Metoprolol

To make sure that it is safe, report it to a doctor before starting metoprolol if:[1]

• any past allergic reaction to metoprolol or any other medicine has happened
• low blood pressure (hypotension) or a slow heart rate
• lung disease or severe asthma
• metabolic acidosis – when there is too much acid in the blood
• an overactive thyroid (hyperthyroidism or thyrotoxicosis) – metoprolol may make it more difficult to recognise the warning signs of having too much thyroid hormone in the body
• severe blood circulation problems in limbs (such as Raynaud's phenomenon), which may make the fingers and toes tingle or turn pale or blue, although this may be less obvious on black or brown skin
• a liver condition

There are ways of coping with most common side effects. These common side effects of metoprolol happen in more than 1 in 100 people:[1]

• headaches
• feeling tired, dizzy or weak
• cold hands or feet
• feeling sick (nausea)
• stomach pain

Speak to a doctor or pharmacist if ways to cope do not help and a side effect is still bothering or lasts more than a few days.[1]

It is rare, but some people have serious side effects when taking metoprolol. Call a doctor or non-emergency services straight away if there is:[1]

• shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems
• shortness of breath with a cough that gets worse with exercise (like walking up stairs), swollen ankles or legs, or an irregular heartbeat – these are signs of heart problems
• fast heart rate, high temperature, trembling or shaking, and confusion – these are signs of too much thyroid hormone in the blood
• whites of the eyes turn yellow, or skin turns yellow (although this may be less obvious on brown or black skin), as these can be signs of liver problems
• unexplained bruising, or bruising more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)

If there is any heavy bleeding or bleeding that cannot be stopped, such as cuts or nosebleeds that do not stop within 10 minutes, call an ambulance or go to A&E. If there is chest pain that does not stop after a few minutes or is new or worse if somebody already has angina, call an ambulance.[1] Chest pain is a possible sign of a heart attack and needs to be checked out as soon as possible.[1]

In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to metoprolol.[1]

These are not all the side effects of metoprolol. For a full list, see the leaflet inside the medicine packet.[1]

Metoprolol can be taken with or without food. The tablets should be swallowed whole with a drink of water.[1]

Some tablets have a score line to help them be broken in half, which makes it easier to swallow. Checking the information leaflet for the specific brand to see if this can be done.[1]

The doctor may advise that the first dose is taken before bedtime because it could make someone feel dizzy. If the first or after the first dose it does not cause dizzy feelings, take metoprolol in the morning. If metoprolol has to be taken more than once a day, try to space the doses evenly throughout the day.[1]

Treatment with metoprolol is usually long term, possibly even for the rest of the patients' life.[1]

And stopping taking metoprolol suddenly can make conditions worse, so talk to a doctor first. If someone stops taking metoprolol, it will take 1 to 2 days for it to be completely out of the body.[1]

If any side effects are a problem, a doctor may be able to prescribe a different medicine for heart problems.[1]

Important: Take metoprolol even if you feel well, as you will still be getting the benefits of the medicine.[1]

If a dose is missed, take the metoprolol as soon as it is remembered, unless it is nearly time for the next dose. If this happens, just leave out the missed dose and take the next dose at the usual time.[1]

Never take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.[1]

If doses are forgotten often, it may be helpful to set up an alarm as a reminder. A pharmacist can be asked for advice on other ways to help remember to take medicines.[1]

The amount of metoprolol that can lead to an overdose varies from person to person. Taking too much metoprolol can slow down heart rate and make it difficult to breathe. It can also cause dizziness and trembling.[1]

A&E: if a visit is needed, then do not drive. Get someone else to drive you or call for an ambulance. Take the metoprolol packet or leaflet inside it, plus any remaining medicine.[1]

There is not enough information to say that herbal remedies and supplements are safe to take with metoprolol. They are not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines[1]. Tell the doctor or pharmacist if any other medicines, including herbal remedies, vitamins or supplements, are being taken.[1]