Metoprolol Side Effects and Considerations

Introduction to Metoprolol Side Effects

Sleep disturbances, including nightmares and night terrors, can occur in patients taking metoprolol 1

Beta-blockers may mask tachycardia occurring with hypoglycemia, though other manifestations like dizziness and sweating may not be significantly affected, particularly important in diabetic patients 2
First- and second-generation beta-blockers are associated with increased incidence of new-onset diabetes 2
Unfavorable changes in blood lipids have been reported in patients taking beta-blockers 2

Metoprolol is considered safe in pregnancy 2
Topical and systemic co-administration of beta-blockers is frequently observed in elderly patients and may result in additive effects including risk of bradycardia 2
Lowering heart rate too much in the elderly with beta-blocker treatment may cause serious adverse events 2

Concurrent medications that lower blood pressure can increase risk of hypotension 4
The risk of hypotension increases with polypharmacy, especially in elderly patients 4
Monitor for signs of heart failure symptoms, fluid retention, hypotension, and bradycardia during titration of metoprolol, as recommended by the European Heart Journal 5
If worsening symptoms occur, first increase diuretics or ACE-inhibitor dose; temporarily reduce beta-blocker dose if necessary, following guidelines from the European Heart Journal 5