Does metoprolol cause drowsiness. What are the common side effects of Lopressor and Toprol XL. How does metoprolol affect heart rate and blood pressure. Can metoprolol lead to gastrointestinal issues.

What is Metoprolol and How Does It Work?

Metoprolol, sold under brand names such as Lopressor and Toprol XL, is a beta-blocker medication primarily used to treat high blood pressure, angina, and certain heart rhythm disorders. It works by blocking the effects of epinephrine (adrenaline) on the heart and blood vessels, thereby slowing heart rate and reducing blood pressure.

This medication belongs to a class of drugs known as beta-adrenergic blocking agents, or simply beta-blockers. By interfering with the body’s stress hormones, metoprolol helps to ease the workload on the heart, making it an effective treatment for various cardiovascular conditions.

How does metoprolol affect the body?

Metoprolol primarily affects the cardiovascular system by:

• Reducing heart rate
• Lowering blood pressure
• Decreasing the heart’s workload
• Improving blood flow to the heart muscle

While these effects are beneficial for many patients with heart conditions, they can also lead to various side effects that users should be aware of.

Common Side Effects of Metoprolol

Like all medications, metoprolol can cause side effects. While not everyone experiences these, it’s important to be aware of potential adverse reactions. Some of the more common side effects include:

Does metoprolol cause fatigue and drowsiness?

Yes, fatigue and drowsiness are common side effects of metoprolol. This occurs because the medication slows down the heart rate and reduces blood flow, which can lead to feelings of tiredness and weakness. These symptoms are reported in 1 to 10% of users and may subside as the body adjusts to the medication. If fatigue persists or worsens, it’s advisable to consult a healthcare provider.

Can metoprolol cause dizziness?

Dizziness is another common side effect of metoprolol, affecting 2 to 10% of users. This is typically due to the medication’s blood pressure-lowering effects. The dizziness may be more pronounced when standing up quickly from a sitting or lying position. While mild dizziness often improves as the body adapts to the medication, severe dizziness or fainting should be reported to a doctor immediately.

How does metoprolol affect heart rate?

Metoprolol can cause bradycardia, or an abnormally slow heart rate. This is defined as a resting heart rate of 60 beats per minute or less. Symptoms of bradycardia may include:

• Fatigue
• Confusion
• Shortness of breath
• Chest pains
• Cold hands and feet

In severe cases, a significantly lowered pulse can compromise oxygen flow to the brain and body, necessitating immediate medical attention.

Gastrointestinal Side Effects of Metoprolol

Metoprolol can affect the digestive system, leading to various gastrointestinal issues. These side effects occur because the medication can interfere with nerve signals sent from the brain to the gut.

Can metoprolol cause diarrhea or constipation?

Yes, metoprolol can cause both diarrhea and constipation. By altering nerve signals to the gut, the medication can either speed up or slow down the digestive process. If digestion moves faster, it can result in diarrhea. Conversely, if it moves slower, constipation may occur.

What other gastrointestinal side effects can metoprolol cause?

In addition to diarrhea and constipation, metoprolol may cause:

• Abdominal pain
• Heartburn
• Bloating
• Gas
• Nausea
• Vomiting

If these symptoms persist or become severe, it’s important to consult with a healthcare provider.

Cardiovascular Side Effects of Metoprolol

While metoprolol is primarily used to treat cardiovascular conditions, it can sometimes cause side effects related to the heart and circulation.

Can metoprolol cause low blood pressure?

Yes, metoprolol can cause hypotension, or low blood pressure. This is actually part of its intended effect, but if the dosage is too high or if the heart receptors are overly sensitive to the drug, it can lead to a severe drop in blood pressure. Symptoms of hypotension may include:

• Light-headedness
• Dizziness
• Fainting
• Blurred vision
• Nausea
• Fatigue

If you experience these symptoms, it’s crucial to seek medical attention promptly.

Does metoprolol affect circulation in the extremities?

Metoprolol can cause cold hands and feet due to its effects on circulation. By slowing the heart rate and lowering blood pressure, the medication can result in decreased blood flow to the extremities. This reduced circulation can make hands and feet feel cold and, in some cases, painful.

Neurological Side Effects of Metoprolol

Metoprolol can affect the nervous system, leading to various neurological side effects.

Can metoprolol cause headaches?

Yes, headaches are a known side effect of metoprolol. While the exact mechanism isn’t fully understood, it’s thought to be related to the medication’s effects on blood vessels in the brain. If headaches are persistent or severe, it’s important to consult with a healthcare provider.

Does metoprolol affect cognitive function?

Some users report experiencing confusion or difficulty concentrating while taking metoprolol. This could be related to the medication’s effects on blood flow to the brain. However, these effects are typically mild and often improve as the body adjusts to the medication.

Allergic Reactions and Severe Side Effects

While rare, severe side effects and allergic reactions to metoprolol can occur and require immediate medical attention.

What are the signs of an allergic reaction to metoprolol?

An allergic reaction to metoprolol may present with the following symptoms:

• Itching
• Rash or hives
• Difficulty breathing
• Swelling of the face, lips, throat, or tongue

If you experience any of these symptoms, seek emergency medical care immediately.

