Metoprolol side effects elderly
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Metoprolol Side Effects in Elderly Patients
Introduction to Metoprolol and Its Use in Elderly Patients
Metoprolol, a beta-blocker, is commonly prescribed to elderly patients for managing cardiovascular conditions due to its efficacy and affordability. However, its use in older adults is associated with a range of side effects that require careful monitoring.
Neuropsychiatric Side Effects of Metoprolol in Elderly
Sleep Disorders and Nightmares
Elderly patients on metoprolol may experience neuropsychiatric side effects such as sleep disorders and nightmares. An 81-year-old patient treated with a low dose of metoprolol (25 mg/day) developed sleep disturbances, nightmares, depression, and anxiety, highlighting the potential for these adverse effects even at low doses1. Another case involving an 84-year-old male reported similar symptoms, including increased confusion, fatigue, and vivid dreams, further emphasizing the need for vigilance in monitoring these side effects2.
Depression and Anxiety
Depression and anxiety are also notable side effects in elderly patients taking metoprolol. The aforementioned 81-year-old patient exhibited these symptoms, which were attributed to the medication1. These findings suggest that beta-blockers like metoprolol can significantly impact mental health in older adults.
Delirium and Psychosis
Although less common, severe neuropsychiatric reactions such as delirium and psychosis have been reported. These reactions are typically associated with overdose or poisoning but can occur even at therapeutic doses in some cases6. This underscores the importance of monitoring for any unusual psychiatric symptoms in elderly patients on metoprolol.
Cardiovascular Side Effects
Bradycardia and Hypotension
Elderly patients, particularly those with certain CYP2D6 genotypes, may experience cardiovascular side effects such as bradycardia and hypotension. A study on elderly Chinese patients found that intermediate metabolizers (IMs) of CYP2D6 had a higher incidence of postural hypotension, bradycardia, and syncope compared to normal metabolizers (NMs)3. This suggests that genetic factors can influence the tolerance and side effect profile of metoprolol in elderly patients.
Exacerbation of COPD
In patients with chronic obstructive pulmonary disease (COPD), metoprolol has been associated with an increased risk of exacerbations leading to hospitalization. A randomized trial found no significant difference in the time to first COPD exacerbation between metoprolol and placebo groups, but hospitalization rates were higher in the metoprolol group4. This indicates that metoprolol may not be suitable for elderly patients with COPD.
Drug-Drug Interactions
Interaction with CYP2D6 Inhibitors
The combination of metoprolol with CYP2D6 inhibitors like paroxetine or fluoxetine can lead to significant drug-drug interactions. These interactions can increase the plasma concentration of metoprolol, resulting in adverse effects such as bradycardia and atrioventricular block5. Therefore, careful consideration and monitoring are required when prescribing these combinations to elderly patients.
Conclusion
Metoprolol, while effective for managing cardiovascular conditions, poses several risks for elderly patients, including neuropsychiatric and cardiovascular side effects. Genetic factors and drug-drug interactions further complicate its use in this population. Close monitoring and individualized treatment plans are essential to minimize these risks and ensure the safe use of metoprolol in elderly patients.
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Most relevant research papers on this topic
Sleep disorders, nightmares, depression and anxiety in an elderly patient treated with low-dose metoprolol.
Low-dose metoprolol can cause sleep disorders, nightmares, depression, and anxiety in elderly patients, which can easily be missed due to their age.
Case ReportMetoprolol-Associated Central Nervous System Complications
Beta-blockers, particularly metoprolol, can cause central nervous system complications in elderly patients, requiring close monitoring for adverse neurological symptoms.
Case Report
Rigorous JournalImpact of the CYP2D6 Genotype on Metoprolol Tolerance and Adverse Events in Elderly Chinese Patients With Cardiovascular Diseases
CYP2D6 genotyping is crucial in elderly Chinese patients with cardiovascular diseases to minimize adverse events and ensure the benefits of metoprolol treatment.
Observational StudyMetoprolol for the Prevention of Acute Exacerbations of COPD.
Metoprolol treatment for moderate or severe COPD patients without established indications showed similar time to first exacerbation but more hospitalization for exacerbation.
RCT
Large Human TrialRigorous Journal
Highly CitedThe impact of CYP2D6 mediated drug–drug interaction: a systematic review on a combination of metoprolol and paroxetine/fluoxetine
The drug-drug interaction between metoprolol and paroxetine/fluoxetine can lead to adverse clinical consequences, and alternative treatments are available.
Systematic Review
Very Rigorous JournalMetoprolol-induced psychosis in a young patient.
Metoprolol-induced acute delirium can occur in young patients, not only in elderly patients, highlighting the need for caution in clinical practice.
Case ReportThe treatment of high blood pressure in the elderly: a multi-centre evaluation of a fixed combination of metoprolol and hydrochlorothiazide ("Co-Betaloc") in general practice.
The metoprolol/hydrochlorothiazide combination effectively reduces blood pressure and is well-tolerated in most hypertensive patients, regardless of age or previous antihypertensive therapy.
Non-RCTLarge Human TrialThe effect of age on the pharmacokinetics of metoprolol and its metabolites.
Age has a less pronounced effect on the pharmacokinetics of metoprolol and its metabolites than for other drugs.
Non-RCTHighly CitedClinical Effect of Metoprolol on Elderly Patients with Chronic Heart Failure and its Safety
Metoprolol is an effective and safe treatment for elderly patients with chronic heart failure, improving heart function and reducing heart rate and blood pressure.
RCTTolerability to treatment with metoprolol in acute myocardial infarction in relation to age.
Tolerability to beta-blockade in acute myocardial infarction patients is similar in elderly and younger patients, with no significant differences in hemodynamic reactions or congestive heart failure incidence.
RCTLarge Human Trial