What are the common side effects of metoprolol. How do metoprolol tartrate and succinate differ in their side effect profiles. Are older adults at higher risk for metoprolol side effects. What serious side effects should you watch out for with metoprolol.

What is Metoprolol and How Does It Work?

Metoprolol is a prescription medication belonging to a class of drugs called beta-blockers. It works by blocking the effects of epinephrine (adrenaline) on the heart and blood vessels, which helps to lower blood pressure, reduce heart rate, and decrease the workload on the heart.

This medication comes in two main oral forms:

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

While both forms contain the same active ingredient, they have different release mechanisms and slightly varied uses.

Primary Uses of Metoprolol

Metoprolol is primarily prescribed for:

1. Treating high blood pressure (hypertension)
2. Preventing angina (chest pain)
3. Improving survival after a heart attack (metoprolol tartrate)
4. Treating heart failure (metoprolol succinate)

In some cases, metoprolol succinate may also be used to treat high blood pressure in children.

Common Side Effects of Metoprolol

While metoprolol is generally well-tolerated, it can cause various side effects. Some of the more commonly reported side effects include:

• Fatigue or tiredness
• Depression
• Diarrhea
• Skin rash or itching
• Dizziness
• Shortness of breath or wheezing
• Slow heart rate (bradycardia)
• Confusion
• Headache
• Sleep disturbances or nightmares
• Cold hands and feet
• Gastrointestinal issues (nausea, vomiting, heartburn, abdominal pain, gas)

Do these side effects typically resolve on their own? In most cases, these mild side effects are temporary and may resolve as your body adjusts to the medication. However, if you experience persistent or bothersome side effects, it’s crucial to consult your healthcare provider.

Serious Side Effects and Precautions

While less common, metoprolol can potentially cause serious side effects that require immediate medical attention. These include:

• Extremely slow heart rate
• Hypotension (low blood pressure)
• New or worsening heart failure
• Severe allergic reactions
• Worsening chest pain or heart attack if the medication is suddenly stopped

How can you recognize a severe allergic reaction to metoprolol? Symptoms may include difficulty breathing, swelling of the face, lips, tongue, or throat, and severe skin reactions. If you experience any of these symptoms, seek emergency medical care immediately.

Metoprolol Tartrate vs. Metoprolol Succinate: Differences in Side Effects

While metoprolol tartrate (immediate-release) and metoprolol succinate (extended-release) contain the same active ingredient, their different release mechanisms can affect the likelihood and intensity of side effects.

Metoprolol Tartrate (Immediate-Release)

This form releases the entire dose of medication shortly after ingestion, leading to a rapid increase in blood levels followed by a gradual decrease until the next dose. As a result, metoprolol tartrate may be more likely to cause:

• More noticeable fatigue
• Increased dizziness
• Higher likelihood of diarrhea

Metoprolol Succinate (Extended-Release)

The extended-release formulation provides a steady release of the medication throughout the day, resulting in more stable blood levels. This can lead to:

• Potentially fewer side effects overall
• Less pronounced peaks in side effects
• Improved tolerability for some patients

Is one form of metoprolol better than the other? The choice between metoprolol tartrate and succinate depends on individual patient factors, the specific condition being treated, and the prescribing physician’s judgment. Your doctor will consider these factors when determining which form is most appropriate for you.

Age-Related Considerations for Metoprolol Side Effects

Older adults, typically defined as those aged 65 and above, may be at an increased risk of experiencing side effects from metoprolol. Several factors contribute to this heightened sensitivity:

• Age-related changes in liver and kidney function
• Increased likelihood of pre-existing medical conditions
• Potential interactions with other medications
• Changes in body composition and metabolism

How does aging affect the body’s response to metoprolol? As we age, our bodies may process medications differently. The liver and kidneys, which are responsible for metabolizing and eliminating drugs, often become less efficient. This can lead to higher blood levels of metoprolol, potentially increasing the risk and intensity of side effects.

Special Considerations for Older Adults

For older patients taking metoprolol, healthcare providers may:

1. Start with lower doses and titrate slowly
2. Monitor more closely for side effects
3. Adjust dosages based on individual response and tolerability
4. Consider potential drug interactions with other medications

It’s crucial for older adults taking metoprolol to communicate any changes in their health or new symptoms to their healthcare provider promptly.