What severe side effects should I watch out for?

While most side effects of metoprolol are mild, some can be more serious. These include:

• Severe dizziness or fainting
• Unusually slow or irregular heartbeat
• Severe weakness
• Shortness of breath
• Swelling of the hands or feet
• Sudden weight gain

If you experience any of these symptoms, contact your healthcare provider immediately.

Managing Side Effects and When to Seek Help

While side effects from metoprolol are common, there are ways to manage them and situations where professional medical help is necessary.

How can I manage mild side effects of metoprolol?

For mild side effects, the following strategies may help:

• Take the medication with food to reduce gastrointestinal symptoms
• Stand up slowly from sitting or lying positions to minimize dizziness
• Stay well-hydrated to help with circulation
• Get regular, moderate exercise as approved by your doctor
• Avoid alcohol, which can worsen side effects

Remember, many side effects improve as your body adjusts to the medication. However, always consult with your healthcare provider before making any changes to your treatment regimen.

When should I contact my doctor about metoprolol side effects?

You should contact your healthcare provider if:

• Side effects persist or worsen over time
• You experience severe side effects like fainting or chest pain
• You have difficulty managing your daily activities due to side effects
• You develop new symptoms after starting metoprolol

Your doctor may adjust your dosage or recommend alternative treatments if side effects are significantly impacting your quality of life.

Drug Interactions and Precautions

Metoprolol can interact with various medications and substances, potentially altering its effectiveness or increasing the risk of side effects.

What medications can interact with metoprolol?

Metoprolol may interact with several types of medications, including:

• Other blood pressure medications
• Certain antidepressants
• Some antiarrhythmic drugs
• Certain antipsychotic medications
• Some antihistamines

Always inform your healthcare provider about all medications, supplements, and herbal products you’re taking to avoid potential interactions.

Are there any lifestyle factors that can affect metoprolol’s effectiveness?

Several lifestyle factors can influence how metoprolol works in your body:

• Alcohol consumption can increase the risk of side effects
• Smoking can reduce the effectiveness of the medication
• High-salt diets can interfere with blood pressure control
• Grapefruit and grapefruit juice can increase the concentration of metoprolol in your blood

Discuss these factors with your healthcare provider to ensure you’re getting the most benefit from your medication while minimizing risks.

Understanding the potential side effects and interactions of metoprolol is crucial for safe and effective use of this medication. While side effects can occur, many people take metoprolol successfully with minimal issues. Always work closely with your healthcare provider to monitor your response to the medication and address any concerns that arise during your treatment.

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. pdf [Accessed 18.07.2018]
6. The Optometric Extension Program Foundation. Ocular & visual side effects of systemic drugs. Available: https://www.oepf.org/sites/default/files/journals/jbo-volume-11-issue-6/11-6%20Valeriewren.pdf [Accessed 18.07.2018]
7. Research Gate. August 2012. The Role of Medications in Causing Dry Eye. Available: https://www.researchgate.net/publication/232227209_The_Role_of_Medications_in_Causing_Dry_Eye [Accessed 18.07.2018]</sup>

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• Metoprolol (Lopressor / Toprol XL)
• Fatigue
• Constipation
• Diarrhoea
• Breathing issues
• Lack of libido
• Dizziness

Side effects of metoprolol – NHS

Like all medicines, metoprolol can cause side effects, but many people have no side effects or only minor ones.

Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects of metoprolol happen in more than 1 in 100 people. There are things you can do to help cope with them:

Headaches

Make sure you rest and drink plenty of fluids. It’s best not to drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Headaches usually go away after the first week of taking metoprolol. Talk to your doctor if the headaches are severe or last longer than a week.

Feeling tired, dizzy or weak

If metoprolol makes you feel dizzy or weak, stop what you’re doing, and sit or lie down until you feel better. Do not drive, ride a bike or use tools or machinery if you’re feeling tired. Try not to drink alcohol, as it may make your symptoms worse.

Cold hands or feet

Put your hands or feet under warm running water, massage them, and wiggle your fingers and toes. Try not to smoke or have drinks with caffeine in – these can make your blood vessels narrower and restrict your blood flow. Smoking also makes your skin colder. Try wearing mittens (they’re warmer than gloves) and warm socks. Do not wear tight watches or bracelets.

Feeling sick (nausea)

Stick to simple meals and avoid rich or spicy food. It might help to take your metoprolol after you have eaten.

Stomach pain

Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help.

If you’re in a lot of pain, speak to your pharmacist or doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or lasts more than a few days.

Serious side effects

It’s rare, but some people have serious side effects when taking metoprolol.

Call a doctor or call 111 straight away if:

• you get shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems
• you get shortness of breath with a cough that gets worse when you exercise (like walking up stairs), swollen ankles or legs, or an irregular heartbeat – these are signs of heart problems
• you have a fast heart rate, high temperature, trembling and confusion – these are signs of too much thyroid hormone in the blood
• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – these can be signs of liver problems
• you get unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)

Immediate action required: Go to A&E or call 999 now if:

• you have any heavy bleeding or bleeding that you cannot stop, such as cuts or nosebleeds that do not stop within 10 minutes

Immediate action required: Call 999 now if:

• you get chest pain that does not stop after a few minutes or is new or worse if you already have angina

Chest pain is a possible sign of a heart attack and needs to be checked out as soon as possible.

