Metoprolol side effects elderly patients should know about

In this article:

• Common side effects
• Serious side effects
• Metoprolol special precautions in older adults
• How to manage and monitor metoprolol side effects in older adults
• Frequently asked questions about metoprolol use in older adults

In this article

• Common side effects
• Serious side effects
• Metoprolol special precautions in older adults
• How to manage and monitor metoprolol side effects in older adults
• Frequently asked questions about metoprolol use in older adults

Metoprolol is a generic prescription drug, available as brand-name Lopressor, that is prescribed for hypertension, angina pectoris (chest pain from reduced cardiac blood flow), and myocardial infarction (when blood flow to part of the heart is severely reduced, causing damage to the heart). Healthcare providers may also prescribe either metoprolol tartrate or metoprolol succinate for heart failure or migraine prevention. Although metoprolol is generally considered safe, it can cause side effects like fatigue and dizziness. Beta blockers like metoprolol have also been known to cause memory loss, which may be particularly concerning for older adults, and there are special precautions for older patients taking this medication.

Common metoprolol side effects in older adults

According to clinical trial data published on the drug’s label, the most common side effects of metoprolol are tiredness, dizziness, and hypotension (low blood pressure). In turn, low blood pressure can cause symptoms such as lightheadedness, fatigue, and irregular heartbeat.

Other common side effects in adults of all ages may include: 

• Depression
• Shortness of breath, especially on exertion
• Bradycardia (slow heart rate)
• Diarrhea
• Itchiness
• Rash
• Weight gain

Older adults may have a higher sensitivity to metoprolol because drug metabolism changes with age. For some older adults, this could increase the risk of side effects or make them more pronounced. Because 50% of older adults take more than one prescription medication, older adults may also have a higher risk of metoprolol interacting with another drug. 

Serious side effects of metoprolol in older adults

Some of the serious side effects of metoprolol are especially dangerous for older adults, although they should be recognized by anyone taking this medication. Serious metoprolol side effects include:

• Worsening of cardiovascular conditions, such as heart failure or angina
• Dangerously slow heartbeat (severe bradycardia)
• Heart block
• Cardiac arrest or heart attack
• Wheezing (bronchospasm)
• Allergic reactions (e.g., swelling of the face, trouble breathing, and hives)

For older adults, even common side effects of metoprolol can become serious or cause further complications. This is particularly true if the patient has another health condition that causes physical weakness or a cognitive condition such as dementia or Alzheimer’s disease. For instance, fatigue and dizziness can increase the risk of falls. Diarrhea also increases the risk of dehydration, which is already more common in older patients. 

Finally, metoprolol is a beta blocker, and other beta blockers have been associated with central nervous system (CNS) side effects. “Metoprolol can contribute to confusion, fatigue, slowed thinking, or memory issues in some older adults,” says Stefanie Diaz, MD, a board-certified nephrologist at the Center for Kidney Care and teaching faculty at the University of Texas at Tyler School of Medicine. 

Metoprolol special precautions in older adults

Metoprolol is generally considered safe, even in older adults. However, adults with multiple health conditions or who are taking various medications have an increased risk of side effects. 

Here are some special precautions to consider for older adults on metoprolol.

1. Share your health history with your doctor before taking metoprolol

Metoprolol is not right for everyone. It’s important to share your complete medical history, including current symptoms, current and previous health conditions, as well as medications and supplements you’re taking, before starting any new prescription medication. 

For example, the drug label information states that though there have been no studies on metoprolol use in people with liver disease, there is a possibility of complications in people with poor liver function. The label also states that metoprolol can cause, or potentially worsen, erectile dysfunction.

2. Understand that metoprolol can interact with other drugs

Older adults are more likely than younger adults to be taking multiple prescription medications, over-the-counter medications, and supplements. However, some of these drugs may interact with metoprolol treatment. 

