What side effects can Metoprolol have?
Below you will find the most important information about possible known side effects of Metoprolol.
These side effects do not occur, but you can. Because every person reacts differently to medication. Please also note that the type and frequency of side effects may vary depending on the drug formulation (eg tablet, syringe, ointment).
Uncommon side effects:
heart rhythm disorders such as slow heart rate; Excitation or conduction disorders; Circulatory disorders until unconsciousness; Palpitations; Strengthening myocardial insufficiency with water retention and respiratory problems; increased blood pressure drop; Fatigue; Dizziness; Fatigue; Lethargy; Malaise; Depressions; A headache; Insomnia; Confusion; Sweat; Nightmares; enhanced dream activity; hallucinations; Diarrhea; Constipation; bloating; Nausea and vomiting; Abdominal pain; Dry mouth; Increase of breathing difficulties in existing asthma; allergic skin reactions; Sensory disturbances such as tingling on the skin); Feeling cold in the arms and legs.
Rare side effects:
Decreased attention; Nervousness; Muscle cramps; Muscle weakness; Cramping of the bronchial muscles; Conjunctivitis (conjunctivitis); reduced flow of tears; Diabetes or exacerbation of pre-existing diabetes.
Very rare or occasionally occurring side effects:
trigger or enhance angina pectoris attacks; Pericarditis (pericarditis); Death of tissue parts (gangrene) in patients with already existing severe circulatory disorders; Personality changes; Loss of short-term memory; restlessness; Nasal mucosal inflammations (rhinitis); increased perception of noises (eg ringing, whistling, tinnitus); hearing loss; Hair loss; Trigger or exacerbate psoriasis (skin disease); Desire disorders; Erectile dysfunction; Hardening of the penile tissue (Peyronie’s disease); inflammatory multiorgan disease (polymyalgia-like syndrome); Joint inflammation (arthritis); Weight gain; Reduction in platelet count (thrombocytopenia); agranulocytosis; blurred vision; Increase of certain enzymes (serum transaminases); Liver inflammation (hepatitis); Carpal tunnel syndrome (pressure damage of a hand nerve); Reinforcement of circulatory disorders on the hands and legs (Raynaud’s syndrome and (Charcot’s syndrome), joint diseases (arthropathies).)
Side effects without frequency:
Hyperthyroidism (hyperthyroidism); Reinforcement of allergic reactions; Worsening of kidney function in existing severe dysfunctions; Increase of various enzyme values (LDH, alkaline phosphatase) or other values (uric acid, triglycerides); Reduction of plasma HDL cholesterol with normal plasma total cholesterol.
After sudden discontinuation of the active ingredient, there is often a rapid increase in high blood pressure (rebound phenomenon).
Prolonged fasting and strenuous exercise may result in hypoglycemia or conceal the warning of an onset of hypoglycaemia.
What interactions does Metoprolol show?
Please note that the interactions may vary depending on the drug formulation of a drug (eg tablet, syringe, ointment).
The antihypertensive effect of metoprolol can be massively increased by the concomitant use of other blood pressure lowering agents such as ACE inhibitors, blood vessel enlargement agents such as dihydralazine and hydralazine, diuretics or nifedipine calcium channel blockers. !!
This is also the case when sedatives (barbiturates), neuroleptics, H1-antihistamines, anesthetics, tricyclic antidepressants, other beta-blockers (eg cimetidine) are taken or alcohol is consumed simultaneously. Such an (excessive) drop in blood pressure can lead to the development of myocardial insufficiency.
Calcium channel blockers of the verapamil or diltiazem type and agents that beat the heart more regularly (antiarrhythmic drugs) lead to a reduction in cardiac output (cardiodepressive effect). Lower blood pressure, slower heart rate, cardiac arrhythmia, heart failure can all be the result. The administration of these agents to the bloodstream should be discontinued during use, except for intensive care. Verapamil should not be given to the veins until 48 hours after discontinuation of metoprolol.
Special antihypertensives such as reserpine, alpha-methyldopa, guanethidine, guanfacine, clonidine, as well as cardiac glycosides, lead to a greater drop in heart rate and delay in cardiac conduction. In particular, after the discontinuation of clonidine, there may be a strong increase in blood pressure. The use of Metoprolol must therefore begin several days after the discontinuation of clonidine.
Blood pressure increasing agents such as norepinephrine, adrenaline or MAO inhibitors (except MAO-B inhibitors) lead to a weakening of the hypotensive effect with excessive blood pressure increase. Concomitant administration of metoprolol with MAO inhibitors such as tranylcypromine and moclobemide is prohibited.
Coagulation of hypoglycaemic agents such as insulin or oral antidiabetics may increase hypoglycaemia. The symptoms of hypoglycaemia, but especially the rapid pulse (tachycardia) and tremor (tremor) can be obscured or mitigated. In diabetics, therefore, regular blood sugar checks are required.
In addition, there may be increased circulatory problems with the use of metoprolol and anti-migraine products such as ergot alkaloids (eg ergotamine).
Concomitant use of or combinations with floctafenine and sultopride may cause severe cardiac arrhythmia and should be avoided.
Alpha-sympathomimetics (including tacrine), when given concomitantly, may extend the conduction time in the atrioventricular node of the heart and induce cardiac arrhythmias.
If digoxin is used to boost cardiac strength at the same time, digoxin secretion in the blood will be delayed. Therefore, medical supervision and monitoring of the amount of digoxin in the blood is necessary. If necessary, a reduction in the dose of digoxin is required.
There is an increased risk of heartbeat reduction (bradycardia) when co-administered with mefloquine (antimalarial drug).
Rheumatoid and analgesics such as indomethacin or ibuprofen weaken the hypotensive effect of bisoprolol. Drugs used to treat tuberculosis (such as rifampicin) also reduce the efficacy of metoprolol and should not be co-administered.
Acid-inhibiting agents (antacids) such as cimetidine or ranitidine also increase the blood pressure-lowering effect.