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to metoprolol.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of metoprolol. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 9 March 2022

Next review due: 9 March 2025

Arpimed

Metoprolol, 50 mg tablets

Release form Tablets

ATC category Cardiology. Angiology

ATC subcategory Adrenoblockers

Trade name Metoprolol

International name of the drug Metoprolol tartrate (Metoprolol tartrate)

Dosage form

Oral tablets

General characteristics

Basic physical and chemical properties

White, round, biconvex tablets scored on one side; without smell.

Composition

One tablet contains:

active substances: metoprolol tartrate – 50 mg

excipients: 9002 3 microcrystalline cellulose, lactose monohydrate, povidone, sodium starch glycolate, magnesium stearate, calcium hydrogen phosphate.

Pharmacological group and ATC code

Cardioselective beta ₁ – adrenoblocker. C07AB02

Pharmacological action

Metoprolol selectively blocks beta1-adrenergic receptors located in the heart muscle. Reduces the formation of cAMP from ATP stimulated by catecholamines, inhibiting the activity of the renin-angiotensin system. It exhibits a membrane-stabilizing effect, has a negative chrono-, dromo-, batmo- and inotropic effect, removing excessive impulses during arrhythmias, extrasystole, tachycardia. It slows down the sinus rhythm and suppresses the increased stimulation of the heart muscle in the atrioventricular node, thereby reducing conduction. As a result, the heart rate slows down, blood pressure decreases, and myocardial oxygen demand decreases. Possesses weakly expressed internal sympathomimetic activity.

Pharmacokinetics

Absorption: After oral administration, metoprolol is almost completely (approximately 95%) absorbed from the gastrointestinal tract. The maximum concentration in blood plasma is reached after 1.5-2 hours. Bioavailability increases with food intake.

Metabolism: Plasma protein binding – 12%. In the liver, metoprolol is intensively biotransformed, undergoing stereoselective metabolism with the formation of inactive metabolites. The half-life with active metabolism lasts 3-4 hours, and with passive metabolism 7-8 hours. Penetrates through the blood-brain and placental barrier. It is excreted in breast milk in small amounts.

Excretion: The plasma half-life is about 3.5 hours. Excreted mainly by the kidneys in the form of inactive metabolites (95%), about 3% – unchanged.

Indications

• moderate to moderate arterial hypertension (as monotherapy or in combination with other antihypertensive drugs)
• cardiac arrhythmia (sinus tachycardia, ventricular and supraventricular arrhythmia, extrasystole)
• early use of metoprolol in acute myocardial infarction, reduces the size of the infarct zone and the frequency of ventricular fibrillation. Pain relief may reduce the need for opioid analgesics.
• angina pectoris
• secondary prevention of myocardial infarction
• thyrotoxicosis (in complex therapy)
• prophylaxis of migraine attacks

Dosage and administration

Inside, with a meal or immediately after a meal, the tablets can be divided in half, but not chewed and washed down with liquid.

The recommended maximum dose should not exceed 400 mg/day.

In arterial hypertension initial dose – 100 mg/day in 1-2 doses, if necessary – 200 mg/day. Combination therapy with diuretics and vasodilators may also be considered to further lower blood pressure.

For angina pectoris – 50 – 100 mg 2-3 times a day.

For tachyarrhythmia – 50 mg 2-3 times a day, if necessary – 200-300 mg / day.

Early prevention of myocardial infarction – 200 mg/day.

Orally, therapy should begin within 15 minutes of the last intravenous injection, 50 mg every 6 hours for 48 hours and preferably within 12 hours of onset of chest pain. Patients who cannot tolerate the full intravenous dose should receive half the recommended oral dose.

Maintenance dose

The usual maintenance dose is 200 mg divided into several doses. Treatment should continue for at least 3 months.

Thyrotoxicosis

50 mg 4 times a day. After normalization of thyroid function, the dose should be gradually reduced.

Migraine prophylaxis – 100-200 mg/day in 2-4 divided doses.

For relief of paroxysmal supraventricular tachycardia is administered parenterally, in a hospital, slowly, at a dose of 2-5 mg (1-2 mg/min). After arresting an attack of arrhythmia, patients are transferred to oral administration at a dose of 50 mg 4 times a day, with the first dose being taken 15 minutes after the cessation of intravenous administration.

Pediatric

Not recommended.

Patients with renal or hepatic insufficiency

Dose adjustment required. You need to follow the doctor’s advice.

