigue

For many patients, reconciling the need for exercise with the fatigue induced by metoprolol can be challenging. Understanding how to approach physical activity while on this medication is crucial for maintaining overall health and managing side effects.

Exercise Capacity and Metoprolol

Metoprolol can affect exercise capacity in several ways:

• Reduced maximum heart rate
• Decreased cardiac output during exertion
• Potential for increased perceived exertion

How does metoprolol impact athletic performance? Metoprolol can limit the maximum heart rate achievable during exercise, which may result in a decreased capacity for high-intensity activities. However, this does not necessarily mean that all forms of exercise are contraindicated or impossible.

Adapting Exercise Routines

Patients on metoprolol can adapt their exercise routines to accommodate the medication’s effects:

• Focus on moderate-intensity activities
• Gradually increase exercise duration and frequency
• Incorporate strength training and flexibility exercises
• Pay attention to perceived exertion rather than heart rate alone

Is it safe to exercise while taking metoprolol? In most cases, exercise is not only safe but beneficial for patients taking metoprolol. However, it’s crucial to start slowly and gradually increase intensity under the guidance of a healthcare provider.

Drug Interactions: Compounds That May Exacerbate Metoprolol-Induced Fatigue

Understanding potential drug interactions is crucial for patients taking metoprolol, as certain medications can intensify fatigue or alter the effectiveness of the beta-blocker.

Common Interacting Medications

Several types of medications can interact with metoprolol:

• Other blood pressure medications
• Certain antidepressants
• Some antiarrhythmic drugs
• Specific antifungal medications

Can combining metoprolol with other medications increase fatigue? Yes, certain drug combinations can potentially increase fatigue. For example, taking metoprolol alongside other medications that lower blood pressure or heart rate may amplify these effects, leading to increased fatigue.

Herbal Supplements and Over-the-Counter Medications

Even seemingly harmless substances can interact with metoprolol:

• St. John’s Wort
• Grapefruit juice
• Some cold and flu medications
• Certain pain relievers

Is it necessary to inform healthcare providers about all supplements and over-the-counter medications? Absolutely. Patients should always provide a comprehensive list of all substances they are taking, including herbal supplements and over-the-counter medications, to their healthcare providers to avoid potential interactions and manage side effects effectively.

Patient Experiences: Real-World Accounts of Metoprolol and Fatigue

While clinical data provides valuable insights, understanding real-world patient experiences with metoprolol-induced fatigue can offer a more nuanced perspective on this side effect.

Diverse Patient Narratives

Patient experiences with metoprolol and fatigue can vary widely:

• Some report minimal to no fatigue
• Others experience significant tiredness affecting daily activities
• Many describe a period of adjustment followed by improvement
• Some patients find the fatigue persistent and challenging

How do patient experiences help in understanding metoprolol-induced fatigue? Personal accounts can provide valuable insights into the range and severity of fatigue experiences, helping both patients and healthcare providers set realistic expectations and develop tailored management strategies.

Coping Strategies Shared by Patients

Many patients have developed their own methods for managing fatigue:

• Adjusting daily schedules to accommodate energy levels
• Incorporating short naps or rest periods
• Experimenting with timing of medication doses
• Engaging in gentle, regular exercise
• Prioritizing sleep hygiene and stress reduction

Can patient-developed strategies be universally applied? While these strategies can be helpful, it’s important to remember that what works for one patient may not work for another. Any significant changes in medication regimen or lifestyle should be discussed with a healthcare provider.

Understanding the complex relationship between metoprolol and fatigue is crucial for patients and healthcare providers alike. While fatigue is a recognized side effect of this beta-blocker, its impact can vary significantly among individuals. By exploring management strategies, considering alternative medications when necessary, and maintaining open communication with healthcare providers, many patients can successfully balance the therapeutic benefits of metoprolol with manageable side effects. As with any medication, the key lies in personalized care and ongoing monitoring to ensure optimal health outcomes.

Medications That Can Cause Fatigue & Drowsiness

Written by Terri D’Arrigo

Medically Reviewed by Poonam Sachdev on November 29, 2021

• Medications That Cause Fatigue
• What You Can Do

You expect to feel tired if you take a sleeping pill, but other kinds of medications can cause fatigue, too. It’s one of the most common side effects of prescription and over-the-counter medicines.

When medicines make you tired, it is often because they affect chemicals in your brain called neurotransmitters. Your nerves use them to carry messages to each other. Some of them control how awake or sleepy you feel.

