Side effects to metoprolol

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Side Effects of Metoprolol: A Comprehensive Review

Cardiovascular Side Effects of Metoprolol

Metoprolol, a beta-blocker commonly used to treat hypertension and angina, has been associated with several cardiovascular side effects. Studies have shown that metoprolol can cause bradycardia and atrioventricular block, particularly when combined with CYP2D6 inhibitors like paroxetine or fluoxetine, which increase the drug's concentration in the blood . Additionally, in patients with chronic obstructive pulmonary disease (COPD), metoprolol was linked to a higher risk of exacerbations leading to hospitalization .

Central Nervous System (CNS) Complications

Metoprolol's lipophilic properties allow it to cross the blood-brain barrier, leading to various CNS side effects. These include confusion, fatigue, lightheadedness, nightmares, sleep disturbances, and gait problems, particularly in elderly patients . Psychiatric symptoms such as delirium, psychosis, and visual hallucinations have also been reported . Furthermore, in patients with chronic heart failure (CHF) and pre-existing mental disorders, metoprolol treatment was found to worsen depressive and burnout symptoms, although it provided some anxiolytic benefits .

Metabolic Effects

Metoprolol has been shown to impact carbohydrate and lipid metabolism. Experimental studies on animals indicated that metoprolol could cause hyperglycemia and hypertriglyceridemia, which are considered unwanted effects . These metabolic disturbances are significant as they can exacerbate conditions like diabetes and hyperlipidemia.

Gastrointestinal and General Side Effects

Gastrointestinal disturbances, such as nausea and diarrhea, are common side effects of metoprolol. Dizziness and temporary fatigue are also frequently reported 35. In a study involving hypertensive patients, 15% experienced side effects that led to treatment withdrawal, highlighting the importance of monitoring and managing these adverse effects .

Conclusion

Metoprolol, while effective in managing cardiovascular conditions, is associated with a range of side effects that can impact various bodily systems. Cardiovascular side effects like bradycardia and exacerbations in COPD patients, CNS complications including psychiatric symptoms, metabolic disturbances, and gastrointestinal issues are notable. Physicians should carefully consider these potential side effects and monitor patients closely, especially those with pre-existing conditions or those taking other medications that may interact with metoprolol.

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Most relevant research papers on this topic

The 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 ReviewVery Rigorous Journal

2018·

28citations

·M. A. Bahar et al.

Metoprolol 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.

RCTLarge Human TrialRigorous JournalHighly Cited

2019·

116citations

·M. Dransfield et al.

Metoprolol

Metoprolol is a well-established first-line drug for treating mild to moderate hypertension and stable angina, and is beneficial in post-infarction patients.

Literature ReviewHighly Cited

2012·

108citations

·P. Benfield et al.

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.

Case ReportRigorous Journal

2020·

10citations

·R. Shah et al.

Metoprolol in hypertension

Metoprolol effectively reduces blood pressure in hypertensive patients, with most patients achieving a diastolic blood pressure of 12 kPa (90 mmHg) or lower, with minimal side effects and good tolerability for asthmatics and diabetics.

Non-RCTLarge Human Trial

1982·

1citation

·T. Assaykeen et al.

Metoprolol 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

1985·

558citations

·J. Herlitz et al.

[Experimental study of metoprolol-induced side effects].

Metoprolol, a beta1-selective adrenoceptor antagonist, can cause high blood glucose and secondary hypertriglyceridaemia in male Wistar rats, potentially causing unwanted effects.

Non-RCTAnimal Study

1998·

1citation

·J. Gergely

Effects of metoprolol CR in patients with ischemic and dilated cardiomyopathy : the randomized evaluation of strategies for left ventricular dysfunction pilot study.

Metoprolol CR improves left ventricular function, reduces renin-angiotensin system activation, and leads to fewer deaths in patients with symptomatic congestive heart failure.

RCTLarge Human TrialHighly Cited

2000·

210citations

·M. White et al.

A controlled study on the antihypertensive effect of a new beta-adrenergic receptor blocking drug, metoprolol, in combination with chlorthalidone.

Metoprolol combined with chlorthalidone effectively reduces blood pressure and is well-tolerated for mild and moderate hypertension in patients not responding to chlorthalidone alone.

RCT

1976·

20citations

·A. Jäättelä et al.

Impact 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 Journal

2017·

24citations

·Xuelu Liu et al.

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