Contraindications

• if you are allergic (hypersensitive) to metoprolol or any of the other ingredients of this medicine
• atrioventricular block 2-3 degree
• uncontrolled heart failure
• severe sinus bradycardia (< 45-50 bpm)
• sick sinus syndrome (in case no pacemaker is installed)
• Prinzmetal’s angina pectoris
• myocardial infarction complicated by severe bradycardia, first-degree conduction block, systolic hypotension (less than 100 mmHg) and/or severe heart failure and cardiogenic shock – severe peripheral circulatory disorders
• bronchial asthma or history of bronchospasm
• pheochromocytoma
• metabolic acidosis
• concomitant intravenous use of calcium blockers such as verapamil or diltiazem or other antiarrhythmic drugs (such as disopyramide) is contraindicated (exception: use in the intensive care unit) – arterial hypotension
• diabetes mellitus with frequent episodes of hypoglycemia
• chronic obstructive pulmonary disease.

Adverse reactions

Adverse reactions identified in the course of clinical trials or as a result of established use according to the indication according to the following classification:

Very often (≥1/10), often (≥1/100 to <1/ 10), rare ((≥1/1000 to <1/100), rare ((≥1/10000 <1/1000) and very rare (<1/10000).

* (relevance to the use of metoprolol has not been clearly established).

Beta-blockers may mask symptoms of thyrotoxicosis or hypoglycemia.

Reporting side effects

If you notice any side effects, tell your doctor, pharmacist or pharmacist, including any side effects not listed in this package insert. You can also report side effects to Arpimed LLC by going to the website www.arpimed.com and filling out the appropriate form “Report a side effect or ineffectiveness of a drug” and to the Scientific Center for Expertise of Drugs and Medical Technologies named after. Academician E.Gabrielyan by going to the website www.pharm.am in the section “Report a side effect of a drug” and fill out the form “Map of reports on a side effect of a drug”. Scientific center hotline: +37410200505; +37496220505 By reporting side effects, you help gather more information about the safety of this drug.

Overdose

Symptoms : severe arterial hypotension, sinus bradycardia, atrioventricular block, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, impaired consciousness, coma, nausea, vomiting, cyanosis, hypoglycemia, and occasionally hyperkalemia. The first manifestations usually appear within 20 minutes – two hours after taking the drug.

Treatment: symptomatic therapy, absorption of any drug still present in the gastrointestinal tract can be prevented by induction of vomiting, gastric lavage, administration of activated charcoal and laxative. Artificial respiration may be required. In case of bradycardia and myocardial conduction disturbances, intensive therapy is indicated: intravenous bolus (with a 25-minute interval) administration of atropine sulfate at a dose of 0.5-2 mg. With a decrease in myocardial contractility, intravenous administration of glucagon is indicated at an initial dose of 1-10 mg, then at a dose of 2-2.5 mg/h as a long-term drip infusion. If a convulsive syndrome occurs, a slow intravenous administration of diazepam is recommended. After taking a large dose or in case of hypersensitivity, the patient should be closely monitored and treated in an intensive care unit.

Hypotension and shock should be treated with plasma/plasma substitutes and, if necessary, catecholamines. The beta-blocking effect can be neutralized by slow intravenous administration of isoprenaline hydrochloride, starting at a dose of about 5 mcg / min, or dobutamine, starting at a dose of 2.5 mcg / min, until the desired effect is achieved.

In resistant cases, isoprenaline can be combined with dopamine. If the desired result is not achieved after this, the possibility of taking 8-10 mg of glucagon can be considered. If necessary, the injection can be repeated within 1 hour, after which, if necessary, make an intravenous infusion of glucagon at a rate of 1-3 mg/hour.

Calcium ions or a pacemaker may be considered.

In patients who have received an overdose of hydrophilic beta-blocking drugs, hemodialysis or hemoperfusion may be considered.

Special instructions

Abrupt discontinuation of therapy with beta-blockers should be avoided, especially in patients with ischemic heart disease. If possible, metoprolol should be discontinued gradually over 10 days, reducing the dose to 25 mg over the last 6 days. If necessary, you can start replacement therapy at the same time to prevent exacerbation of angina pectoris. In addition, hypertension and arrhythmia may develop.

In combination therapy with clonidine, the latter should be discontinued a few days after the withdrawal of metoprolol, in order to avoid a hypertensive crisis. At a dose above 200 mg / day, cardioselectivity decreases.

If a decision has been made to interrupt beta-blockade in preparation for surgery, therapy should be discontinued for at least 24 hours. Continued beta blockade reduces the risk of arrhythmia during induction and intubation, but the risk of hypertension may also increase. If treatment is continued, caution should be exercised when using certain anesthetics. The patient can be protected from vagal reactions by intravenous atropine. During its cancellation, the patient’s condition should be carefully monitored.

Although cardioselective beta-blockers may have less effect on lung function than nonselective beta-blockers, their use should be avoided in patients with reversible obstructive airway disease unless there are compelling clinical reasons for their use. Although metoprolol has been shown to be safe in a large number of asthma patients, caution is advised when treating patients with chronic obstructive pulmonary disease. Beta-2 stimulant therapy or adjustment of current therapy may be required. Thus, non-selective beta-blockers should not be used in such patients, and beta-1-selective blockers should only be used with extreme caution. It is recommended to stop therapy with the appearance of skin rashes and the development of depression caused by taking beta-blockers.

Discontinuation of the drug should be considered if any similar reaction cannot be explained by anything other than the drug. Cancellation of beta-blockers should be gradual.