Some of the most common drugs that can make you tired are:

Allergy medications (antihistamines), such as brompheniramine (Bromfed, Dimetapp), diphenhydramine, hydroxyzine (Vistaril, Atarax), and meclizine (Antivert). Some of these antihistamines are in sleeping pills, too.

Antidepressants. One type of antidepressant called tricyclics can make you feel tired and sleepy. Some are more likely to do that than others, like amitriptyline (Elavil, Vanatrip), doxepin (Silenor, Sinequan), imipramine (Tofranil, Tofranil PM), and trimipramine (Surmontil).

Anxiety medications. Benzodiazepines like alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) can make you feel drowsy or weak for a few hours to several days, depending on which one you take.

Blood pressure medications. Beta-blockers, like atenolol (Tenormin), metoprolol tartrate (Lopressor), metoprolol succinate (Toprol XL), and propranolol hydrochloride (Inderal), to name a few. They work by slowing down your heart, which can make you tired.

Cancer treatment. Different types of cancer treatment can make you very tired by changing protein and hormones levels in your body. As they kill cancer cells, they also damage or destroy some normal cells. Then your body has to spend extra energy to fix or clean up the cells.

Gut medications. Drugs that control nausea, keep you from throwing up, or treat diarrhea can make you sleepy.

Muscle relaxants. Most muscle relaxants don’t work on your muscles directly. Instead, they work on the nerves in your brain and spine to make the muscles relax. Their effects on your nervous system can make you tired. Some common muscle relaxants are carisoprodol (Soma) and cyclobenzaprine (Flexeril).

Opioid pain medications. Opioids act like the chemicals your body makes to control pain, called endorphins. Common ones are fentanyl (Actiq, Duragesic, Fentora), oxycodone and aspirin (Percodan), oxycodone and acetaminophen (Percocet, Roxicet), morphine, oxymorphone (Opana, Opana ER), oxycodone (OxyContin, OxyIR),and hydrocodone and acetaminophen (Lorcet, Lortab, Vicodin).

Seizure or epilepsy medications. Also called anticonvulsants, these medications can work on your brain cells or the chemicals they use to send messages. Some of these drugs are the same ones that treat anxiety, like benzodiazepines. Other common seizure medications are carbamazepine (Tegretol/Tegretol XR/Carbatrol), phenobarbital, phenytoin (Dilantin, Phenytek), topiramate (Topamax), and valproic acid (Depakene, Depakote).

If the kind of medication you take is not listed here, check the label for words like “may cause drowsiness.” That can help you know what to expect while you take it.

If your medicine makes you feel worn out, don’t stop taking it. You can try other ways to fight the side effect and get an energy boost:

• Get some exercise, like a quick walk or some stretches.
• Take deep breaths.
• Drink a little bit of caffeine, like coffee or tea.

If you’re taking an over-the-counter medication, ask your doctor or pharmacist if there are “non-drowsy” versions of it you can use instead. It’s important to ask to make sure it won’t affect any other medications you’re taking.

Your doctor can help you handle any fatigue you feel from prescription medications. They might:

• Change your medication
• Change your dose
• Tell you to take your medicine at a different time, like in the evening or before bed
• Prescribe a medication to help you feel alert and awake

Don’t take any medications that are supposed to help you stay awake, unless your doctor says it’s OK.

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What are the side effects of Metoprolol (Lopressor / Toprol XL)?

Written by: Nicole Mitton

Reviewed by: Dr Tamlyn Maree

• Metoprolol (Lopressor / Toprol XL)
• Warnings when taking Metoprolol (Lopressor / Toprol XL)?
• What are the side effects of Metoprolol (Lopressor / Toprol XL)?
• Can Metoprolol (Lopressor / Toprol XL) interfere with other medications?
• Metoprolol (Lopressor / Toprol XL) outlook

There are a number of possible metoprolol side effects, it is best to speak to your doctor about these and consult with him/her should any of these persist and become bothersome. The side effects listed below pertain to the orally administered form of this medication.

• NOTE: If you experience symptoms of an allergic reaction which often involve a combination of itching, the development of a rash or hives, difficulty breathing and noticeable swelling of the face, lips, throat and / or tongue visit your doctor or an emergency room immediately.

Common metoprolol side effects

Some of the more common side effects that may be experienced when taking metoprolol (sold as Lopressor, Toprol XL, Betaloc, Lopresor) include:

• Bradycardia (abnormally slow heart beat): This is defined as a resting heart rate of 60 beats per minute or less. Metoprolol slows down nerve impulses travelling from the brain to the heart, which can, in turn, slow your heart rate. A severely lowered pulse can compromise oxygen flow to the brain and body. Symptoms of this condition include:
  • Fatigue
  • Confusion
  • Dizziness
  • Shortness of breath
  • Fainting
  • Chest pains
  • Cold hands and feet

  
  If you experience severe symptoms, visit your doctor or nearest emergency room.

