Metopolol long-term side effects

In this article:

• Most common side effects of metoprolol
• What are the long-term side effects of metoprolol?
• Serious side effects of metoprolol
• Considerations when taking metoprolol long-term
• How to manage long-term metoprolol side effects
• Bottom line: Is it safe to take metoprolol long-term?

In this article

• Most common side effects of metoprolol
• What are the long-term side effects of metoprolol?
• Serious side effects of metoprolol
• Considerations when taking metoprolol long-term
• How to manage long-term metoprolol side effects
• Bottom line: Is it safe to take metoprolol long-term?

Metoprolol is a generic prescription medication that’s available in two formulations: metoprolol tartrate (brand-name Lopressor) and metoprolol succinate (brand-name Toprol XL). Both formulations are approved by the Food and Drug Administration (FDA) to treat hypertension (high blood pressure) and angina pectoris (exercise- or stress-induced chest pain) in adults. Metoprolol tartrate is also indicated as a heart attack treatment, while metoprolol succinate can help prevent heart failure. Metoprolol long-term side effects are similar for both formulations. 

Most common side effects of metoprolol

The most common side effects of metoprolol are fatigue and dizziness or lightheadedness. About 10% of people taking metoprolol tartrate reported at least one of these side effects during clinical trials. The incident rate was much lower (1.8%) among people taking metoprolol succinate. 

Other common side effects of metoprolol include:

• Rash
• Itching
• Depression
• Diarrhea
• Shortness of breath or trouble breathing, especially with exertion
• Low blood pressure (hypotension)
• Slow heartbeat (bradycardia)

About 1% of people taking metoprolol tartrate also report dry mouth, nausea, heartburn, and/or constipation. None of these side effects were reported among metoprolol succinate users.  

Michael Genovese, MD, JD, a New York City-based physician, says his metoprolol patients sometimes experience sleep disturbances like vivid dreams and insomnia, and research suggests visual hallucinations and nightmares may occur as well. Dr. Genovese also hears complaints about cold hands and feet, which can happen due to the way metoprolol affects blood flow. 

“These effects usually occur as the body adjusts to metoprolol and often improve within the first few weeks of consistent use,” he says. 

What are the long-term side effects of metoprolol?

Sometimes the body doesn’t adjust to metoprolol side effects, causing them to linger until the medication is discontinued. 

According to Dr. Genovese, long-term metoprolol side effects “include the potential for persistent fatigue, reduced exercise tolerance, mild weight gain, or mood changes such as depression in sensitive individuals.” 

Glucose intolerance may also occur when taking metoprolol long-term. Metoprolol side effects can overlap with hypoglycemia symptoms, so people with diabetes may miss the first signs of low blood sugar. 

Some people report sexual side effects like erectile dysfunction or low libido while taking metoprolol. However, it’s unclear whether sexual dysfunction is a result of the existing cardiovascular disease or of metoprolol itself.  

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Discontinuing this medication will almost always cause side effects to eventually go away, but you should never stop taking metoprolol abruptly. Doing so can potentially cause angina (chest pain), heart attack, thyroid crisis, tachycardia (rapid heartbeat), rebound hypertension, and other withdrawal symptoms. To avoid these effects, the dosage of metoprolol should be slowly decreased over a two-week period under medical guidance. 

Serious side effects of metoprolol

In rare cases, metoprolol can cause serious and potentially life-threatening side effects that require immediate medical attention:

• Anaphylactic allergic reaction: Difficulty breathing, hives, swollen throat, tongue, lips, or face, or shock 
• Cardiac arrhythmias: fainting, heart palpitations,  chest pain, heart attack, or heart block 
• Worsening heart failure: Cough, shortness of breath, weight gain, or swollen legs and ankles 

Considerations when taking metoprolol long-term

Eve Elizabeth Pennie, MD, an Atlanta-based physician and clinical trial manager, says it’s important to get regular check-ups to minimize the risk of serious or long-term metoprolol side effects. 

“I recommend regular follow-ups with ECG or heart rate checks and blood pressure monitoring, taking the medication exactly as prescribed, not missing doses, and avoiding abrupt discontinuation.” 

Dr. Pennie also stresses the importance of telling your healthcare provider about any new or worsening side effects or symptoms and adopting “healthy lifestyle measures such as diet and exercise so the medication works in synergy.” 

Your healthcare provider will likely start you on a low dose of metoprolol and increase to a higher dose if your blood pressure and heart rate goals are not met and the medication is well-tolerated. However, increasing the dose also increases the risk of worsening heart failure. Tell your healthcare provider right away if your symptoms get worse.

Metoprolol and other beta blockers should be avoided by people with certain lung conditions, such as bronchospastic disease, or those taking certain antidepressants or calcium-channel blockers. If you have a type of adrenal tumor called pheochromocytoma or are preparing for major surgery, your healthcare provider may adjust your dose or start you on additional medication. Other contraindications exist, so tell your doctor about all of your medications and symptoms before starting metoprolol.  

Metoprolol considerations when pregnant or breastfeeding

If you’re pregnant or planning to become pregnant, talk to your healthcare provider about whether metoprolol is safe for you. High doses of metoprolol increase the risk of miscarriage and neonatal death in rats, but there’s not enough data to prove that the same outcomes happen in people. The benefits of metoprolol in reducing maternal high blood pressure and preventing heart attack may outweigh the potential risks, so it’s important to talk to your healthcare provider about all of the pros, cons, and alternatives. Metoprolol doesn’t seem to impact breastfed infants. 

How to manage long-term metoprolol side effects

Long-term metoprolol side effects can be minimized or managed by starting at a low dose and allowing the body to adjust before increasing to the next-higher dose. If intolerable side effects appear or cardiovascular symptoms worsen, the dose can be lowered again. A healthcare professional should always supervise dose adjustments.

Mood-related side effects like depression should be handled with care. Some antidepressants called selective serotonin reuptake inhibitors (SSRIs) can interact with metoprolol and increase its effects. A healthcare professional can recommend safer alternatives for managing depression while taking metoprolol. 

Persistent tiredness may be managed with regular exercise, hydration, and a healthy diet. Metoprolol may cause exercise intolerance, so talk to your healthcare provider about the best ways to stay physically active. Gastrointestinal side effects may improve by taking the medication with food. 

Ideally, the cardiovascular benefits of metoprolol will outweigh the burden of dealing with its side effects. If the side effects are difficult to manage, talk to a healthcare provider about metoprolol alternatives. Experiencing side effects with one antihypertensive medication doesn’t mean you’ll feel the same side effects with another. That said, you may have to try several prescriptions to find a tolerable solution.  

Switching from metoprolol tartrate to metoprolol succinate may lower the risk of some side effects. However, there are key differences in how long it takes each formulation to work. Your healthcare provider may have a good reason to keep you on fast-acting metoprolol tartrate instead of the slower once-daily metoprolol succinate tablets. 

Bottom line: Is it safe to take metoprolol long-term?

Yes, many people can safely take metoprolol long-term. “It has a well-established safety profile when dosed appropriately and with regular follow-ups,” Dr. Pennie says. 

A three-year study dating back to 1986 demonstrates that metoprolol is not only safe to take long-term, but also extends the life-span of patients by an average of one month compared to a placebo. Quality of life improved as well. 

It’s worth mentioning that about 90% of patients taking metoprolol experience no side effects. However, some people may experience serious adverse effects that require immediate medical attention. Watch for signs like shortness of breath, swelling of the legs, mouth, face, or throat, and fainting, especially after a dose increase.