Metoprolol should not be administered to patients with untreated congestive heart failure. The first step is to get congestive heart failure under control. If concomitant treatment with digoxin is carried out, it must be borne in mind that both drugs slow down AV conduction and, therefore, there is a risk of AV dissociation. In addition, mild cardiovascular complications may occur, manifesting as dizziness, bradycardia, and a tendency to collapse.

Serious, sometimes even life-threatening, deterioration in cardiac function may occur with the use of beta-blockers, especially in patients whose cardiac function depends on the supportive action of the sympathetic system. This is not so much due to an excessive beta-blocking effect, but to the fact that patients with limited heart function do not tolerate a decrease in sympathetic nervous system activity, even if this decrease is small. This leads to a weakening of contractility, a decrease in heart rate and a slowdown in AV conduction. This may result in pulmonary edema, atrioventricular block, and shock. Sometimes an existing AV conduction disorder may worsen, leading to AV block. Patients with pheochromocytoma should be given concomitant alpha-blockers.

If surgery is required, the anesthesiologist should be warned about the ongoing therapy (selection of a drug for general anesthesia with a minimal negative inotropic effect), discontinuation of the drug is not recommended.

Initial administration of high doses of metoprolol to patients undergoing extracardiac surgery should be avoided as it is associated with bradycardia, hypotension and stroke, including death in patients who have risk factors for the cardiovascular system.

Beta-blockers mask some of the clinical signs of thyrotoxicosis. Therefore, metoprolol should be used with caution in patients with or suspected of developing thyrotoxicosis, and thyroid and cardiac function should be closely monitored.

Concomitant use of epinephrine (epinephrine), norepinephrine (norepinephrine) and β-blockers may lead to increased blood pressure and bradycardia.

Metoprolol may cause or exacerbate bradycardia, peripheral arterial circulation symptoms and anaphylactic shock. If the pulse rate drops below 50-55 beats per minute at rest and the patient develops symptoms associated with bradycardia, the dose should be reduced.

Metoprolol can be used in controlled heart failure. In patients with a history of heart failure or low cardiac reserve, treatment with cardiac glycosides and/or diuretics should also be considered.

Metoprolol may reduce the effectiveness of diabetes treatment and mask the symptoms of hypoglycemia. The risk of impaired carbohydrate metabolism or masking symptoms of hypoglycemia is lower with extended release metoprolol tablets than with conventional beta-1 selective blocker tablets and significantly lower than with non-selective beta-blockers. In unstable and insulin-dependent diabetes mellitus, adjustment of hypoglycemic therapy may be required.

In the case of unstable or insulin-dependent diabetes mellitus, adjustment of hypoglycemic treatment may be required (because of the likelihood of severe hypoglycemic conditions).

In patients with significant hepatic impairment, dosage adjustment may be required because metoprolol is biotransformed in the liver. Patients with hepatic or renal insufficiency may require a lower dosage, metoprolol is contraindicated in patients with hepatic or renal disease / insufficiency. Older people should be given with caution, starting with a lower dose, although the elderly usually tolerate this drug well. In elderly patients and patients with hepatic or renal insufficiency, it may be necessary to use the drug at a lower dose, as well as the need to prescribe an alternative drug.

Patients with a history of psoriasis should only take beta-blockers after careful consideration as the drug may exacerbate psoriasis.

Beta-blockers can increase both sensitivity to allergens and the severity of anaphylactic reactions. Treatment with epinephrine (epinephrine) does not always provide the desired therapeutic effect in individuals receiving beta-blockers.

Beta-blockers may unmask myasthenia gravis.

In cirrhosis of the liver, the bioavailability of metoprolol may be increased and the dosage should be adjusted accordingly.

1 tablet of the drug contains 16 mg of lactose monohydrate, so if you have intolerance to some sugars, contact your doctor before taking this drug.

Patients using contact lenses should take into account that during treatment with beta-blockers, a decrease in the production of lacrimal fluid is possible. Dry eyes may occur, sometimes accompanied by skin rashes. In most cases, the symptoms disappeared after discontinuation of treatment with metoprolol. Patients should be closely monitored for adverse eye reactions. If such reactions occur, the possibility of discontinuing metoprolol should be considered.

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Pregnancy and lactation

Pregnancy

Metoprolol is not recommended during pregnancy or lactation unless the expected benefit outweighs the possible risk to the fetus/infant.

Metoprolol, however, has been used for pregnancy-associated hypertension under close supervision after the 20th week of pregnancy. Although the drug crosses the placental barrier and is found in cord blood, there are no reported cases of fetal anomalies. Despite this, there is an increased risk of cardiac and pulmonary complications in the newborn in the postpartum period. Beta-blockers reduce placental perfusion and can cause fetal death and preterm birth.

Fetal growth retardation has been observed after long-term treatment in pregnant women with mild to moderate hypertension. Beta-blockers have been reported to cause fetal and neonatal bradycardia, and there have been reports of hypoglycemia and hypotension in neonates.

Interrupt treatment with metoprolol 48-72 hours before delivery. If this is not possible, close medical monitoring of the newborn is required 24 to 48 hours after birth for symptoms of beta-blockade (eg, cardiac and pulmonary complications). Careful medical supervision of newborns in the first 3-5 days of life is required. The drug passes into breast milk. If necessary, the use of the drug during lactation should stop breastfeeding.