Managing and Mitigating Metoprolol Side Effects

While side effects from metoprolol can be concerning, there are several strategies to manage and potentially reduce their impact:

1. Dosage Adjustment

Your healthcare provider may adjust your dosage to find the optimal balance between effectiveness and side effect management. This may involve:

• Starting with a lower dose and gradually increasing
• Splitting the daily dose into multiple smaller doses
• Switching between immediate-release and extended-release formulations

2. Timing of Medication

Taking metoprolol at specific times can help minimize certain side effects:

• Taking the medication with food may help reduce gastrointestinal side effects
• For those experiencing fatigue, taking the dose before bedtime might be beneficial

3. Lifestyle Modifications

Certain lifestyle changes can help counteract some of metoprolol’s side effects:

• Regular exercise to combat fatigue and improve cardiovascular health
• Maintaining proper hydration to help with blood pressure regulation
• Adopting a balanced diet rich in potassium, magnesium, and other heart-healthy nutrients

4. Regular Monitoring

Consistent follow-ups with your healthcare provider can help identify and address side effects early. This may include:

• Regular blood pressure and heart rate checks
• Periodic blood tests to monitor electrolyte levels and kidney function
• Discussing any new symptoms or changes in your health

How often should you have follow-up appointments while taking metoprolol? The frequency of follow-ups will depend on your individual health status and how well you’re tolerating the medication. Initially, more frequent visits may be necessary, with the interval potentially increasing as your condition stabilizes.

Drug Interactions and Their Impact on Side Effects

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

1. Other Blood Pressure Medications

Combining metoprolol with other antihypertensive drugs may lead to:

• Excessive lowering of blood pressure
• Increased risk of dizziness and fainting
• Potential for bradycardia (abnormally slow heart rate)

2. Certain Antidepressants

Some antidepressants, particularly those in the SSRI class, may:

• Increase blood levels of metoprolol
• Enhance the risk of bradycardia
• Potentially exacerbate side effects like fatigue and dizziness

3. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Regular use of NSAIDs like ibuprofen or naproxen may:

• Reduce the blood pressure-lowering effects of metoprolol
• Increase the risk of kidney problems in some patients

4. Certain Diabetes Medications

Metoprolol may mask some of the symptoms of low blood sugar (hypoglycemia) in diabetic patients. This interaction requires:

• More frequent blood sugar monitoring
• Potential adjustments to diabetes medication dosages

Why is it crucial to inform your healthcare provider about all medications and supplements you’re taking? By having a comprehensive understanding of your medication regimen, your healthcare provider can anticipate potential interactions, adjust dosages as needed, and monitor for specific side effects more effectively.

Long-Term Use of Metoprolol: What to Expect

Metoprolol is often prescribed for long-term use in managing chronic conditions like hypertension and heart failure. Understanding what to expect over time can help patients better manage their health and any potential side effects.

Potential Long-Term Effects

While many patients tolerate metoprolol well over extended periods, some may experience:

• Changes in lipid profiles (cholesterol levels)
• Slight increases in blood glucose levels
• Potential for weight gain in some individuals
• Rare cases of mood changes or depression

Monitoring and Management

For patients on long-term metoprolol therapy, healthcare providers typically recommend:

1. Regular blood pressure and heart rate checks
2. Periodic blood tests to monitor electrolytes, lipids, and glucose levels
3. Annual comprehensive health assessments
4. Ongoing evaluation of medication effectiveness and side effect profile

Can long-term use of metoprolol lead to dependency? Unlike some medications, metoprolol does not cause physical dependence. However, abrupt discontinuation can lead to a temporary increase in blood pressure and heart rate, potentially causing serious cardiac events. Always consult your healthcare provider before making any changes to your metoprolol regimen.

Lifestyle Considerations for Long-Term Use

Patients on long-term metoprolol therapy should consider:

• Maintaining a heart-healthy diet and regular exercise routine
• Avoiding excessive alcohol consumption, which can interact with the medication
• Being cautious with activities that require alertness, especially if experiencing dizziness or fatigue
• Staying well-hydrated, particularly in hot weather or during exercise

By working closely with their healthcare providers and adopting healthy lifestyle habits, many patients can successfully manage long-term metoprolol therapy while minimizing side effects and optimizing their cardiovascular health.

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?

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

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. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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

Metoprolol succinate (Metoprolol succinate).

Substance-powder Reference book of medicines. Tomsk

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Packaging

Substance-powder

Pharmacological action

Selective beta-blocker without internal sympathomimetic activity. Due to the peculiarities of the dosage form, a constant concentration of metoprolol in the blood plasma is maintained and a stable clinical effect is provided for 24 hours. The drug is characterized by better beta-selectivity compared to traditional metoprolol.

