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

Metoprolol Oral Tablet Side Effects and How to Manage Them

If you have certain heart problems, you may be interested in learning more about metoprolol. It’s a generic prescription drug that comes in two forms:

• metoprolol tartrate immediate-release tablets
• metoprolol succinate extended-release tablets

Metoprolol also comes in injectable forms, but those are not covered in this article.

Both oral forms of metoprolol are used in adults to:

• treat high blood pressure
• help prevent angina (a type of chest pain)

Metoprolol tartrate is used in adults to improve survival after a heart attack. Metoprolol succinate is also used to treat heart failure in adults, and high blood pressure in some children.

Metoprolol is usually taken on a long-term basis for all its uses.

This article describes metoprolol’s side effects, also called adverse effects. For more information about metoprolol, including details about its uses, see this in-depth article.

Some people may experience mild to serious side effects during their metoprolol treatment. Examples of the drug’s more commonly reported side effects include:

• tiredness
• depression
• diarrhea
• skin rash or itching
• dizziness*

* To learn more about this side effect, see the “Side effects explained” section below.

Metoprolol can cause mild side effects in some people. In most cases these are temporary and some may be easily managed.

Examples of mild side effects that have been reported with this drug include:

• tiredness
• depression
• diarrhea
• skin rash or itching
• shortness of breath or wheezing
• slow heart rate
• confusion
• headache
• nightmares
• trouble sleeping
• cold hands and feet
• nausea, vomiting, heartburn, belly pain, or gas
• dizziness*
• memory loss*
• joint pain*
• constipation*
• hallucinations*
• mild allergic reaction*

* To learn more about this side effect, see the “Side effects explained” section below.

If you have symptoms that are ongoing or bother you, talk with your doctor or pharmacist. But do not stop taking metoprolol unless your doctor recommends it.

Metoprolol may cause mild side effects other than those listed above. For details, see the prescribing information for metoprolol tablets and metoprolol ER tablets.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with metoprolol, visit MedWatch.

Serious side effects have been reported with metoprolol. These include:

• very slow heart rate
• hypotension (low blood pressure)
• new or worsening heart failure
• heart problems such as worsening chest pain or heart attack if you suddenly stop taking metoprolol
• severe allergic reaction*

If you develop serious side effects while taking metoprolol, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

* To learn more about this side effect, see the “Side effects explained” section below.

Below are answers to some frequently asked questions about metoprolol’s side effects.

Do any of the side effects of metoprolol succinate ER tablets differ from those of metoprolol tartrate tablets?

Metoprolol succinate extended-release (ER) tablets and metoprolol tartrate immediate-release (IR) tablets contain the same active ingredient metoprolol. (An active ingredient is what makes a drug work.) So both drugs can cause the same kinds of side effects.

Metoprolol is released into your system differently depending on its form. So you may be more likely to have certain side effects with the immediate-release form of the drug.

With metoprolol tartrate IR tablets, all the metoprolol in the tablet is released into your body soon after you take it. The level of metoprolol in your body increases soon after you take the tablet, then decreases until your next dose is due. You’ll likely take a dose twice per day.

But with metoprolol succinate ER tablets, the metoprolol is released into your body slowly as the tablet passes through your digestive system. This produces a steady level of metoprolol in your body over the course of the day. With this form, you’ll only need to take a dose once per day.

Due to the spikes in metoprolol levels that you get with IR tablets, this form may be more likely to cause certain side effects, such as tiredness, dizziness, and diarrhea.

Your doctor can recommend the form of metoprolol that’s best for you. (Note that the different forms have some different uses.)

Do older people have an increased risk of side effects from metoprolol compared with younger people?

Yes, older people (ages 65 years and older) may have an increased risk of side effects from metoprolol. There are several reasons for this.

As you age, your liver and kidneys become less effective at clearing drugs such as metoprolol from your body. This means you may have a higher level of the drug in your system for longer periods of time. As you age, you’re also more likely to have heart problems or other health conditions that can increase your risk of metoprolol side effects. And you’re more likely to be prescribed other drugs that may interact with metoprolol. All of these factors can increase your risk of side effects with many medications, not just metoprolol.

With metoprolol, especially with the metoprolol tartrate immediate-release form, the most common side effects in people of all ages are tiredness and dizziness. In older people, these side effects can increase the risk of falls.

If you’re age 65 years or older, your doctor will likely prescribe a metoprolol dosage that’s lower than usual. This can help prevent side effects.

Can metoprolol cause weight gain or weight loss?

It’s not likely. Weight loss wasn’t reported in studies of metoprolol. And although weight gain has been very rarely reported with metoprolol, it’s not known for sure if the drug was the actual cause of this side effect.

But metoprolol can sometimes cause or worsen heart failure. And one possible symptom of this side effect is sudden weight gain.

If you have weight changes with metoprolol, especially sudden weight gain, talk with your doctor. They can investigate the possible cause.

Is my risk of side effects with metoprolol ER higher if I take a higher dose (25 mg, 50 mg, 100 mg, 200 mg)?