Breast-feeding

Metoprolol is excreted in milk. Despite the fact that the concentration of metoprolol in milk is very low, it is necessary to stop breastfeeding during treatment with metoprolol.

If you are pregnant or breastfeeding, think you are pregnant or plan to become pregnant, ask your doctor or pharmacist for advice before using this medicine.

Drug interactions

• drugs used to treat stomach ulcers such as cimetidine – drugs used to treat high blood pressure such as hydralazine, clonidine or prazosin
• drugs used to treat irregular heart rhythms such as amiodarone and propafenone
• medicines used to treat depression such as tricyclic antidepressants or SSRIs
• drugs used to treat epilepsy, such as barbiturates
• medicines for the treatment of mental illness, such as phenothiazines
• anesthetics such as cyclopropane or trichloroethylene
• medicines used to treat certain types of cancer, particularly kidney cancer, such as aldesleukin
• medicines used to treat erectile dysfunction, such as alprostadil
• anxiolytics or hypnotics (eg temazepam, nitrazepam, diazepam),
• indomethacin or celecoxib (NSAID)
• rifampicin (antibiotic) or terbinafine (antifungal)
• estrogens, such as contraceptives or hormone replacement therapy
• corticosteroids (eg hydrocortisone, prednisolone)
• other beta-blockers, eg eye drops
• epinephrine (epinephrine) or norepinephrine (norepinephrine), used in anaphylactic shock or other sympathomimetics, drugs used to treat diabetes mellitus
• lidocaine (local anesthetic)
• moxisilite (used for Raynaud’s syndrome)
• drugs used in the treatment of malaria, such as mefloquine
• medicines used to prevent nausea and vomiting, such as tropisetron – medicines used to treat bronchial asthma, such as xanthines, such as aminophylline or theophylline
• drugs used to treat migraine, such as ergotamine
• drugs used to treat heart problems, such as cardiac glycosides, such as digoxin
• medicines used to treat rheumatoid arthritis, such as hydroxychloroquine
• diphenhydramine (sedative, antihistamine).

Use with alcohol

Alcohol must be avoided while using this medicine. Alcohol can increase blood pressure, thereby weakening the effects of metoprolol.

Storage conditions

The drug should be stored out of the reach of children, protected from moisture and light at a temperature of 15-25 ⁰ C.

Shelf life

Shelf life – 3 years. Do not use after the expiration date.

Dispensing conditions

Available by prescription.

Release form and packaging

3 blisters (1 blister containing 10 tablets) together with the leaflet are placed in a cardboard box.

interactions with other drugs and side effects

Contents

• 1 .3 Influence of Metoprolol-Krka on the effectiveness of other drugs
• 1.4 Influence of other drugs on the effectiveness of Metoprolol-Krka
• 1.5 Side effects of Metoprolol-Krka
• 1.6 Side effects on the cardiovascular system
• 1. 7 Side effects on the digestive system
• 1.8 Side effects on the nervous system
• 1.9 Side effects on other body systems
• 1.10 Q&A:
  • • 1.10 .0.1 Which drugs should not be taken concomitantly with Metoprolol-Krka?
    • 1.10.0.2 What side effects can occur when taking Metoprolol-Krka?
    • 1.10.0.3 Can Metoprolol-Krka be taken during pregnancy?
    • 1.10.0.4 How often should I take Metoprolol-Krka?
    • 1.10.0.5 Can Metoprolol-Krka be taken while breastfeeding?

Metoprolol-krka (metoprolol) is a drug used to treat hypertension and other cardiovascular conditions. This article discusses the interactions of metoprolol-krka with other drugs, food and alcohol, as well as possible side effects when they are used simultaneously.

Metoprolol-Krka is an effective drug that is used to treat various cardiovascular diseases such as arterial hypertension, angina pectoris and heart failure. It belongs to the group of beta-blockers that work by reducing the heart rate and force of contraction of the heart. This allows you to lower blood pressure and improve blood circulation in the body.

However, before starting the use of Metoprolol-Krka, it is important to consider its interaction with other drugs. Some medicines may affect the effectiveness of Metoprolol-Krka or cause unwanted side effects. Therefore, before you start taking the drug, you should consult with your doctor and tell him about all the medicines you take, including prescribed and over-the-counter drugs, vitamins and nutritional supplements.

Some drugs that may interact with Metoprolol-Krka include:

• Other beta-blockers: Simultaneous use of Metoprolol-Krka with other beta-blockers may enhance their action and increase the risk of side effects.
• Antiarrhythmic drugs: Some antiarrhythmic drugs may increase the effect of Metoprolol-Krka on heart rate and cause cardiac arrhythmias.
• Diuretics: The use of Metoprolol-Krka with diuretics may increase their hypotensive effect and lead to a decrease in blood pressure.

