Side effects of missing a dose of metoprolol
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Side Effects of Missing a Dose of Metoprolol
Metoprolol is a commonly prescribed beta-blocker used to manage cardiovascular conditions such as hypertension and angina. However, missing a dose of metoprolol can lead to various side effects and complications. This article synthesizes the research findings on the side effects associated with missing a dose of metoprolol.
Patient Compliance and Awareness
A significant issue with metoprolol is patient compliance. Research indicates that around 90% of patients are not aware of the proper actions to take when they miss a dose of metoprolol2. This lack of awareness can lead to patients either skipping the missed dose entirely or doubling up on the next dose, both of which can have adverse effects.
Common Side Effects
Tiredness and Fatigue
One of the most frequently reported side effects of metoprolol, even when doses are not missed, is tiredness2. This side effect can be exacerbated when doses are missed, as the body may experience fluctuations in drug levels, leading to inconsistent therapeutic effects.
Dyspnea and Bradycardia
Dyspnea (shortness of breath) and bradycardia (slow heart rate) are also common side effects associated with metoprolol2. Missing a dose can lead to a sudden drop in the drug's plasma concentration, potentially causing these symptoms to become more pronounced.
Neuropsychiatric Effects
Sleep Disorders and Nightmares
In elderly patients, metoprolol has been associated with neuropsychiatric adverse reactions such as sleep disorders and nightmares1. Missing a dose can disrupt the steady-state concentration of the drug, potentially leading to the onset or worsening of these symptoms.
Depression and Anxiety
Depression and anxiety are other neuropsychiatric side effects that have been observed in patients taking metoprolol1. Missing a dose can lead to fluctuations in drug levels, which may contribute to mood instability and increased anxiety.
Drug-Drug Interactions
Interaction with CYP2D6 Inhibitors
Metoprolol is metabolized by the CYP2D6 enzyme, and its interaction with CYP2D6 inhibitors like paroxetine or fluoxetine can significantly increase its plasma concentration3. Missing a dose of metoprolol while on these inhibitors can lead to unpredictable drug levels, increasing the risk of adverse effects such as bradycardia and atrioventricular block3.
Conclusion
Missing a dose of metoprolol can lead to a range of side effects, from tiredness and dyspnea to more severe neuropsychiatric symptoms like sleep disorders and anxiety. Patient education on the proper management of missed doses is crucial to minimize these risks. Additionally, close monitoring is recommended, especially for patients on concurrent medications that interact with metoprolol.
Sources and full results
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 ReportRational use of Metoprolol: The Relationship of Its Blood Concentration to Patient Compliance, Poor Quality Medicines and Side Effects
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.
Observational StudyThe 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 JournalThe effect of the CYP2D6 genotype on the maintenance dose of metoprolol in a chronic Dutch patient population.
The CYP2D6 genotype is associated with the maintenance dose of metoprolol, and patients with the CYP2D6 PM phenotype may benefit from a lower starting dose and further dose titration to provide patient-tailored therapy and increase treatment effectiveness.
Observational StudyHemodynamic Effects of Intravenous, High‐Dose Lipid Emulsion With and Without Metoprolol Infusion in Healthy Volunteers: A Randomized Clinical Trial
High-dose intravenous lipid emulsion with metoprolol has marginal and delayed hemodynamic effects, potentially having limited clinical relevance in short-term clinical toxicological settings.
RCT
Rigorous JournalCYP2D6 polymorphism and its impact on the clinical response to metoprolol: A systematic review and meta-analysis.
CYP2D6 poor metabolizers may experience greater heart rate reduction and higher risk of bradycardia during metoprolol treatment compared to active CYP2D6 phenotypes.
Meta-AnalysisVery Rigorous JournalImpact of metoprolol treatment on mental status of chronic heart failure patients with neuropsychiatric disorders
Metoprolol treatment worsens depressive and high burnout symptoms in chronic heart failure patients with mental disorders, but provides anxiolytic benefits independent of heart rate reduction.
Observational StudyRigorous JournalOnce‐daily metoprolol in primary hypertension
Once-daily metoprolol effectively reduces blood pressure in primary hypertension patients, with 71% of patients responding to 300 mg dose, and heart rates remain reduced for 26 hours after a 150-mg dose.
RCTComparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial
Carvedilol extends survival in chronic heart failure patients compared to metoprolol, with similar side-effect profiles and drug withdrawals.
RCT
Large Human TrialRigorous Journal
Highly CitedMetoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial. The MIAMI Trial Research Group.
Metoprolol may reduce mortality in high-risk acute myocardial infarction patients, but its effect on overall mortality and morbidity remains unclear.
RCTLarge Human TrialHighly Cited