8 Metoprolol Side Effects To Know About

GoodRx Health

Metoprolol is a beta blocker that's FDA approved to treat high blood pressure (hypertension) and chest pain (angina). The immediate-release (IR) version, known as metoprolol tartrate (Lopressor), is also FDA approved to prevent death after a heart attack. And the extended-release (ER) versions, known as metoprolol succinate (Toprol XL, Kapspargo Sprinkle), are approved to lower the risk of death and hospitalization in people with heart failure.

Although there are some differences between the two versions of metoprolol, they have similar risks. In fact, all beta blockers share some common side effects. And knowing which metoprolol side effects to watch for can help you prevent or manage them.

This article focuses on metoprolol IR. Check out another GoodRx Health article for more information on metoprolol ER side effects.

Metoprolol side effects at a glance

Metoprolol is typically well tolerated. Common side effects are usually mild and tend to go away as your body gets used to the medication. Metoprolol may also have some side effects that can be serious, although these are rare.

Common metoprolol side effects include:

• Dizziness

• Low blood pressure

• Fatigue

• Itchiness

• Mood changes

• Nausea

• Diarrhea

• Headache

Rare but serious metoprolol side effects include:

• Masking symptoms of low blood glucose (sugar)

• Masking signs of hyperthyroidism

• Extremely low heart rate

• Worsening heart failure, heart block, or peripheral artery disease

• Worsening lung conditions, such as asthma or chronic obstructive pulmonary disease (COPD)

Below, we'll go into more detail about eight of these metoprolol side effects and how to manage them.

1. Dizziness and low blood pressure

Dizziness is one of the most common metoprolol side effects. This can occur because metoprolol lowers blood pressure. Usually, this is a good thing. But in some cases, it may cause your blood pressure to drop too low (hypotension), leading to dizziness and lightheadedness.

Low blood pressure with metoprolol typically improves as your body gets used to the medication. You can also take a few steps to help lessen dizziness if you're experiencing it.

• Change positions slowly and hold onto something steady, such as a stable piece of furniture.

• If you feel dizzy as you stand up, sit back down until the dizziness passes. Then, try to stand again.

• If you're lying down, sit up first and wait a minute or two before slowly standing.

If you have dizziness that disrupts your day-to-day life or doesn't go away after a few weeks, talk with your prescriber. They can check your blood pressure. If it's too low, they may lower your metoprolol dosage or consider whether something else is causing your dizziness.

2. Tiredness

Along with dizziness, tiredness is one of the most common metoprolol side effects. This may occur because metoprolol slows your heart rate, which can make you sleepy. Metoprolol also passes into the brain, which may be another reason it makes you tired.

Like other common metoprolol side effects, fatigue and drowsiness should improve as your body adjusts to the medication. There are also a few things you can do to help relieve fatigue.

• Stay active. Regular exercise can help increase your energy levels. Talk with your healthcare team about what your target heart rate should be during exercise.

• Eat a healthy diet. Nutrient-rich foods can help boost your energy level. Some examples include fatty fish, berries, and beans.

• Maintain a regular sleep schedule. Getting adequate sleep can help minimize fatigue. Depending on your age, you may need 7 or more hours of sleep each night for optimal health. Avoiding caffeine in the late afternoon or evening and sticking to a regular bedtime routine can help improve your sleep.

3. Diarrhea

Diarrhea is another possible metoprolol side effect. Mild diarrhea typically doesn't require medical attention. If medications are needed, there are over-the-counter options such as loperamide (Imodium A-D). But it's a good idea to check with a healthcare professional before using it.

If you have diarrhea with metoprolol, there are some things you can do to prevent it from getting worse. These include avoiding foods that can cause diarrhea, such as fried or fatty foods. And drinking plenty of fluids, such as water and electrolyte drinks, can help you avoid dehydration from diarrhea.

If your diarrhea continues longer than a few days, let your prescriber know. They may want to consider whether something else could be the cause.

4. Itchiness

Some people may experience itchiness or a rash while taking metoprolol. In most cases, itchiness is mild and temporary.

However, itchiness with a rash may also be a symptom of an allergic reaction. Let your prescriber know right away if you have severe itchiness or a sudden rash while taking metoprolol.

Seek immediate emergency care if you have symptoms of a serious allergic reaction, such as trouble breathing or swelling of your face or throat.

5. Depression

Depression has also been reported with beta blockers. However, research in the past few years has shown that beta blockers may not be as likely to cause depression as we thought. Still, it's important to let your prescriber know if you have a history of depression before you start taking metoprolol. They can help you decide if metoprolol is right for you.

Tell your prescriber if you experience new or worsening depression symptoms while taking metoprolol. These may include:

• Persistent feelings of sadness or hopelessness

• Sleeping more or less than usual

• Trouble concentrating

• Suicidal thoughts or actions

If you or someone you know is having thoughts of suicide, you're not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text "HOME" to 741-741 to reach the Crisis Text Line.

6. Hypoglycemia

Metoprolol doesn't directly lower your blood glucose. However, it can make it harder to notice if you're experiencing hypoglycemia (low blood glucose).

Metoprolol slows your heart rate. This can mask several signs of hypoglycemia such as a fast heart rate, shakiness, and nervousness. However, other signs of hypoglycemia, such as dizziness, sweating, hunger, and confusion may still be present. Watching for these symptoms is important, especially if you are taking medication to treat diabetes or prediabetes.

If you have diabetes, it's a good idea to test your blood glucose regularly. So talk to your prescriber about your individual blood glucose goals. Typically, if your blood glucose is below 70 mg/dL or you have symptoms of hypoglycemia, you should treat it with a quick-acting sugar source, such as: One-half cup of non-diet juice or soda or four glucose tablets.

7. Heart problems

Metoprolol works by slowing your heart rate and lowering your blood pressure. In rare cases, this can sometimes cause heart problems (or make existing heart issues worse). Metoprolol may slow your heart rate too much,causing what's known as bradycardia.

In severe cases, bradycardia may cause symptoms and require medical attention. Symptoms may include:

• Dizziness

• Chest pain

• Weakness or fatigue

• Fainting

• Shortness of breath

Bradycardia can also make heart failure worse. In fact, people with severe heart failure should typically avoid metoprolol. So if you notice any symptoms of worsening heart failure, such as unexplained weight gain or swelling, talk to your prescriber immediately. You may need a lower metoprolol dose, or they may need to adjust the doses of your other heart failure medications.

8. Worsening lung conditions

If you have lung problems, such as asthma or chronic obstructive pulmonary disease (COPD), beta blockers may not be the best choice for you. This is because they can worsen these conditions. However, beta blockers that mainly affect the heart (including metoprolol), may be safe for people with mild lung conditions. For others, it may be too risky.

Let your prescriber know if you have asthma or COPD before taking any beta blocker. They can decide if it's safe for you.

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