In addition to interactions with other drugs, Metoprolol-Krka may also cause some side effects. The most common of these include:

1. Fatigue and weakness: These symptoms may occur at the beginning of treatment and usually resolve with time.
2. Dizziness and headache: these symptoms may be caused by low blood pressure.
3. Bradycardia: Metoprolol-Krka may decrease the heart rate, which may result in a slow heart rate.

It is important to remember that these side effects can be temporary and usually disappear after the body adapts to the drug. However, if they become severe or prolonged, a doctor should be consulted.

In summary, Metoprolol-Krka is an effective drug for the treatment of cardiovascular diseases. However, before using it, it is necessary to take into account the possible interaction with other drugs and familiarize yourself with possible side effects. Only when used correctly and under the supervision of a physician can Metoprolol-Krka have a positive effect on your health and quality of life.

Interactions of Metoprolol-Krka with other drugs

Metoprolol-Krka is a drug that is used to treat various cardiovascular diseases. It belongs to the group of beta-blockers and helps to reduce heart rate, lower blood pressure and improve blood flow to the heart.

When using Metoprolol-Krka, it is necessary to take into account its interaction with other drugs. Some drugs may increase or decrease the effect of Metoprolol-Krka, as well as cause unwanted side effects.

The following drugs may interact with Metoprolol-Krka:

• Antiarrhythmic drugs : in combination with Metoprolol-Krka, they may increase its antiarrhythmic effect. With a joint appointment, it is necessary to control the heart rate and blood pressure.
• Antidepressants : Some antidepressants may increase the effect of Metoprolol-Krka and cause drowsiness. You need to be careful when using these drugs at the same time.
• Antihypertensive drugs : Concomitant use with Metoprolol-Krka may lead to a decrease in blood pressure. Adjust the dosage of both drugs if necessary.
• Diabetes medicines : Metoprolol-Krka may mask some symptoms of hypoglycemia (low blood sugar). Patients with diabetes need to carefully monitor blood glucose levels while using these drugs.

Before starting the use of Metoprolol-Krka, it is necessary to consult a doctor and inform about all medications taken, including prescribed and over-the-counter medications, as well as about the state of health and the presence of chronic diseases.

Always follow your doctor’s instructions and do not change your dosage or stop taking Metoprolol-Krka without your doctor’s consent. This will help avoid unwanted side effects and ensure that your cardiovascular disease is effectively treated.

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Effect of Metoprolol-Krka on the effectiveness of other drugs

Metoprolol-Krka is a drug used to treat hypertension, angina and other cardiovascular diseases. It belongs to the group of beta-blockers and affects the functioning of the heart muscle.

When Metoprolol-Krka is taken concomitantly with other drugs, an interaction is possible that may affect the effectiveness of treatment. Below are some examples of such interactions:

• Antihypertensive drugs: Metoprolol-Krka may increase the hypotensive effect of other drugs such as diuretics, angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARBs).
• Antiarrhythmic drugs: Metoprolol-Krka may increase the effect of antiarrhythmic drugs such as amidarone, propafenone and atenolol.
• Antidepressants: Concomitant use of Metoprolol-Krka with certain antidepressants such as fluoxetine and sertraline may increase the hypotensive effect and decrease heart rate.

It is important to note that the list of drugs that interact with Metoprolol-Krka is not exhaustive. Before starting treatment with Metoprolol-Krka, you should consult your doctor or pharmacist to avoid possible unwanted interactions with other drugs.

In the event of side effects or changes in the effectiveness of treatment while taking Metoprolol-Krka with other drugs, you should immediately consult a doctor to correct the treatment.

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Effect of other drugs on the effectiveness of Metoprolol-Krka

prevention of myocardial infarction. However, it is important to take into account the interaction of Metoprolol-Krka with other drugs in order to avoid unwanted side effects and increase the effectiveness of treatment. The following is a list of drugs that may affect the way Metoprolol-Krka works:

• Antiarrhythmics : Co-administration of Metoprolol-Krka with antiarrhythmic drugs may cause long QT interval syndrome. Therefore, it is necessary to carefully control the heart rate and conduct electrocardiographic monitoring.
• Antidepressants : Some antidepressants, especially serotonin reuptake inhibitors, may increase the hypotensive effect of Metoprolol-Krka. When used together, blood pressure must be carefully monitored.
• Nephrotoxic drugs : Metoprolol-Krka may reduce the effectiveness of drugs that are toxic to the kidneys. With simultaneous use, it is necessary to carefully monitor renal function and adjust the dosage of drugs.
• Anticoagulants : Metoprolol-Krka may increase the effect of anticoagulants such as warfarin. It is necessary to carefully monitor blood clotting and adjust the dosage of anticoagulants.

Always consult your doctor or pharmacist before taking Metoprolol-Krka in combination with other medicines to avoid possible negative effects and ensure effective treatment.

Side effects Metoprolol-Krka

Metoprolol-Krka is an effective drug for the treatment of various cardiovascular diseases. However, like any drug, it can have side effects. It is important to be aware of possible side effects so that you can be prepared and take the necessary measures.