• Cold hands and feet: The slowing of the heart rate and lowering of the blood pressure caused by this medication can result in decreased circulation and less blood being pumped to the hands and feet. This results in a loss of warmth, making them feel cold and, on occasion, painful.
• Diarrhoea: Metoprolol can block the nerve signals sent from the brain to the gut which can affect the digestive system, either speeding it up or slowing it down. If it moves faster it can result in diarrhoea, and if it moves slower it results in constipation.
• Dizziness: Due to its blood pressure lowering effects, metoprolol may cause mild dizziness, particularly when moving quickly from a lying or seated position to a standing one (this has been reported in 2 to 10% of users). This feeling will often disappear when the body has adjusted to the drug. However, severe drops in blood pressure may result in severe dizziness and fainting, which is considered a serious side effect. It is best to consult with a doctor should you experience either of these.
• Fatigue, drowsiness and weakness: Metoprolol will slow your heart rate down by blocking the hormone adrenaline. This results in blood being transported to the brain and body at a slower pace, making some feel tired (reported in 1 to 10% of cases), drowsy and weak. This symptom may fade after a few days when first taking the drug as the body adapts to its effects. If fatigue persists or worsens, speak to your doctor.
• Gastrointestinal issues: In addition to diarrhoea, metoprolol may cause other gastrointestinal issues such as constipation, abdominal pain, heartburn, bloating, gas, flatulence, nausea and vomiting.
• Headache
• Heart palpitations: With beta blocker use the atrium (the upper chamber in which blood enters the heart) does not fill or contract as hard and effectively. The atrium then becomes stretched and stiff. This causes poor conduction of the electric signal telling the heart to contract and ultimately leads to irregular heartbeats and atrial fibrillation (a condition wherein the upper and lower chambers of the heart to beat irregularly out of sync). If you experience palpitations, shortness of breath and fatigue after taking metoprolol, speak to your doctor as he/she may wish to change your medication.
• Hypotension (low blood pressure): Metoprolol is prescribed to lower blood pressure. If the dosage is too high, this may result in a severe drop in blood pressure. This can also be a result of heart receptors being overly sensitive to the drug. Symptoms of hypotension may include light-headedness, severe dizziness or fainting.
• Shortness of breath: This symptom may be experienced, particularly when engaging in physical activity, due to the fact that metoprolol hinders the effect of adrenaline (epinephrine) and noradrenaline (norepinephrine) on the lungs. These hormones relax the small airways (bronchioles) of the lungs, making breathing easier, when they are inhibited, shortness of breath may occur. Metoprolol also affects cardiac output (reducing the volume of blood that is pumped by the heart) which can decrease the amount of oxygen in the body, leaving you short of breath. If you have a predisposition to respiratory issues or experience this side effect, discuss this with your doctor during your initial consultation or as soon as possible after being prescribed and taking this medication. Beta blockers such as Metoprolol are rarely prescribed to patients with asthma as this medication can exacerbate this condition.

Other side effects of metoprolol

In addition to the above, other side effects may include:

