Metoprolol for anxiety: what you need to know

In a world of public health emergencies, political tension, societal pressure, and 24/7 access to social media, it's no wonder that anxiety disorders are the most common mental disorders in the United States. According to the National Alliance on Mental Health, nearly 40 million people in the U.S.—or 18% of the population—live with an anxiety disorder in any given year (NIMH, 2017). 

A little bit of stress can be healthy, but when the feeling becomes so overwhelming that it's a barrier to living a fulfilling life, it may be time to explore treatment options. 

Beta-blockers are a class of medication that controls the body's fight-or-flight response and temporarily block the effects of the hormone epinephrine, also known as adrenaline. Since the 1960s, they've been considered a safe and effective way to treat and prevent high blood pressure, abnormal heart rhythms, heart disease, and chest pain. 

Beta-blockers like metoprolol tartrate (brand name Lopressor) tend to be utilized for conditions related to the heart, but healthcare providers also prescribe them for "off-label" reasons like managing anxiety symptoms. Off-label means that the FDA did not specifically approve a drug for that particular purpose. Propranolol (brand name Inderal) and atenolol (brand name Tenormin) are two other commonly prescribed beta-blockers for anxiety. Generally speaking, any beta-blocker that contains the "-lol" suffix is a viable option for treating performance anxiety and social phobias (Dooley, 2015).

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Research shows that beta-blockers can help manage some of the physical symptoms of stress and anxiety. Although they cannot treat the actual psychological causes of the condition, they can be used to manage sweating, dizziness, rapid heart rate (palpitations), and shaky voice and hands—all common reactions to stress.

Beta-blockers work well for social anxiety and other short-term stressors. For example, a healthcare provider might prescribe a beta-blocker before public speaking to help with performance anxiety and stage fright. However, metoprolol tartrate (brand name Lopressor), propranolol (brand name Inderal), atenolol (brand name Tenormin), and other beta-blockers are not used for long-term treatment.

Also important to note is that beta-blockers are most effective for managing anxiety when prescribed in conjunction with treatments such as therapy, lifestyle changes, and other medications.

FDA has issued a black box warning for metoprolol: Do not abruptly stop taking metoprolol as stopping metoprolol suddenly may cause chest pain or heart attack. Your healthcare provider will help you decrease the dose gradually if you need to stop metoprolol.

Overall, beta-blockers are a relatively safe, non-habit-forming solution for short-term anxiety. One of the reasons that healthcare providers tend to prescribe beta-blockers is because most people will experience minimal side effects.

Common side effects of beta-blockers, in general, include fatigue, dizziness, headache, difficulty sleeping, and cold fingers or toes (Farzam, 2020).

Metoprolol side effects include tiredness, dizziness, diarrhea, shortness of breath, and wheezing (FDA, 2008). More serious, yet less common, adverse effects are irregular heartbeat and weight gain.

Potential drug interactions can occur with metoprolol. An interaction between two medications doesn't always mean that you need to stop taking one of the medicines. Still, it does require a conversation with your healthcare provider about how to manage your medications used.

Below are some commonly prescribed drugs that may have a drug interaction—meaning a change in the action or side effect—when taken along with beta-blockers (DailyMed, 2018).

• Sildenafil (brand name Viagra) is a medication used to treat erectile dysfunction. When taken with metoprolol (Lopressor), it may add to metoprolol's blood-pressure-lowering effects. This can lead to dizziness, lightheadedness, fainting, flushing, headache, and rapid heart rate (Jackson, 2006). 

• Thioridazine (brand name Mellaril) and chlorpromazine (brand name Thorazine) are both antipsychotic medications used to treat psychotic disorders such as schizophrenia and depression. When combined with metoprolol, people may experience low blood pressure and abnormal heart rhythms.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (brand names Advil, Motrin, Nuprin) may decrease the ability of metoprolol to lower blood pressure.

• Clonidine (brand name Catapres) is a medication used to treat high blood pressure, attention deficit hyperactivity disorder (ADHD), and drug withdrawal. When combined with a beta-blocker, monitor blood pressure for dangerous increases, especially after starting or stopping either medication after using them together.

• Drugs that slow the heart rate can lead to a very slow heart rate (bradycardia) if combined with metoprolol. Examples include digoxin, clonidine, diltiazem, and verapamil.

• Drugs that block the CYP2D6 enzyme in the liver (responsible for the breakdown of metoprolol) can lead to higher than normal levels of metoprolol in your system, which increases your risk of side effects. Examples of these medications include quinidine, fluoxetine, paroxetine, and propafenone.

This does not include all side effects or potential drug interactions, and you should seek medical advice from your healthcare provider or pharmacist for more drug information.

Before starting metoprolol, let your healthcare provider know if you've experienced a previous allergic reaction to it or any other medicine.

Let them know if you have a history of low blood pressure, slow heart rate, heart failure, heart problems, or problems with blood circulation. You should also consult your provider if you're considering metoprolol while pregnant, planning to become pregnant, or breastfeeding. Metoprolol is pregnancy Category C, meaning that we don't know whether it may cause harm to the fetus (DailyMed, 2018).

Metoprolol tartrate is a nonselective beta-blocker, affecting both beta-1 and beta-2 receptors (beta receptors on the heart and the lungs, respectively). Nonselective beta-blockers should be used with caution in people who smoke, have asthma, or live with other lung conditions. Metoprolol may make it more challenging to recognize the warning signs of low blood sugar (hypoglycemia) among people with diabetes who are taking insulin or other diabetic medications to manage their condition (DailyMed, 2018). 

Metoprolol is considered an inexpensive solution for managing anxiety related to social phobias. 

Most insurance plans cover metoprolol tartrate (brand name Lopressor), and the price for the generic drug ranges from $4 to $9 for a 30-day supply (GoodRx, 2020).

Before starting metoprolol for anxiety, review all treatment options with your healthcare provider. As a reminder, metoprolol and other beta-blockers are a useful tool for managing some of the physical symptoms of anxiety and stress—such as sweating, dizziness, and rapid heart rate—but cannot treat the actual psychological causes of the condition.

In conclusion, metoprolol is considered a safe and effective solution for social phobia and performance anxiety, especially when prescribed with therapy, lifestyle changes, and other medications (Dooley, 2015).

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

October 02, 2020

Written by

Alexandria Bachert

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.