Metoprolol succinate extended-release (ER) tablets come in strengths of 25 milligrams (mg), 50 mg, 100 mg, and 200 mg.

As with many drugs, your risk of side effects with metoprolol ER may be higher if you take a higher dose. Your risk of side effects with metoprolol tartrate immediate-release tablets may also be higher if you take a higher dose.

Talk with your doctor if you’re concerned about your risk of side effects with the dosage of metoprolol you’re prescribed.

Does metoprolol cause any long-term side effects?

No, it’s not likely. Metoprolol isn’t known to cause any long-term side effects. And most mild side effects tend to improve with continued treatment as your body gets used to the medication.

If you do have bothersome side effects that don’t improve, they’ll likely go away if your doctor reduces your dose, or after you stop treatment.

Also, taking metoprolol for long periods of time isn’t known to increase your risk of having side effects.

Learn more about some of the side effects metoprolol may cause.

Memory loss

Some people may have short-term memory loss while taking metoprolol, but this side effect isn’t likely to be common.

Memory loss was reported in studies of metoprolol tartrate immediate-release tablets. But it’s not known how often this side effect occurred.

Memory loss wasn’t reported in studies of metoprolol succinate extended-release tablets. There have been reports of memory loss in people using this form of metoprolol since this drug came on the market. But it’s unclear how often this has happened or if the drug was the cause.

Note that memory loss has also been reported with other beta-blockers, the group of drugs metoprolol belongs to.

What might help

If you notice any problems with your memory while taking metoprolol, talk with your doctor. They can help identify the possible cause. If they determine the problems are caused by metoprolol, they may recommend switching you to a different treatment for your condition.

Joint pain

Some people may have joint pain with metoprolol, but this is likely to be rare.

Arthritis (joint swelling that causes joint pain) was very rarely reported in studies of metoprolol tartrate immediate-release tablets. But it’s unknown if the drug was the cause. Musculoskeletal pain was also reported in these studies, but it’s not known how often this side effect occurred. (Musculoskeletal pain refers to pain in the muscles or bones, for example leg pain or back pain.)

Joint pain wasn’t reported in studies of metoprolol succinate extended-release tablets. There have been reports of joint pain and musculoskeletal pain in people using this form of metoprolol since this drug came on the market. But it’s unclear how often this has happened or if the drug was the cause.

What might help

If you have joint pain while taking metoprolol, talk with your doctor. They can help you determine the possible cause.

Joint pain can sometimes be eased with gentle movement. Hot or cold packs may also help, as can over-the-counter anti-inflammatory gels. If you have pain that’s bothersome, ask your doctor to recommend a suitable pain reliever.

If your doctor determines the problem may be caused by metoprolol, they may recommend switching you to a different treatment for your condition.

Constipation

Some people may have constipation while taking metoprolol, but it’s more common to have diarrhea with this drug.

Constipation was reported in studies of metoprolol tartrate immediate-release tablets, but this side effect wasn’t common.

Constipation wasn’t reported in studies of metoprolol succinate extended-release tablets. There have been reports of constipation in people using this form of metoprolol since this drug came on the market. But it’s unclear how often this has happened or if the drug was the cause.

What might help

If you have constipation with metoprolol it may help to:

• increase your fluid intake
• get regular, gentle exercise
• eat more high fiber foods

If these things don’t help, talk with your doctor. They may recommend taking a laxative medication.

Hallucinations

Some people may have hallucinations while taking metoprolol, but this side effect is likely to be rare. (With hallucinations, you see or hear things that aren’t really there.)

Hallucinations were reported in studies of metoprolol tartrate immediate-release tablets, but it’s not known how often this happened or if the drug was the cause.

Hallucinations weren’t reported in studies of metoprolol succinate extended-release tablets. There have been reports of hallucinations in people using this form of metoprolol since this drug came on the market. But it’s unclear how often this has happened or if the drug was the cause.

What might help

If you have hallucinations while taking metoprolol, talk with your doctor. They can help you identify the possible cause. If they determine the hallucinations may be caused by metoprolol, they may recommend switching you to a different treatment for your condition.

Dizziness

It’s common to have dizziness while taking metoprolol. This side effect was commonly reported in studies of metoprolol tartrate immediate-release tablets and studies of metoprolol succinate extended-release tablets. But it occurred less often with the extended-release form.

Dizziness tends to be worse when you first start taking metoprolol and after any dose increase. It usually gets better in a few days or weeks as your body adjusts to the drug. But if you have ongoing or severe dizziness, this could be a sign that your blood pressure is too low.

If you take metoprolol with certain other medications, especially blood pressure medications, you may have an increased risk of dizziness.

What might help

If you feel dizzy while taking metoprolol, sit or lie down until the feeling passes. It may help to move slowly when moving positions or standing up. Don’t drive or operate machines if you’re having dizzy spells with metoprolol. You should also avoid drinking alcohol, as this could make dizziness worse.

If dizziness doesn’t improve or is severe, talk with your doctor. They’ll likely check your blood pressure. If it’s too low, they may adjust your dosage of metoprolol or other blood pressure medications you take.

