The People's Perspective on Medicine

What Are Metoprolol Side Effects When Prescribed for High Blood Pressure:

Beta blockers such as atenolol, metoprolol and propranolol remain popular first-line treatments for hypertension. Some cardiologists question this approach.
Beta blocker blood pressure Metoprolol

Metoprolol is one of the most prescribed drugs in the United States. At last count, nearly 90 millions prescriptions were dispensed annually. It has FDA approval to treat high blood pressure and heart pain (angina pectoris). This drug is sometimes injected intravenously after a heart attack patient has been stabilized. Not infrequently such patients are also sent home on oral metoprolol to reduce the likelihood of “cardiovascular mortality” after recovering from a heart attack. Many people want to know more about this commonly prescribed medication, especially metoprolol side effects.

What Are Metoprolol Side Effects?

Q. My doctor just prescribed metoprolol to control migraines and slightly elevated blood pressure at the same time. At 49, I have been trying to control my BP for more than a year through diet and exercise. It remains just slightly too high for everyone’s comfort, and seems to spike when I take sumatriptan for migraine.

I am concerned about metoprolol. Is it safe and will it really help me with both migraine and BP? I really do not want to take a drug on a daily basis.

A. Let’s start with one potential problem right off the bat: the migraine medicine sumatriptan (Imitrex) can increase blood pressure, sometimes to a dangerous level. Here’s what the FDA includes in its WARNINGS AND PRECAUTIONS section for sumatriptan:

Increase in Blood Pressure:

“Significant elevation in blood pressure, including hypertensive crisis with acute impairment of organ systems, has been reported on rare occasions in patients treated with 5-HT1 agonists, including patients without a history of hypertension. Monitor blood pressure in patients treated with IMITREX. IMITREX Tablets are contraindicated in patients with uncontrolled hypertension.”

Sumatriptan Side Effects:

  • Heart attack, heart pain, angina, chest tightness and/or pressure, jaw pain, palpitations
  • Spasms in blood vessels leading to belly pain, bloody diarrhea, cold hands and feet, etc.
  • Serotonin syndrome, especially when combined with SSRI-type antidepressants. Symptoms include agitation, hallucinations, uncontrollable muscle contractions and/or movements, rapid heart rate, elevated temperature, digestive distress and coma
  • Seizures
  • Severe allergic reactions, anaphylaxis
  • Abnormal sensations, tingling, numbness, prickling feelings

Although sumatriptan can be a very useful drug for the treatment of migraines, it does pose a problem for people with a susceptibility to high blood pressure.

Metoprolol and Migraines:

Metoprolol can help reduce the frequency of migraines. The FDA has not approved this beta blocker heart medicine for the prevention of migraines. Prescriptions for metoprolol for this indication are considered off-label. That said, the American Academy of Neurology has published guidelines that “support the use metoprolol” for this purpose (Continuum, Aug., 2015).

Based on the available evidence the authors note:

“Beta-blockers are the most widely used class of drugs in prophylactic migraine treatment and are about 50% effective in producing a greater than 50% reduction in attack frequency.”

Metoprolol and High Blood Pressure:

The case for using metoprolol (or other beta blockers such as atenolol or propranolol) as first line drugs against hypertension is much less secure. Franz Messerli, MD, is Professor of Medicine at Mount Sinai Health Medical Center. He is arguably one of the grand old men of preventive cardiology. He has written extensively about the use of beta blockers as first-line treatments for hypertension [HTN].

Please pardon the medical jargon, but in the editorial comment in the Journal of the American College of Cardiology (Sept. 22, 2009), Dr. Messerli and his colleagues are extremely candid.

“Beta-Blockers as First-Line Antihypertensive Therapy:

The Crumbling Continues.”

Under the title of their article is a quote from Mark Twain:

“Supposing is good but finding out is better.”

Here is what Dr. Messerli and colleagues say:

“Compared with other agents used in the treatment of uncomplicated HTN [hypertension], BBs [beta blockers] have a number of potential adverse effects. In fact, after 4 decades of using BBs as primary treatment for HTN, no study has shown reduced morbidity or mortality when used as monotherapy when compared with placebo. In contrast, many meta-analyses have suggested the potential detrimental effects of these agents. In a recent meta-analysis of 12 studies evaluating over 90,000 patients with HTN, BB therapy resulted in a 22% increased risk for new-onset diabetes mellitus, a known powerful risk factor for CV [cardiovascular] disease. Recent studies have focused on the epidemic in obesity and therapy with BBs might be associated with weight gain…”

In their concluding remarks these authors ask the question:

“On the basis of the current information, how should clinicians currently proceed when treating patients with HTN? The seminal question to be asked is: “Are BBs still alive as first-line therapy for HTN?”