Metoprolol drug interactions to be aware of  in patients of all ages include:

• Monoamine oxidase inhibitors (MAOIs) such as Azilect (rasagiline), Emsam (selegiline), and Marplan (isocarboxazid)
• Antidepressants such as Paxil (paroxetine), Wellbutrin (bupropion), Prozac (fluoxetine), and Zoloft (sertraline)
• Antipsychotics such as haloperidol or chlorpromazine
• Certain calcium channel blockers, such as verapamil or Cardizem (diltiazem)

Metoprolol can also increase the risk of low blood sugar (hypoglycemia) and diminish warning signs of low blood sugar. Because of that, metoprolol use can impact the effects of insulin, metformin, and other antidiabetic drugs. Older adults should seek medical advice from their healthcare provider to determine whether their diabetes medication dosage should be adjusted while taking metoprolol.

Don’t stop taking metoprolol suddenly

It’s important to know that metoprolol and other beta blockers carry a black box warning (also called a boxed warning) about the risk of sudden discontinuation. The Food and Drug Administration has associated sudden withdrawal with rebound symptoms that can significantly increase the risk of cardiovascular events such as a heart attack. 

Hence, you should not stop metoprolol abruptly or without the guidance of a healthcare professional.

Alert a healthcare professional to any adverse effects after a dose adjustment

“There isn’t one universal safe dose. It must be individualized,” Dr. Diaz says. “But the safest approach is always to start on a low dose and titrate up the dose as tolerated. The clinician will adjust the dose based on the blood pressure, heart rate, and symptoms.”

Regularly monitor for side effects

“It is important to monitor closely for side effects: memory loss, low blood pressure, allergic reactions as well,” says  Jennifer L. Armendariz, AOCNP, a family nurse practitioner and hematology/oncology specialist in El Paso, Texas. She points out that some metoprolol side effects, like fatigue and memory loss, can be overlooked “as just part of the aging process.” If an older adult on metoprolol starts experiencing new symptoms, it’s essential to pay attention and report them to a healthcare professional. 

How to manage and monitor metoprolol side effects in older adults

Metoprolol side effects don’t always occur, as everyone responds differently to medication. There are also ways to prevent metoprolol side effects. Tips for older adults include the following:

1. Take it at the same time(s) every day. Metoprolol succinate is taken once per day, whereas metoprolol tartrate is taken twice or three times daily, depending on the reason for taking it. Taking your medication at the same time(s) every day can help maintain steady levels in your body, reducing the risk of sudden side effects. 
2. Start with a low dose of metoprolol. Though beta blockers are often beneficial for cardiovascular health, Dr. Diaz says healthcare providers take a more cautious approach, starting at lower doses for older adults. 
3. Track blood pressure. “Patients and caregivers should be educated to monitor blood pressures at home and to keep a blood pressure log,” Armendariz says.
4. Report symptoms early. Tell your provider right away if you notice new or worsening side effects of metoprolol. Your dosage might need to be decreased.
5. Attend regular check-ups. Both Drs. Diaz and Armendariz emphasize the importance of monitoring the health of older adults on metoprolol. Patients should do their best to keep appointments with their provider and not hesitate to schedule additional check-ups if side effects develop.
6. Avoid sudden discontinuation. “Metoprolol should not be stopped abruptly,” Armendariz reminds. “If this medication is stopped abruptly, the risk of increased chest pain or even a heart attack can occur.” When abruptly discontinued, a patient’s heart rate can shoot up, a condition called tachycardia.
7. If you miss a dose, take the next dose as soon as possible. However, don’t ever double your dosage. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule.  

Ultimately, older adults and their caregivers need to stay alert to possible metoprolol side effects. “When used thoughtfully, beta blockers are an important tool in heart health and longevity and can be both safe and beneficial in older adults,” Dr. Diaz says.

Frequently asked questions about metoprolol use in older adults

Can metoprolol cause confusion or memory loss in older adults?

Yes, metoprolol may cause confusion or memory loss in older adults, especially if they are dehydrated or are on other medications, according to Dr. Diaz. However, these are not common side effects. 

What is the safest metoprolol dosage for older adults?

There is no one-size-fits-all safest metoprolol dosage for older adults. Dr. Armendariz says the safest dose is the lowest possible that achieves the medication’s intended effects. It is best to start low and titrate upward as advised by your healthcare provider.

Should older adults avoid beta blockers?

Not necessarily. Dr. Diaz suggests that, rather than avoiding beta blockers altogether, older adults might need to start at lower doses. Older adults and their caregivers should also be educated to carefully monitor for side effects, per Dr. Armendariz.