Metoprolol side effects fatigue

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Metoprolol Side Effects: Fatigue and Tiredness

Prevalence of Fatigue as a Side Effect of Metoprolol

Fatigue and tiredness are among the most commonly reported side effects of metoprolol. Studies consistently identify tiredness as a frequent complaint among patients taking metoprolol, often appearing alongside other symptoms such as dyspnea and bradycardia . Fatigue can occur in both healthy individuals and those with underlying health conditions, and it is not limited to a specific age group 256.

Mechanisms Behind Metoprolol-Induced Fatigue

Metoprolol, as a beta-blocker, reduces heart rate and exercise capacity, which can directly contribute to feelings of fatigue. Research shows that after taking metoprolol, subjects experience a significant reduction in exercise heart rate and an increase in subjective fatigue, even after a single dose 56. This effect is more pronounced at higher doses and with immediate-release formulations, which cause higher peak plasma concentrations 678. Controlled-release (CR/ZOK) formulations of metoprolol, which provide a more even plasma concentration over 24 hours, are associated with less general and leg fatigue compared to conventional tablets or other beta-blockers like atenolol 789.

Individual Differences in Fatigue Response

The degree of fatigue experienced can vary based on individual metabolism. People who are poor metabolizers of metoprolol may experience higher fatigue scores and longer exercise times compared to extensive metabolizers, especially at higher doses . Additionally, patients with underlying mitochondrial disorders may be more susceptible to muscular fatigue and other side effects when taking metoprolol .

Central Nervous System and Other Related Symptoms

Fatigue from metoprolol can also be accompanied by other central nervous system symptoms, such as confusion, sleep disturbances, and vivid dreams, particularly in elderly patients . These symptoms may be related to the drug’s ability to cross the blood-brain barrier, especially in more lipophilic beta-blockers like metoprolol .

Patient Awareness and Management

Many patients are not fully aware of how to manage missed doses or potential side effects of metoprolol, which can impact both the effectiveness of treatment and the experience of side effects like fatigue . Education on proper medication use is important to minimize unnecessary fatigue and other adverse effects .

Conclusion

Fatigue is a well-documented and common side effect of metoprolol, influenced by dosage, formulation, individual metabolism, and patient awareness. Using controlled-release formulations and educating patients about their medication can help reduce the severity of fatigue and improve overall treatment outcomes 256789.

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Most relevant research papers on this topic

Metoprolol-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.

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Metoprolol is an interchangeable drug with no significant difference in blood concentrations, and patient awareness of proper drug use is crucial for increasing treatment effectiveness and reducing side effects.

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Marked hypertriglyceridemia in a woman receiving metoprolol succinate.

Metoprolol succinate can cause high triglyceride levels, which can lead to fatigue and mild abdominal discomfort, but discontinuing the medication can lower these levels.

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·Yeunjung Kim et al.

Mitochondrial Disorder Aggravated by Metoprolol

Metoprolol may aggravate mitochondrial dysfunction in pediatric patients, leading to respiratory distress and chest wall weakness when discontinued.

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Influence of debrisoquine oxidation phenotype on exercise tolerance and subjective fatigue after metoprolol and atenolol in healthy subjects.

Metoprolol prolongs exercise time and increases fatigue more than atenolol, with poor metabolisers needing longer exercise and experiencing higher fatigue scores compared to extensive metabolisers.

RCT

1991·

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·R. Lewis et al.

Maximal exercise power after a single dose of metoprolol and of slow-release metoprolol

Slow-release metoprolol may be preferable for treating hypertension due to reduced maximal exercise power and potential side-effects.

1980·

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·H. Folgering et al.

Treatment with β‐blockers—the value of an even plasma concentration over 24 h

Metoprolol CR/ZOK has a more even plasma concentration over 24 hours, providing more effective 1-blockade and fewer side-effects compared to atenolol and conventional metoprolol tablets.

1997·

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·S. Agewall et al.

Treatment with beta-blockers--the value of an even plasma concentration over 24 h.

Metoprolol CR/ZOK has a more even plasma concentration over 24 hours, leading to more beta 1-blockade and fewer side-effects compared to atenolol and conventional metoprolol tablets.

1997·

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Exercise metabolism in healthy volunteers taking atenolol, high and low doses of metoprolol CR/Z0K, and placebo.

Atenolol and metoprolol CR/Z0K reduce fat oxidation during exercise, potentially affecting exercise capacity and causing fatigue.

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1994·

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·A. Head et al.

To Study the Comparative Effect of Nebivolol and Metoprolol on Fasting and Post meal Blood Glucose Level in Patients of Type II Diabetes Mellitus with Essential Hypertension

Nebivolol is more effective than metoprolol in reducing blood glucose, HbA1c, and blood pressure with lesser side effects in type II diabetic and hypertension patients.

2021·

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