• Chest pain / discomfort: Metoprolol, despite being used to treat chest pain (angina), may actually cause or worsen it in some people. This is due to the fact that it slows the heart rate, which in severe cases can lead to pain. Never ignore chest pain, always get checked out by your doctor to be safe.
• Depression: While depression is often listed as a metoprolol side effect as it has been reported by between 2 and 5% of users in clinical studies¹, comprehensive studies^2,3 which have examined this specific side effect have not conclusively proven or disproven metoprolol’s link to drug-induced depression as yet. It is believed that those suffering from the chronic health problems for which metoprolol is often prescribed may be more susceptible to suffering depression as well. If you do find yourself feeling depressed after using this medication, always consult your doctor.
• Difficulty breathing and coughing: As mentioned above, metoprolol can cause shortness of breath due to the fact that it blocks the action of adrenaline on the lungs and affects the heart’s ability to pump oxygen through the blood, making it more difficult to breathe. In some instances, this inhibitory action may lead to asthma-like symptoms such as trouble breathing. Coughing and wheezing may occur. If you experience these side effects, consult your doctor.
• Fluid retention: This may lead to swelling of the face, limbs, hands and feet.
• Heart conduction disturbances: This may result from a lowered heart rate due to metoprolol use, causing what is known as a first degree atrioventricular block. In this condition, electrical impulses in the heart are slowed, generally symptoms or issues are rare.
• Increase in perspiration / sweating (diaphoresis): Metoprolol can cause heat sensitivity and excessive perspiration in some.
• Musculoskeletal pain and arthralgia (joint pain)
• Skin Issues: Metoprolol may induce the following skin related issues as side effects:
• Pruritis: Metoprolol can cause a severe itching of the skin that may be accompanied by a burning sensation.
• Rash: Skin rashes can start to develop as a result of metoprolol use. Hives and itching can also be experienced, this is considered seriousand it is important to seek professional advice from your doctor should you experience this symptom.
• Tingling in the skin / Pins and needles
• Sleep disturbances: Metoprolol may cause issues with sleep in some, these include:
• Issues with falling and staying asleep (insomnia)
• Nightmares
• Weight gain: Metoprolol (Lopressor, Toprol XL) may cause slight weight gain as a side effect. Generally, a gain of 1.2kg (2.6lb) is average. If you are taking Metoprolol to prevent heart failure and suddenly gain more than this in a day and more than 2.3kg (5.1lb) in a week, make an appointment to see your doctor immediately as this may indicate a build-up of fluid in your body, rather than actual weight gain which may be a result of your condition worsening.
• Worsening of heart failure symptoms: This may occur initially but is usually only temporary and generally resolves. You should work closely with your doctor if your symptoms worsen after taking metoprolol.

Rare metoprolol side effects

Rare metoprolol side effects affect 1 in 1000 people. They are considered to be^4,5:

• Anxiety and nervousness
• Changes in liver test results
• Dry mouth (Xerostomia)
• Hair loss (alopecia): Hair loss may occur, this is, however, reversible once the medication is stopped.
• Irregular heart beat (arrhythmia)
• Runny nose
• Sexual dysfunction: In men metoprolol can disrupt the section of the brain that signals an erection during sexual arousal, causing impotence. The same mechanism can also make orgasm difficult for both sexes when taking this medication.
• Peyronie’s syndrome (a condition which causes the penis to bend on erection) may also occur in rare instances.

• Visual disturbances: Visual side effects reported when taking Metoprolol include:
• Blurred vision which may cause difficulty in focussing on objects both near and far. This is due to the fact that beta blockers like metoprolol can lower intraocular pressure (IOP) by decreasing fluid production in the eye⁶. When IOP is very low, this may lead to blurred vision.
• Double vision
• Dry eyes⁷ (as a result of metoprolol reducing fluid production in the eye)
• Conjunctivitis

• Unstable diabetes

Very rare side effects of metoprolol

Affecting 1 in 10,000 people, very rare metoprolol (lopressor / Toprol XL) side effects include:

• Arthritis
• Changes in blood cells
• Changes in blood triglycerides and a decrease in High Density Lipoprotein (i. e. the ‘good’ type of cholesterol).
• Changes in taste: Things that once tasted good may not taste the same, this can affect appetite.
• Cognitive issues:
• Confusion
• Forgetfulness
• Hallucinations
• Temporary memory loss (amnesia)
• Changes in personality (mood)

• Hearing issues:
• Difficulty hearing
• Ringing in the ears (tinnitus)

• Light sensitivity (photosensitivity)
• Liver inflammation (hepatitis)
• Jaundice (yellowing of the skin, mucous membranes and whites of the eyes due to high levels of bilirubin in the body)
• Psoriasis (new cases or exacerbation of existing ones)
• Tissue death (necrosis) in those suffering from severe circulation disorders.

References

<sup>1. Harvard Health Publishing. Harvard Medical School. October 2015. Is your medication making you depressed? Available: https://www.health.harvard.edu/drugs-and-medications/is-your-medication-making-you-depressed [Accessed 18.07.2018]
2. US National Library of Medicine. December 2008. General Medical Drugs Associated with Depression. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729620/ [Accessed 18.07.2018]
3. US National Library of Medicine. January 2017. Impact of metoprolol treatment on mental status of chronic heart failure patients with neuropsychiatric disorders. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279819/ [Accessed 18.07.2018]
4. The electronic Medicines Compendium (eMC). Metoprolol tartrate film-coated tablets. Available: https://www.medicines.org.uk/emc/files/pil.5200.pdf [Accessed 18.07.2018]
5. US Food and Drug Administration. LOPRESSOR (metoprolol tartrate) tablet. Available: https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017963s062,018704s021lbl.</sup>