They answer:

“…for the patient with HTN without other compelling indications, the evidence supporting BB therapy has vanished…Thus, in response to Mark Twain, we no longer need to suppose–we have found out!…Finally, as the evidence supporting BBs as first-line therapy for HTN continues to crumble, one could answer the question posed earlier, “Maybe alive, but barely breathing!”

NEVER Stop Metoprolol Suddenly!

No one should EVER stop beta blocker treatment suddenly. That could lead to angina, heart attacks and other serious complications. Patients who are treated with beta blockers as first-line therapy for hypertension should discuss this article with their prescribers. There may be a compelling reason for metoprolol. It may also be helpful to ask the question: What are metoprolol side effects? To help further the discussion with a prescriber, we list the following from the Food and Drug Administration:

Metoprolol Side Effects:

According to the FDA:

Central Nervous System:

“Tiredness and dizziness have occurred in about 10 of 100 patients. Depression has been reported in about 5 of 100 patients. Mental confusion and short-term memory loss have been reported. Headache, nightmares, and insomnia have also been reported.”

Cardiovascular:

“Shortness of breath and bradycardia [slow heart rate] have occurred in approximately 3 of 100 patients. Cold extremities; arterial insufficiency, usually of the Raynaud type; palpitations; congestive heart failure; peripheral edema; and hypotension have been reported in about 1 of 100 patients…”

Respiratory:

“Wheezing (bronchospasm) and dyspnea [shortness of breath] have been reported in about 1 of 100 patients. Rhinitis has also been reported.”

Gastrointestinal:

“Diarrhea has occurred in about 5 of 100 patients. Nausea, dry mouth, gastric pain, constipation, flatulence, and heartburn have been reported in about 1 of 100 patients. Vomiting was a common occurrence….”

Hypersensitive Reactions:

“Pruritus [itching] or rash have occurred in about 5 of 100 patients…

Miscellaneous:

The FDA considers these metoprolol side effects quite rare, but does list them:

Peyronie’s disease [bent penis syndrome], hair loss, dry eyes, blood disorders, weight gain, memory loss, confusion, increased triglyceride levels, decreased HDL cholesterol and arthritis.

Other Ways to Control Hypertension:

You describe your blood pressure as “just slightly too high for everyone’s comfort.” You did not provide us with actual numbers so we cannot comment on your situation. The sumatriptan you have been using for migraine attacks may be contributing to your elevated blood pressure readings.

We are sending you our Guide to Blood Pressure Treatment so you will have more information on metoprolol and non-drug approaches to controlling hypertension. Anyone who would like a printed copy, please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope:

  • Graedons’ People’s Pharmacy, No. B-67,
  • P. O. Box 52027,
  • Durham, NC 27717-2027.

It can also be downloaded at this link.

Share your own experience with metoprolol and/or sumatriptan below in the comment section.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I had a heart attack in June of 2018 and had two stents inserted. I have now very high blood pressure. I am on 100 mg Lorsartan, 25 mg Metroporol and 10 mg of Norvasc for blood pressure. Since the Norvasc was added to my meds, my blood pressure has gone down but my blood sugar has gotten totally out of control. I’m wondering if the Norvasc is what is causing the blood sugar problem. Has anyone had this problem?

I was on 50mg daily of Atenolol for just over 20 years for slightly elevated blood pressure, I was in my mid 30’s when diagnosed. About 10 years ago, I was prescribed Triamterene-HCTZ 37.5-25mg daily to help lower my blood pressure as well. A little more than a year ago, I was told that I could not get Atenolol because of something with the manufacturer and my doctor changed me to Metoprolol, 100mg daily. In May of 2017, I fell down and cracked 6 ribs on my left side and that is when it seems like everything started falling apart. My hair and eyebrows had already thinned due to the Atenolol, but during a CT with contrast it was discovered that I had nodules on my thyroid. Consequently, I went through all of the tests and biopsies to have that checked out. Shortly after all of this, I discovered my A1c was a little elevated. I had never had it checked before. I made an appointment with an endocrinologist and when she tested it, it was at 8.2 so I was put on Metformin, 2000 mg daily. After reading that Metropolol or BB’s could be the culprit, I am going to definitely talk to my doctor about it. I also have other symptoms like being very tired all of the time, not sleeping well at night, no energy, achy joints, leg and foot cramps. Before I fell down, I was pretty active and felt pretty good. It seems like that fall knocked things loose on the inside and it’s all causing problems now. I just really wonder how much could be caused by the Metropolol and Triamtrene-HCTZ 37.5-25mg daily. I just want to feel normal again and have more energy so that I get up and down off the floor to play with my grandsons.

