Metoprolol sweating

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Metoprolol and Sweating: A Comprehensive Review

Introduction to Metoprolol and Its Effects

Metoprolol, a beta-1 selective beta-blocker, is commonly prescribed for managing hypertension, angina, and heart failure. While effective in controlling cardiovascular conditions, metoprolol has been associated with various side effects, including increased sweating. This article synthesizes research findings on the relationship between metoprolol and sweating.

Metoprolol and Sweating During Hypoglycemia

Hypoglycemia-Induced Sweating

Several studies have investigated the effects of beta-blockers, including metoprolol, on physiological responses during hypoglycemia. One study found that during hypoglycemia, all three beta-adrenoceptor blockers (propranolol, atenolol, and metoprolol) augmented sweating compared to placebo . This suggests that metoprolol can enhance sweating as a response to low blood sugar levels.

Hormonal and Physiological Responses

The same study noted that the rise in plasma adrenaline and other counter-regulatory hormones during hypoglycemia was enhanced by beta-adrenoceptor blockade, which could contribute to the increased sweating observed . This indicates that metoprolol's effect on sweating may be linked to its influence on hormonal responses during hypoglycemia.

Metoprolol and Sweating During Exercise

Acute and Chronic Effects

Research on hypertensive men undergoing moderate exercise revealed that a single dose of metoprolol increased sweating from the forehead during exercise . Interestingly, while the effect of propranolol on sweating diminished with chronic treatment, the effect of metoprolol was maintained over time . This suggests that metoprolol consistently enhances sweating during physical activity, regardless of treatment duration.

Metoprolol and Sweating in General Use

Comparison with Other Antihypertensive Agents

In a study comparing metoprolol with diltiazem, it was found that metoprolol-treated patients reported increased sweating more frequently than those treated with diltiazem . This indicates that sweating is a more common side effect of metoprolol compared to some other antihypertensive medications.

Withdrawal Symptoms

Another study highlighted that abrupt withdrawal of metoprolol in patients with mild hypertension led to symptoms such as general malaise, palpitations, headache, sweating, and tremor . These symptoms were more pronounced in the standing position and disappeared upon resumption of beta-blocker therapy or gradually over several days . This underscores the importance of gradual tapering when discontinuing metoprolol to avoid excessive sweating and other withdrawal symptoms.

Conclusion

Metoprolol, while effective in managing cardiovascular conditions, is associated with increased sweating, particularly during hypoglycemia and physical exercise. This side effect is consistent across acute and chronic use and can be more pronounced compared to other antihypertensive agents. Understanding these effects is crucial for healthcare providers in managing and advising patients on metoprolol therapy.

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Most relevant research papers on this topic

Beta-adrenoceptor blockade and hypoglycaemia. A randomised, double-blind, placebo controlled comparison of metoprolol CR, atenolol and propranolol LA in normal subjects.

Beta-adrenoceptor antagonists modify physiological and hormonal responses to moderate hypoglycemia in healthy volunteers, but do not adversely affect awareness of the condition.

RCT

1990·

46citations

·David Kerr et al.

The effects of acute or chronic ingestion of propranolol or metoprolol on the physiological responses to prolonged, submaximal exercise in hypertensive men.

Propranolol and metoprolol effectively reduce heart rate and blood pressure during exercise in hypertensive men, with propranolol having a greater effect, but their effects diminish after chronic treatment.

RCT

1984·

42citations

·R. Wilcox et al.

Beta blockade and diabetes mellitus: effect of oxprenolol and metoprolol on the metabolic, cardiovascular, and hormonal response to insulin-induced hypoglycemia in normal subjects.

Both oxprenolol and metoprolol delay hypoglycemia recovery, but oxprenolol raises diastolic blood pressure during hypoglycemia.

1980·

30citations

·G. Viberti et al.

Pharmacokinetics and pharmacodynamics of oral and intravenous metoprolol tartrate in clinically healthy horses.

Intravenous and oral metoprolol tartrate in horses have similar pharmacokinetic properties and cardiovascular effects, with sweating as the most common side effect.

RCTAnimal Study

2021·

2citations

·D. Luethy et al.

A comparison of diltiazem and metoprolol in hypertension

Diltiazem and metoprolol both effectively reduce blood pressure in mild to moderate hypertension, with similar antihypertensive properties and adverse effects.

RCT

2004·

7citations

·T. Hedner et al.

Comparison of metoprolol and hydrochlorothiazide as antihypertensive agents

Both metoprolol and hydrochlorothiazide effectively reduce blood pressure in mild hypertension patients, with few side effects and potential risks.

1976·

4citations

·O. Lederballe Pedersen

Effects of metoprolol on the counter-regulation and recognition of prolonged hypoglycemia in insulin-dependent diabetics.

Metoprolol does not aggravate prolonged hypoglycemia in insulin-dependent diabetics with blunted glucagon response, and may compensate for its inhibitory effect on insulin clearance through increased responses of counter-regulatory hormones.

Non-RCT

2009·

41citations

·N. Clausen-Sjöbom et al.

Improvement in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double-blind, randomized, placebo-controlled trial.

Metoprolol can safely improve symptoms and exercise capacity in patients with dilated cardiomyopathy, with seven out of 20 patients experiencing resolution of heart failure symptoms and doubled their exercise capacity.

RCTHighly Cited

1985·

471citations

·R. Engelmeier et al.

Metoprolol

Metoprolol CR/XL effectively decreases mortality and improves clinical status in patients with stable mild to moderate chronic heart failure due to left ventricular systolic dysfunction, and is effective in patients with ischaemic or dilated cardiomyopathy.

RCT

2000·

21citations

·A. Prakash et al.

Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in-Congestive Heart Failure (MERIT-HF)

Metoprolol CR/XL once daily in addition to standard therapy improved survival in chronic heart failure patients with decreased ejection fraction and symptoms, and was well-tolerated.

RCTLarge Human TrialHighly Cited

1999·

4941citations

·A. Hjalmarson et al.

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