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Dec 01, 2021
5 min read

Metoprolol interactions: what should I avoid while taking metoprolol?

Metoprolol (brand names Lopressor and Toprol XL) is a beta-blocker that slows the heart rate, lowers blood pressure, and improves blood flow. It’s used to treat various heart conditions. Certain drugs may interfere with how metoprolol works. Avoid alcohol and limit driving when first starting metoprolol or increasing the dose because of the potential side effects of drowsiness and dizziness. There’s an FDA black box warning against suddenly stopping metoprolol. Doing so can lead to chest pain and heart attack, so you must work with your healthcare provider to create a plan to come off of the medication safely if you need to.

Disclaimer

If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.

When you start a new medication, the last thing you want is to accidentally do something that could undermine what that drug is supposed to be helping you with. That’s especially true if you’re trying to treat something as severe as heart disease. 

Metoprolol (brand names Lopressor and Toprol XL) is a type of drug called a beta blocker, commonly used to treat congestive heart failure, chest pain, blood pressure, and more. In this article, we’ll give you the run-down on what you need to know about metoprolol interactions.

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Metoprolol interactions and warnings

Certain drugs may interfere with the way metoprolol works. Before starting metoprolol, tell your healthcare provider about any prescription drugs, as well as any over-the-counter medicines, vitamins, and herbal supplements you are taking. You may need to change the dose or monitor for side effects while you’re on metoprolol (NIH, 2017).

There are a few different forms of metoprolol (more on that below), but they all share similar drug interactions. So, regardless of the form of metoprolol you’re taking, be extra careful (and speak with your healthcare provider!) (DailyMed, 2018):

  • Heart and blood pressure medications: reserpine, other beta-blocking agents (like propranolol), propafenone, hydralazine, calcium-channel blockers (like diltiazem)
  • Mental health medications: bupropion (brand name Wellbutrin; see Important Safety Information), fluoxetine (brand name Prozac; see Important Safety Information), paroxetine, clonidine, thioridazine
  • Other medications: antiretroviral drugs like ritonavir, antihistamine drugs like diphenhydramine (brand name Benadryl), antimalarial drugs like quinidine, antifungal drugs like terbinafine (brand name Lamisil)

This list does not include all potential drug interactions. Seek medical advice for additional drug information if you have any questions or concerns. 

Aside from drug interactions, there are a few other things to be aware of when taking metoprolol. 

Metoprolol and alcohol

There isn’t a lot of data on how alcohol affects beta-blockers, but the chances are high that healthcare providers will tell you to avoid or limit alcohol while taking them.

Alcohol is a central nervous system (CNS) depressant, which means that it slows down brain activity and its control over your vital functions. That’s why consuming alcohol can cause drowsiness (Abrahao, 2017). Metoprolol’s side effects include dizziness or lightheadedness, so adding the drug to a few drinks could potentially aggravate these unwanted effects. 

The drug label even lists alcohol as a drug interaction for the extended-release form of metoprolol (metoprolol succinate). Alcohol speeds up the action of metoprolol, and the drug is released into your system faster than expected, which can lead to more side effects (DailyMed, 2018).

Food interactions

There’s been limited research on foods to avoid while taking metoprolol, but unlike some other medications, you don’t need to avoid grapefruits or greens with this drug. 

Because metoprolol is a beta-blocker, a type of drug known to increase potassium levels in the blood, you might want to be mindful of potassium-rich foods like meat, bananas, and sweet potatoes. However, metoprolol only increases your risk of elevated potassium by 13%, compared to 54% for ACE (angiotensin-converting enzyme) inhibitors, another type of heart medication (Chang, 2016). 

Generally speaking, focus on eating a healthy and balanced diet as advised for anyone living with a heart condition. 

Metoprolol and pregnancy

Metoprolol is a category C pregnancy drug, which means that there aren’t adequate studies in humans to determine whether it may harm a fetus (CHEMM, 2021). If you’re pregnant and have a heart condition, your healthcare provider will discuss your medication options with you. 

Metoprolol is also present in small quantities in breast milk. Nursing mothers should seek medical advice regarding the risks and benefits of using metoprolol (DailyMed, 2018).

Operating heavy machinery

Metoprolol can cause some people to feel dizzy, so you should be cautious when driving, riding a bicycle, operating heavy machinery, or doing anything else that could be dangerous while dizzy (NIH, 2017).

What is metoprolol?

We’ve already mentioned that metoprolol is a medication used to treat a variety of heart conditions, but let’s dig a little deeper into this drug. 

Metoprolol (brand names Lopressor and Toprol-XL) belongs to a class of medications known as beta-blockers or beta-adrenergic blocking agents. Metoprolol slows down your heart rate, making it easier for your heart to circulate blood throughout your body. This mechanism makes it an effective drug for treating and preventing various heart conditions, including angina (chest pain), heart failure, heart attack, atrial fibrillation (irregular heartbeat), and hypertension (high blood pressure) (Morris, 2021). 