I never understand the ‘it could be worse’, more like ‘it should be better!’. How? Cap rent and provide affordable housing. Cap working hours at 30 and increase minimum wage (creating more jobs and getting people off benefits). Scrap zero hour contracts and cap wages of executives. Regulate banks and cap bonuses. Deal with corporate tax avoidance! And yeah the economic exploitation of people around the world and what our government (who the public voted in) has done is sickening

Lopressor/Metoprolol 50mg per day for husband 25mam, 25mg pm since 2009. Take Lisinopril as well. Many times had to go to walk in clinic for cold or somthing. HR 40.. All doctors concerned. His Cardio, received memo. Said it was normal b/c he was in 50″s very active and hard working mechanic. Well, husband just injured himself on job. Had to go to ER. Heart Rate 38. Foggy, short term memory loss. Always feeling crappy. Never complains. Now out of work.

I told cardo dr. That everyone said that it is NOT normal. He was in reality starving his brain of blood for all of these years. I took him off. Heart rate after 5 days is 55. He feels Fantastic! Clear as a bell. REMEMBERS everything. I will start with 20mg when HR hits in high 70/low 80 and will change dr. Please do not try this. Talk to your doctor. but for him this was a poison.. God Bless

My 90 year old mother had taken metoprolol for over 10 years and was recently on 200mg daily due to a kidney stone. After removing the stone, she is now on 50mg. I still don’t like the hallucination side effects (and I know they are from the metoprolol based on studying her after I give her the pills and when they are wearing off). She also has macular degeneration and Parkinson’s. We are trying no THC hemp oil for her Parkinson’s and that is helping her flexibility and isn’t bad for her heart. Would like to find another medication to replace the metoprolol because we are both losing a lot of sleep.

I have macular degeneration in my left eye. On PubMed/Nih I learned that anyone over the age of 65 who takes a beta blocker has a 72% greater risk of developing AMD. I shared this information with my Retinologist. He thanked me, as he was unaware of this. We really do need to educate ourselves. Thanks for your informative web site. I hope this information will be of help.

My husband has shortness of breath, tiredness & memory loss. He is 91. he uses Metoprolol and Lisinophil.

I have been on metropolol for about five years. Guess I’m lucky, I haven’t had any side effects.

I’m a 67 year old female. I have mitral valve prolapse, and I had a resting heart rate of 100 beats per minute. I also had a really jumpy heart, with the fish-flopping sensations and, at times, yanking and jerking of the mitral valve (tendons? I think). My BP is normal, even GREAT, if I don’t over do consumption of sodium. My cardiologist prescribed Metropolol a couple of years ago.

My heart rate slowed to about 85 beats per minute and my heart settled down enormously. (I also take a magnesium supplement, which helps.) I’ve been happy with the prescription, but I was recently alarmed to see a side effect could be hair loss. I realized my hair began thinning around the time I began the prescription.

Now, I see possible weight gain can be a side effect!! Noooo! Any ideas on how to keep the calmer heart while getting my thick hair back, and maybe losing tonnage, would be much appreciated. Thanks! Carlie

Nasty stuff! I have low blood pressure but was given Metoprolol for a-fib and began fainting from even the exertion of a brisk walk. It was like aging fifteen or twenty years overnight.

Another side effect from this drug: onychomycosis

Metoprolol is not a medicine its a metabolic poison Cardiologist prescribed me this drug after by pass surgery 6 years ago. On my flight home from the surgery, my heart rate when they could find it was 43 BPM miraculously I made it to an awaiting ambulance in my home town.