The following are some of the possible side effects of Metoprolol-Krka:

• Dizziness and fatigue: Some patients may experience dizziness or fatigue while taking Metoprolol-Krka. If these symptoms do not disappear or worsen, you should consult a doctor.
• Drowsiness: Some patients may experience drowsiness while taking Metoprolol-Krka. This may affect their ability to drive or perform other dangerous activities. It is recommended to be careful when performing such tasks until the patient knows how the drug affects his body.
• Elevated blood sugar: Metoprolol-Krka may cause an increase in blood sugar. Patients with diabetes should carefully monitor their blood sugar levels and consult with their doctor about adjusting the dose of insulin or other sugar-lowering drugs.
• Lowering blood pressure: Metoprolol-Krka may cause a decrease in blood pressure. Patients taking the drug should regularly measure blood pressure and consult a doctor if it drops to undesirable levels.

If you experience any side effects of Metoprolol-Krka, contact your doctor or pharmacist immediately. You should not stop taking the drug without consulting your doctor.

It is important to remember that the side effects of Metoprolol-Krka may be individual and not all patients will experience them. Discuss any possible side effects with your doctor and take the drug as recommended.

Cardiovascular side effects

When using the drug Metoprolol-Krka, some side effects associated with the cardiovascular system may occur. It is important to know about them in order to consult a doctor in a timely manner and take the necessary measures.

• Bradycardia Slow heart rate. This can lead to reduced blood flow to organs and tissues, which can cause various symptoms such as dizziness, weakness, and fatigue.
• Hypotension – decrease in blood pressure. This can cause dizziness, a feeling of weakness, darkening of the eyes when standing up, and increased fatigue.
• Dyspnea – difficult breathing. This may be due to a deterioration in the work of the heart and a decrease in its efficiency.
• Edema – tissue swelling due to fluid retention. Swelling may occur in the legs, shins, feet, or other parts of the body.

If you notice any of the above symptoms or other unusual symptoms, please consult your doctor. He will be able to assess your condition and, if necessary, adjust the dosage or prescribe an alternative treatment.

Do not forget that self-medication can be hazardous to health. Always follow the doctor’s recommendations and do not change the dosage of the drug without his consent.

Digestive side effects

The use of Metoprolol-Krka may cause some digestive side effects. It is important to be attentive to your body and pay attention to the following possible reactions:

• Dyspepsia: discomfort in the stomach, nausea, vomiting, heartburn.
• Diarrhea: frequent and loose stools.
• Constipation: difficulty or retention of stool.
• Increased flatulence: excessive flatulence in the intestines.

If you notice the above symptoms, be sure to consult your doctor. He will be able to assess the situation and find the best solution for you.

It is important to remember that this list is not complete and you may experience other side effects. In any case, if unusual or unpleasant symptoms appear, be sure to seek medical help.

Side effects on the nervous system

Various side effects on the nervous system may occur when Metoprolol-Krka is used. It is important to know that not all side effects occur in every patient and their intensity may vary.

The following are the most common side effects on the nervous system that may occur with the use of the drug:

• Dizziness;
• Drowsiness;
• Fatigue;
• Weakness;
• Headache;
• Depression;
• Insomnia;
• Concentration disorders;
• Tremor;
• Increased nervousness;
• Increase or decrease in mood;
• Loss of memory;
• Dizziness when rising from a sitting or lying position;
• Hypersensitivity to cold;
• Numbness or tingling in the extremities.

If you experience any of these side effects, be sure to check with your doctor. He will be able to assess the situation and, if necessary, adjust the dosage or prescribe a different medication.

Do not stop taking this medicine without first talking to your doctor, as this may make your condition worse.

Side effects on other body systems

Metoprolol-Krka is an effective drug for the treatment of cardiovascular diseases, however, its use may cause some side effects on other body systems. It is important to be careful and know about the possible reactions of the body to the drug.

• Nervous system: Metoprolol may cause dizziness, fatigue, drowsiness, depression, insomnia and mood changes. In rare cases, headaches, convulsions and mental disorders are possible.
• Digestive system: metoprolol may cause dry mouth, nausea, vomiting, diarrhea or constipation. In some cases, digestive disturbances are possible, including abdominal pain and changes in taste sensations.
• Respiratory system: some patients may experience shortness of breath, shortness of breath or rapid breathing while taking metoprolol.
• Genitourinary system: Possible erectile dysfunction in men and changes in the menstrual cycle in women.
• Hematopoietic system: metoprolol may cause a decrease in the number of platelets and leukocytes in the blood, which may lead to an increased susceptibility to bleeding and infections.

If you notice any side effects while taking metoprolol-Krka, ask your doctor or pharmacist for more information and advice.

Q&A:

Which drugs should not be taken at the same time as Metoprolol-Krka?

Metoprolol-Krka is not recommended for concomitant use with antidepressants, monoamine oxidase inhibitors, antiarrhythmic drugs, insulin, drugs containing alcohol, and certain other drugs. Before you start taking Metoprolol-Krka, you should consult your doctor or pharmacist.

What side effects can occur when taking Metoprolol-Krka?

When taking Metoprolol-Krka, the following side effects may occur: dizziness, fatigue, drowsiness, lowering blood pressure, bradycardia, fainting, sleep disturbances, dry mouth, nausea, constipation, diarrhea, liver changes and others.