Indications for use

Selective beta-blocker without internal sympathomimetic activity. Due to the peculiarities of the dosage form, a constant concentration of metoprolol in the blood plasma is maintained and a stable clinical effect is provided for 24 hours. The drug is characterized by better beta-selectivity compared to traditional metoprolol.

Presentation form

substance-powder; package (bag) polyethylene two-layer 0.1 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 0. 5 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 1.2.5 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 10.15.20.25 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 10,15,20,25,30 and 35 kg cardboard container 1;

Pharmacodynamics

Selective beta-blocker without internal sympathomimetic activity. Due to the peculiarities of the dosage form, a constant concentration of metoprolol in the blood plasma is maintained and a stable clinical effect is provided for 24 hours. The drug is characterized by better beta-selectivity compared to traditional metoprolol.

Reduces the risk of side effects (bradycardia, weakness). To a lesser extent, it affects the smooth muscles of the bronchi, the release of insulin, carbohydrate metabolism and the activity of the cardiovascular system. Application for arterial hypertension leads to a decrease in blood pressure for more than 24 hours. At the beginning of treatment, an increase in OPSS is noted, with prolonged use, OPSS decreases.

Pharmacokinetics

Bioavailability – 30-40%. The release rate depends on the acidity of the medium. Communication with proteins – 5-10%. T1 / 2 – 3.5 hours. Biotransformation – in the liver by oxidation. It is excreted in the urine as metabolites, about 5% unchanged.

Use during pregnancy

Possible if the expected effect of therapy outweighs the potential risk to the fetus. At the time of treatment should stop breastfeeding.

Contraindications for use

AV block II and III degree, sinoatrial block, SSSU, arterial hypotension, CHF in the stage of decompensation, cardiogenic shock, suspected acute MI with a heart rate of less than 45 bpm, peripheral circulatory disorders, i/ in the introduction of calcium channel blockers (with simultaneous intravenous administration of verapamil, the risk of cardiac arrest should be borne in mind), age up to 18 years, hypersensitivity to metoprolol.

Side effects

At the beginning of therapy, weakness, fatigue, dizziness, headache, muscle cramps, a feeling of coldness and paresthesia in the extremities are possible. Also possible are bradycardia, hypotension, AV conduction disturbances, the appearance of symptoms of heart failure, a decrease in the secretion of lacrimal fluid, conjunctivitis, rhinitis, depression, sleep disturbances, nightmares, dry mouth, hypoglycemic conditions in patients with diabetes mellitus, vomiting, diarrhea, constipation. Predisposed patients may develop symptoms of bronchial obstruction. Individual cases of liver dysfunction, thrombocytopenia have been noted.

Method of administration and dosage

In arterial hypertension, the initial dose is 50-100 mg 1 r / day. With angina pectoris, the daily dose is 50-100 mg 1 r / day.

With maintenance treatment of MI, the drug is prescribed at 200 mg 1 r / day. The minimum duration of the course of treatment is 3 months. With supraventricular tachycardia and extrasystole, the drug is prescribed at 100-100 mg 1 r / day.

In CHF, the dose is selected individually, the initial dose for the first 2 weeks is 12.5 mg 1 r / day, then the dose is increased to 25 mg 1 r / day, after 2 weeks – up to 50 mg 1 r / day, with good tolerance, the dose can be increased up to 200 mg 1 r / day. For the prevention of migraine attacks, the drug is used in a daily dose of 100-200 mg 1 r / day.

Overdose

Symptoms: arterial hypotension, acute heart failure, bradycardia, cardiac arrest, AV blockade, cardiogenic shock, bronchospasm, impaired breathing and consciousness / coma, nausea, vomiting, generalized convulsions, cyanosis (manifested 20 minutes – 2 hours after ingestion ).

Treatment: gastric lavage, symptomatic therapy: the introduction of atropine sulfate (in / in quickly 0.5-2 mg) – with bradycardia and impaired AV conduction; glucagon (1-10 mg IV, then IV drip 2-2.5 mg/h) and dobutamine – in case of decreased myocardial contractility; adrenomimetics (norepinephrine, adrenaline, etc.) – with arterial hypotension; diazepam (in / in slowly) – to eliminate seizures; inhalation of beta-adrenergic agonists or intravenous jet administration of aminophylline for the relief of bronchospastic reactions; pacing.

Interaction with other drugs

Class I antiarrhythmic drugs – summation of negative inotropic action.