I told my cardiologist that similar events appeared shortly after taking the medication he asked if I would take it on the next prescribed time which I did and approximately 20 minutes. Later, they where having a tough time finding a pulse. The Doctor came in and commented we had better turf the metoprolol. I did a lot more than that I turfed the statins, aspirins and blood thinners and blood pressure pills as well.

Two weeks ago, had an echo-cardiogram the Cardiologist told me my heart was perfect I told him I exercise every day and had lost 10lbs.Then he asked me what medications I was taking I told him none he just about went ballistic on me and he told me if I do not take the medications do not expect to be looked after in emergency if you have a problem.

I asked him if he thought my heart would have been more perfect if I had stayed on the drugs as my blood pressure after listening to a fool was rising. When you learn about the molecular structure of the medication and the cellular damage it does both to your central nervous system and total body the medication is poisonous to a whole lot of people.

Some can metabolize this toxin but I for one can not. Just as a footnote it has been found that patients with vascular dementia do much better with elevated blood pressures which stands to reason as your body demands more pressure to reach the periphery and brain on a person with occluded arteries and or damaged veins.

35 years ago, I was prescribed a beta blocker for migraines. I was afraid to be alone while I took it, so I took it on a driving trip from Chicago to Florida with a friend who did all the driving. The trip took 2.5 days.

Although I didn’t have a headache for those 2.5 days, I was a total zombie for those 2.5 days sleeping (if that’s what you call it) the whole way down. My friend woke me up to see the Ohio River, and that’s the only thing I saw on our whole trip down! My migraines have subsided with menopause, but nowadays I have high-ish bp. I take garlic. Does the trick. I’ll never take a beta blocker for anything ever again. If this helps even one person, I will be glad.

Dreaming such vivid dreams was my experience. I would wake up each morning totally exhausted from ridiculous never-ending dreams. Plus I would get so cold on this medication.

I had many of the issues associated with Metoprolol – dizziness, depression, weakness, weight gain, dry eyes and memory loss…plus I had big problems with generic Metoprolol – almost incapacitating at times – switching back to the brand name “always” fixed those episodes…I had to pay out of pocket for those because the insurance would only pay for generics. Off Metoprolol now and doing much better.

At 86, fresh off a golf course drubbing of his 3 sons, my father was placed on 3 anti-hypertensives which were soon followed by 3 more scrips to treat the memory loss, anxiety and depression any high functioning man whose brain was not getting enough blood would suffer. Even swollen ankles didn’t persuade his internist to cut the metoprolol. He died 3 months later, at 89, and they wrote “heart disease” on the certificate.

Do you offer any information on stopping beta blockers? My mom and I both take them for different reasons (hypertension and headache prevention). Once, a doctor recommended that Mom stop taking hers which resulted in the optic neuropathy in one eye. From what I’ve learned, some drugs are considered beta-1 and others are beta-2, and I believe that switching from one to another could cause heart block, I think.

I was placed on Metropolol many years ago by my family doctor, because of HBP and rapid pulse. At the same time, I was given Enalopril. I am now off the Enalopril, but still on Metropolol, as well as Eliquis, following a diagnosis of a-fib. I have many side effects, but my cardiologist will not budge from his position that Metropolol is the best drug for my condition and Eliquis is a wonder drug. I also take Synthroid for my thyroid problem. I would like to get off these problem drugs, and my primary care doc is supportive, but defers to the cardiologist. My BP runs from a low of 102/60 to 142/78 in the doc’ office. What can I do?

I am currently on Atenolol to control my non-sustained ventricular tachycardia (NSVT). After an episode was observed that laster 8 seconds, I was switched to Metoprolol. I immediatlty started having continual heart fluttering, maybe PVT’s. So I was switched back to Atenolol and the symptoms stopped. Now I am in a quandry as to what to do about the NSVT.

I have pretty high BP upon rising and throughout the day. If I exercise, mostly walking. My BP drops sometimes very low. I would think it would be just the opposite, low heart rate, low BP, high heart rate, higher BP The cardiologist’s explanation for this was that I was not normal. He prescribed a Amlopidine 5mg and Metoprolol 100mg/day. The Amlopidine gave me heartburn which I never got before and the Metoprolol made be very tired. I quit the Metoprolol and convinced him to change the Amlopidine to Telmisartan, an ARB. Does anyone have similar symptoms? If so, what has been your experience? I am a 72 year old male who have never been on drugs before. I don’t smoke, drink very little, exercise and have a good diet.

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