Allergic reaction

Like most drugs, metoprolol can cause an allergic reaction in some people. Symptoms can be mild to serious and can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)
• swelling under your skin, usually in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

• an antihistamine you swallow, such as Benadryl (diphenhydramine)
• a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to metoprolol, they’ll decide whether you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to metoprolol, they may have you switch to a different treatment.

Keeping track of side effects

During your metoprolol treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

• what dose of the drug you were taking when you had the side effect
• how soon you had the side effect after starting that dose
• what your symptoms were
• how it affected your daily activities
• what other medications you were taking
• any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how metoprolol affects you. They can then use this information to adjust your treatment plan if needed.

Metoprolol may not be right for you if you have certain medical conditions. (This is known as a drug-condition interaction.) Other factors may also affect whether metoprolol is a good treatment option for you. Talk with your doctor about your health history before starting metoprolol. Factors to consider include those described below.

Allergic reaction. If you’ve had an allergic reaction to metoprolol or any of its ingredients, your doctor will likely not prescribe it. Ask them about other medications that might be better options.

Slow heart rate. Metoprolol slows down your heart rate. If you already have a very slow heart rate, taking metoprolol could be dangerous. Your doctor will likely not prescribe metoprolol if you have a very slow heart rate. Ask them what other medications might be better options for you.

Certain heart conditions. Metoprolol slows down your heart rate. If you have certain heart conditions, metoprolol could be dangerous. Examples of these heart conditions include heart block, sick sinus syndrome, shock, and certain kinds of heart failure. Your doctor will likely not prescribe metoprolol if you have any of these conditions. Ask them what other medications might be better options for you.

Lung conditions. Metoprolol can sometimes cause wheezing or shortness of breath. You may be more likely to have these side effects if you have a lung condition such as asthma or chronic obstructive pulmonary disease (COPD). If you have a lung condition, your doctor will likely recommend a medication other than metoprolol for you.

Blood circulation problems. Metoprolol can reduce blood flow to your hands and feet. If you have blood circulation problems, such as peripheral vascular disease or Raynaud’s syndrome, metoprolol could make your symptoms worse. Talk with your doctor about whether metoprolol is right for you.

Thyroid problems. Metoprolol can reduce some of the symptoms caused by high levels of thyroid hormones in your body, such as a fast heartbeat and tremors. Because of this, you may be less aware if your thyroid hormone levels are abnormal while taking metoprolol. If you have a thyroid problem, your doctor may order thyroid function tests more often than usual while you’re taking this drug.

Diabetes. If you have diabetes, especially type 1 diabetes, you may sometimes have hypoglycemia (low blood sugar). Metoprolol can reduce some of the symptoms of low blood sugar, such as a fast heartbeat and tremors. If you have low blood sugar while taking metoprolol, you may be less aware of it and less likely to treat it. This could increase your risk of dangerously low blood sugar. If you have diabetes, your doctor may recommend checking your blood sugar more often while you’re taking metoprolol.

Liver problems. Your liver is responsible for breaking down metoprolol in your body. If you have liver problems, metoprolol could build up in your system. This could increase your risk of the drug’s side effects. Due to this risk, your doctor may prescribe a dosage of metoprolol that’s lower than usual.

Severe allergies. If you have severe allergies, for example to foods or insect stings, taking metoprolol could make your allergies worse. It could also make epinephrine (EpiPen, Adrenaclick, Adrenalin) less effective at treating anaphylaxis (a severe allergic reaction). If you have severe allergies, talk with your doctor about whether metoprolol is right for you.

Alcohol and metoprolol

Your doctor will likely recommend avoiding or limiting alcohol consumption while taking metoprolol. Alcohol could increase many of metoprolol’s side effects, such as:

• dizziness
• low blood pressure
• tiredness
• diarrhea
• nausea
• headache

If you drink alcohol, talk with your doctor about how much, if any, is safe to consume while taking metoprolol.

Pregnancy and breastfeeding while taking metoprolol

It’s not known if metoprolol is safe to take during pregnancy. If you’re pregnant or planning to become pregnant, talk with your doctor about the risks and benefits of taking this drug.

Metoprolol can pass into breast milk in small amounts. If you’re breastfeeding or planning to breastfeed, talk with your doctor about the safety of breastfeeding while taking this drug.

Like all drugs, metoprolol can cause side effects, including some serious ones. But most people taking metoprolol have only minor side effects or none at all. Most of the drug’s side effects are mild and tend to improve as your body adjusts to the medication.

If you have any questions about side effects that metoprolol can cause, talk with your doctor. You can also ask them about Lopressor, which is the brand-name version of metoprolol tartrate, and Toprol XL, which is the brand-name version of metoprolol succinate.

A generic drug and its brand-name version are expected to have the same side effects because they contain the same active ingredient. (An active ingredient is what makes a drug work.)

Some examples of questions you may want to ask your doctor include:

• Do my other medications increase my risk of side effects with metoprolol?
• If I have side effects with metoprolol tartrate tablets, will they likely go away if I switch to metoprolol succinate ER tablets?
• If I take too much metoprolol, what overdose symptoms might I experience?

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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional.