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10 Metoprolol Side Effects You Should Know About
Metoprolol is a commonly prescribed medicine used to slow the heart rate, lower blood pressure, reduce the heart’s workload, and treat several cardiovascular conditions. It belongs to a group of medicines called beta blockers and may be prescribed for high blood pressure, angina, certain abnormal heart rhythms, and after a heart attack. It can also be used for some other conditions, including migraine prevention and symptoms associated with an overactive thyroid.
Like any medication, metoprolol can cause side effects. Many are mild and improve as the body adjusts to treatment, but some symptoms deserve medical attention.
If you take metoprolol—or are considering it—knowing what to expect can help you distinguish between a common nuisance and a symptom that shouldn’t be ignored.
1. Tiredness or Fatigue
Feeling unusually tired is one of the more commonly reported effects of metoprolol.
Because the medicine slows the heart rate and reduces the heart’s workload, some people may initially feel less energetic than usual. Fatigue may be particularly noticeable when treatment is first started or after the dose is increased.
For many people, this improves as the body adjusts.
If fatigue is severe, persists, or interferes with everyday activities, let your doctor know. The dose or timing of the medication may need to be reviewed.
2. Dizziness or Lightheadedness
Metoprolol can lower blood pressure and slow the heart rate. As a result, some people experience dizziness or lightheadedness, particularly when standing up quickly.
The NHS lists dizziness and weakness among common metoprolol side effects.
If you feel dizzy:
- Sit or lie down until you feel better.
- Stand up slowly.
- Avoid driving or operating machinery while dizzy.
- Stay adequately hydrated unless you’ve been told to restrict fluids.
Persistent or severe dizziness should be discussed with your healthcare professional.
3. Slow Heart Rate
One of the intended effects of metoprolol is to slow the heart rate.
For some people, however, the heart rate may become slower than desired. The prescribing information lists bradycardia, or an abnormally slow heart rate, among recognized adverse reactions.
A slower pulse isn’t automatically dangerous—your doctor may intentionally prescribe metoprolol to achieve this effect.
However, a very slow heart rate accompanied by fainting, severe dizziness, weakness, chest discomfort, or difficulty breathing requires prompt medical evaluation.
Don’t change your dose based on a home pulse reading without discussing it with your healthcare professional.
4. Low Blood Pressure
Because metoprolol reduces the heart’s workload and can lower blood pressure, some people may develop hypotension.
Possible symptoms include:
- Dizziness
- Lightheadedness
- Weakness
- Blurred vision
- Feeling faint
- Fainting
The risk may be greater when metoprolol is combined with other medicines that lower blood pressure.
If you’re experiencing repeated episodes of lightheadedness or fainting, tell your healthcare professional. Your blood pressure and medication regimen may need to be reviewed.
5. Cold Hands and Feet
Some people taking metoprolol notice that their fingers or toes feel unusually cold.
The NHS specifically lists cold hands or feet as a common side effect.
This happens partly because beta blockers can affect blood flow to the extremities.
Keeping your hands and feet warm may help. However, severe or worsening circulation symptoms—particularly fingers or toes that become painful, pale, blue, or numb—should be evaluated.
This is especially important if you already have a circulation disorder.
6. Nausea or Stomach Upset
Metoprolol can cause digestive symptoms in some people.
The NHS lists nausea, stomach pain, vomiting, and diarrhea among possible side effects.
Mild nausea may improve as your body becomes accustomed to the medicine.
If you’re vomiting repeatedly or experiencing significant diarrhea, dehydration can become a concern. Contact your healthcare professional if symptoms are severe or persistent.
Don’t automatically stop your heart medication because of an upset stomach. Ask your doctor or pharmacist what to do instead.
7. Diarrhea
Diarrhea is another recognized adverse effect of metoprolol. It is also listed among the adverse reactions in the U.S. prescribing information for metoprolol tartrate.
Mild diarrhea may settle without treatment.
However, prolonged or severe diarrhea can cause dehydration and may make you feel weak or dizzy—symptoms that can be particularly troublesome when you’re taking a medication that can already lower blood pressure.
Drink adequate fluids unless your doctor has given you fluid restrictions, and seek medical advice if diarrhea is severe or doesn’t improve.
8. Headache
Headaches are another relatively common complaint.
The NHS lists headaches among the common side effects of metoprolol and notes that they often improve as the body adjusts to the medicine.
Rest, adequate hydration, and avoiding excessive alcohol may help.
If headaches are severe, persistent, or significantly different from your usual headaches, talk with a healthcare professional rather than assuming the medication is responsible.
A sudden, extremely severe headache—especially with weakness, confusion, difficulty speaking, or vision changes—requires urgent medical assessment.
9. Shortness of Breath
Shortness of breath deserves more attention because it can have several possible causes.
The official prescribing information lists shortness of breath among reported adverse reactions.
Metoprolol is relatively selective for beta-1 receptors at usual doses, but beta blockers can still affect the airways, particularly in susceptible people. The prescribing information warns about bronchospastic disease, while the NHS advises urgent evaluation for shortness of breath accompanied by wheezing or chest tightness.
Don’t assume new breathing difficulty is simply a side effect.
Seek prompt medical attention if you develop:
- New or worsening shortness of breath
- Wheezing
- Chest tightness
- Difficulty breathing when lying down
- Swelling of the ankles or legs
- A significant decline in exercise tolerance
These symptoms can also indicate an underlying heart or lung problem.
10. Depression or Mood Changes
Mood changes are another possible concern.
The U.S. prescribing information lists depression among reported adverse reactions to metoprolol.
If you notice persistent sadness, loss of interest in activities, unusual emotional changes, sleep disruption, or other significant changes in mood after starting metoprolol, discuss them with your healthcare professional.
Never stop a beta blocker abruptly because you suspect it is affecting your mood. Your doctor can determine whether metoprolol is likely contributing and whether another treatment might be appropriate.
If you develop thoughts of harming yourself, seek immediate professional help.
Other Possible Metoprolol Side Effects
The 10 symptoms above aren’t a complete list.
Depending on the formulation, dose, and individual circumstances, metoprolol may also be associated with:
- Itching
- Skin rash
- Weakness
- Sleep-related symptoms
- Circulation problems
- Sexual difficulties
- Changes in blood sugar warning symptoms
The NHS notes that some people report reduced sex drive or erectile difficulties, although there isn’t enough evidence to establish that metoprolol definitely causes these problems in every case.
If a symptom begins after starting metoprolol and doesn’t go away, tell your doctor or pharmacist.
When Metoprolol Side Effects May Be More Concerning
Some symptoms shouldn’t simply be watched at home.
The NHS advises urgent medical evaluation for certain symptoms, including worsening shortness of breath with swelling or an irregular heartbeat, unexplained easy bruising, and symptoms associated with excessive thyroid hormone.
Call emergency services immediately for potentially serious symptoms such as:
- New or severe chest pain
- Severe difficulty breathing
- Fainting or inability to stay conscious
- Severe allergic reaction
- Sudden neurological symptoms
- Severe wheezing or chest tightness
A serious allergic reaction can cause swelling of the lips, mouth, throat, or tongue and difficulty breathing and requires emergency treatment.
Metoprolol and Diabetes: An Important Consideration
If you have diabetes, make sure your healthcare professional knows.
Beta blockers can mask some warning signs of low blood sugar, particularly a rapid heartbeat. The U.S. prescribing information specifically warns about this effect.
This doesn’t necessarily mean people with diabetes cannot take metoprolol. It means blood-glucose management may require appropriate monitoring and awareness of other signs of hypoglycemia.
Ask your healthcare team what symptoms you should watch for.
What About Asthma or Other Lung Conditions?
Metoprolol may not be appropriate for everyone with asthma or certain lung conditions.
Although it primarily affects beta-1 receptors at usual doses, beta blockers can potentially worsen bronchospasm in susceptible individuals. The prescribing information includes a warning concerning bronchospastic disease.
Tell your doctor if you have:
- Asthma
- Chronic obstructive pulmonary disease
- A history of wheezing
- Other significant breathing problems
Don’t discontinue the medicine yourself; your clinician can determine the safest treatment.
Can You Stop Metoprolol Suddenly?
No—unless your healthcare professional specifically instructs you to do so.
This is one of the most important things to know about metoprolol.
