Side effects of metoprolol
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Side Effects of Metoprolol: A Comprehensive Overview
Cardiovascular Side Effects of Metoprolol
Metoprolol, a beta-blocker commonly used to treat hypertension and angina, has several cardiovascular side effects. One significant concern is the potential for bradycardia and atrioventricular block, especially when metoprolol is co-prescribed with CYP2D6 inhibitors like paroxetine or fluoxetine. These drug interactions can significantly increase the area under the curve (AUC) of metoprolol, leading to decreased systolic blood pressure and heart rate. Additionally, in patients with chronic obstructive pulmonary disease (COPD), metoprolol has been associated with a higher risk of exacerbations leading to hospitalization.
Central Nervous System (CNS) Side Effects
Metoprolol's lipophilicity is linked to various CNS side effects. Patients have reported vivid and bizarre dreams, hallucinations, sleep disturbances, and even psychosis . These side effects are more pronounced in elderly patients, who may experience increased confusion, fatigue, lightheadedness, and gait problems. A study comparing metoprolol with atenolol found that metoprolol caused a significant increase in sleep disturbances and restless nights.
Metabolic Side Effects
Metoprolol can also impact metabolic processes. Experimental studies have shown that metoprolol can lead to hyperglycemia and hypertriglyceridemia. These effects are attributed to increased blood glucose and triglyceride levels, along with decreased HDL-C, which may contribute to secondary hypertriglyceridemia.
Gastrointestinal and General Side Effects
Gastrointestinal disturbances and dizziness are common side effects of metoprolol, occurring in about 15% of patients. These side effects can lead to treatment discontinuation in a small percentage of cases. Other frequently reported side effects include temporary fatigue, dizziness, and headache.
Mental Health Implications
Metoprolol treatment in patients with chronic heart failure (CHF) and pre-existing mental disorders can exacerbate depressive symptoms and burnout, although it may provide some anxiolytic benefits. This suggests that while metoprolol can help manage heart rate, it may worsen certain mental health conditions, necessitating careful monitoring by healthcare providers.
Conclusion
Metoprolol is an effective beta-blocker for managing hypertension, angina, and heart failure, but it comes with a range of potential side effects. These include cardiovascular issues like bradycardia, CNS disturbances such as vivid dreams and hallucinations, metabolic changes leading to hyperglycemia, and general side effects like dizziness and gastrointestinal discomfort. Special caution is needed when prescribing metoprolol to elderly patients and those with pre-existing mental health conditions. Close monitoring and possible dose adjustments are essential to mitigate these side effects.
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