It comes in three forms: 

  • An immediate-release tablet (metoprolol tartrate; brand name Lopressor), taken two to four times per day
  • An extended-release tablet (metoprolol succinate; brand name Toprol XL), taken once per day
  • An injectable form (metoprolol tartrate), given in a hospital setting 

The dosage will depend on what it’s being used to treat. 

Side effects of metoprolol

Metoprolol is a safe and widely prescribed medication, but it does come with a risk of some side effects. 

The most common side effects of metoprolol are mild and tend to go away after some time. These include (NIH, 2017): 

  • Depression
  • Tiredness
  • Diarrhea
  • Wheezing
  • Shortness of breath
  • Dry mouth
  • Stomach pain
  • Nausea
  • Weight gain
  • Constipation
  • Hives
  • Dizziness or lightheadedness

There is a small chance of more severe side effects, like low blood pressure (hypotension), heart block, worsening asthma or other lung conditions, slow heart rate (bradycardia), and worsening heart failure. If you experience these, see your healthcare provider right away. 

If you’re experiencing side effects that are bothersome enough to make you want to stop the medication, don’t do so all of a sudden. The FDA has issued a black box warning that sudden discontinuation of metoprolol can lead to chest pain and heart attack. Your healthcare provider can help you create a safe plan for tapering off of the medication to avoid serious adverse effects (FDA, 2006).

And if you experience signs of an allergic reaction—hives, difficulty breathing, or swelling—seek immediate medical attention from a healthcare professional. 

Working with your healthcare provider

Before starting metoprolol, review your health information with your healthcare provider. Let them know if you have a history of slow heart rate, heart failure, blood circulation problems, thyroid disease, or pheochromocytoma. You should also consult your provider if you’re considering metoprolol while pregnant, planning to become pregnant, or breastfeeding.

While taking the medication, your healthcare provider may ask you to regularly check your blood pressure and pulse to make sure metoprolol isn’t causing any negative effects on your blood pressure. 

If you skip a dose, take the missed dose as soon as possible. If this aligns with the next dose, don’t double up. Just continue with your regular dosing schedule (NIH, 2017).

Finally, as we stated earlier, you should always consult your healthcare provider before ending a medication—this is especially important with metoprolol. Abruptly stopping metoprolol can cause severe side effects, such as chest pain and an increased risk of heart attacks, so discuss a plan for slowly decreasing the dose before stopping this medication.

References

  1. Abrahao, K. P., Salinas, A. G., & Lovinger, D. M. (2017). Alcohol and the brain: neuronal molecular targets, synapses, and circuits. Neuron, 96(6), 1223–1238. doi: 10.1016/j.neuron.2017.10.032. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566861/
  2. Chang, A. R., Sang, Y., Leddy, J., Yahya, T., Kirchner, H. L., Inker, L. A., et al. (2016). Antihypertensive medications and the prevalence of hyperkalemia in a large health system. Hypertension (Dallas, Tex. : 1979), 67(6), 1181–1188. doi: 10.1161/HYPERTENSIONAHA.116.07363. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4865437/
  3. DailyMed from the U.S. National Library of Medicine and the National Institutes of Health (NIH). (2014). Metoprolol tartrate tablet, film coated. Retrieved on Nov. 22, 2021 from https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=011ee828-5c2a-49b9-bf8e-07f5eb5fc635
  4. DailyMed from the U.S. National Library of Medicine and the National Institutes of Health (NIH). (2018). Metoprolol succinate capsule, extended-release. Retrieved on Nov. 22, 2021 from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=90aa06a3-100f-4466-b950-506303707b01
  5. Morris, J. & Dunham, A. (2021). Metoprolol. [Updated Jul 13, 2021]. In: StatPearls [Internet]. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532923/
  6. U.S. Food & Drug Administration (FDA). (2006). LOPRESSOR (metoprolol tartrate) tablet. Retrieved on Nov. 22, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2008/017963s062,018704s021lbl.pdf
  7. U.S. Food & Drug Administration (FDA). (n.d.). METOPROLOL SUCCINATE EXTENDED-RELEASE TABLETS. Retrieved on Nov. 22, 2021 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/019962s032lbl.pdf
  8. U.S. Department of Health & Human Services (HHS). (2020). FDA Pregnancy Categories. Retrieved on Nov. 22, 2021 from https://chemm.nlm.nih.gov/pregnancycategories.htm
  9. U.S. National Library of Medicine (NIH). (2017). Medline Plus – Metoprolol. Retrieved on Nov. 22, 2021 from https://medlineplus.gov/druginfo/meds/a682864.html#side-effects