Sudden withdrawal can worsen angina and may exacerbate myocardial ischemia. The prescribing information specifically warns against abrupt cessation.
The NHS likewise advises talking with your doctor before stopping metoprolol because suddenly stopping it can make your condition worse.
If you want to stop because you’re experiencing side effects, contact your prescriber. They can determine whether the dose should be adjusted or whether another medication would be more appropriate.
Metoprolol Can Interact With Other Medicines
Tell your doctor and pharmacist about all medications and supplements you take.
Some medicines can increase the effects of metoprolol or increase the risk of a slow heart rate.
The prescribing information identifies interactions involving medicines such as:
- Certain calcium-channel blockers, including verapamil and diltiazem
- Digoxin and other cardiac glycosides
- Clonidine
- Certain medicines that inhibit the CYP2D6 enzyme
These combinations don’t necessarily mean they can never be used together, but they may require careful monitoring or dose adjustments.
Metoprolol Tartrate vs. Metoprolol Succinate
You may notice two common names on your prescription:
Metoprolol tartrate and metoprolol succinate.
They are different formulations of metoprolol and aren’t simply interchangeable milligram-for-milligram without medical guidance.
Metoprolol may be prescribed once or multiple times a day depending on the formulation and reason for treatment.
Always check the exact product and instructions on your prescription.
How to Reduce Some Common Side Effects
If your healthcare professional has prescribed metoprolol, a few practical steps may make treatment easier.
Get Up Slowly
If you’re prone to dizziness, move gradually from lying down to sitting and then standing.
Avoid Driving When Dizzy
Don’t drive, cycle, or use machinery if metoprolol makes you dizzy or unusually tired.
Take It Consistently
Try to take metoprolol at the same time each day according to your prescription.
Don’t Double a Missed Dose
If you forget a dose, follow the instructions provided with your medication or ask your pharmacist. The NHS advises against taking two doses together to compensate for a missed dose.
Keep Your Healthcare Team Updated
Report persistent or troublesome side effects. Sometimes a dosage adjustment or alternative medicine can solve the problem.
Frequently Asked Questions
What are the most common side effects of metoprolol?
Commonly reported effects include tiredness, dizziness, weakness, headache, cold hands or feet, nausea, stomach discomfort, vomiting, and diarrhea.
Does metoprolol make you tired?
It can. Fatigue or tiredness is a recognized side effect and may improve as your body adjusts to the medication.
Can metoprolol cause dizziness?
Yes. Metoprolol can cause dizziness, particularly when it lowers blood pressure or slows the heart rate. Persistent or severe dizziness should be discussed with a healthcare professional.
Does metoprolol lower your heart rate too much?
Metoprolol is intended to slow the heart rate, but excessive slowing can occur in some people. Your doctor may monitor your pulse and blood pressure and adjust treatment if necessary.
Can metoprolol cause shortness of breath?
Shortness of breath is a reported adverse reaction, but breathing problems can also signal an underlying heart or lung condition. New or worsening breathing difficulty should be medically evaluated.
Can metoprolol affect blood sugar?
Yes. Beta blockers can mask some symptoms of low blood sugar, particularly a rapid heartbeat. People with diabetes should discuss appropriate monitoring with their healthcare team.
Should I stop taking metoprolol if I have side effects?
Don’t stop it abruptly on your own. Contact your prescriber, because sudden withdrawal can worsen certain heart conditions.
The Bottom Line
Metoprolol is an established beta blocker that can be highly beneficial for people with high blood pressure, angina, certain heart-rhythm problems, and other conditions. Like all medicines, however, it can cause unwanted effects.
The 10 metoprolol side effects worth knowing about are:
- Tiredness or fatigue
- Dizziness
- Slow heart rate
- Low blood pressure
- Cold hands and feet
- Nausea or stomach upset
- Diarrhea
- Headache
- Shortness of breath
- Depression or mood changes
Most side effects are manageable and may improve as your body adjusts to treatment. But severe dizziness, fainting, significant breathing difficulty, new chest pain, or signs of a serious allergic reaction require prompt or emergency medical attention.
Most importantly, don’t stop metoprolol suddenly. If you’re experiencing side effects, your doctor or pharmacist can help determine whether they’re related to the medication and whether your treatment needs to be adjusted.
