In Summary

Commonly reported side effects of metoprolol include: cardiac failure, bradycardia, and hypotension. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to metoprolol: oral capsule extended release, oral tablet, oral tablet extended release

Other dosage forms:

• intravenous solution

Along with its needed effects, metoprolol may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking metoprolol:

More common

• Blurred vision
• chest pain or discomfort
• confusion
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• slow or irregular heartbeat
• sweating
• unusual tiredness or weakness

Less common

• Bloating or swelling of the face, arms, hands, lower legs, or feet
• cough
• decreased urine output
• difficult or labored breathing
• difficulty with speaking
• dilated neck veins
• disturbed color perception
• double vision
• extreme tiredness or weakness
• fast, pounding, or racing heartbeat or pulse
• halos around lights
• headache
• inability to move the arms, legs, or facial muscles
• inability to speak
• irregular breathing
• loss of vision
• night blindness
• noisy breathing
• overbright appearance of lights
• pain, tension, and weakness upon walking that subsides during periods of rest
• paleness or cold feeling in the fingertips and toes
• rapid weight gain
• seeing, hearing, or feeling things that are not there
• short-term memory loss
• slow speech
• swelling of the face, fingers, feet, or lower legs
• tightness in the chest
• tingling of the hands or feet
• tingling or pain in the fingers or toes when exposed to cold temperatures
• troubled breathing
• tunnel vision
• unusual weight gain or loss

Rare

• Bluish color of the skin of the fingers or toes
• chills
• clay-colored stools
• continuing loss of appetite
• continuing or severe abdominal or stomach pain
• continuing or severe nausea and vomiting
• dark urine
• difficulty with moving
• fever
• general tiredness and weakness
• hoarseness
• increased frequency of urination
• itching skin
• light-colored stools
• lower back or side pain
• muscle pain or stiffness
• numbness of the fingers or toes
• pain, swelling, or redness in the joints
• rash
• sore throat
• sores, ulcers, or white spots on the lips or in the mouth
• unpleasant breath odor
• unusual bleeding or bruising
• upper right abdominal or stomach pain
• vomiting of blood
• weakness
• yellow eyes and skin

Incidence not known

• Black, tarry stools
• bleeding gums
• blood in the urine or stools
• burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
• cool, sweaty skin
• pinpoint red spots on the skin

Get emergency help immediately if any of the following symptoms of overdose occur while taking metoprolol:

Symptoms of overdose

• Bluish color of the fingernails, lips, skin, palms, or nail beds
• change in consciousness
• loss of consciousness
• no blood pressure or pulse
• stopping of the heart
• very drowsy or sleepy

Some side effects of metoprolol may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

• Belching
• bloated feeling
• decreased interest in sexual intercourse
• difficulty having a bowel movement
• discouragement
• dry mouth
• excess air or gas in stomach or bowels
• feeling of constant movement of self or surroundings
• feeling of fullness
• feeling of indigestion
• feeling sad or empty
• inability to have or keep an erection
• irritability
• loss in sexual ability, desire, drive, or performance
• loss of interest or pleasure
• nightmares
• pain in the chest below the breastbone
• passing gas
• redness or other discoloration of the skin
• runny nose
• sensation of spinning
• sneezing
• stuffy nose
• tiredness
• trouble concentrating
• trouble sleeping

Rare

• Bone pain
• continuing ringing or buzzing or other unexplained noise in the ears
• dry eyes
• hair loss or thinning of the hair
• hearing loss
• increased sensitivity of the skin to sunlight
• pain in the penis on erection
• severe sunburn

Incidence not known

• Change in taste or bad, unusual, or unpleasant (after) taste
• fear or nervousness
• hives or welts

For Healthcare Professionals

Applies to metoprolol: compounding powder, injectable solution, oral capsule extended release, oral solution, oral tablet, oral tablet extended release

General

The most common adverse reactions were tiredness, dizziness, depression, shortness of breath, bradycardia, hypotension, diarrhea, pruritus, and rash.

Cardiovascular

Very common (10% or more): Heart failure (up to 27.5%), hypotension (systolic blood pressure less than 90 mmHg) (up to 27.4%), bradycardia (heart rate less than 40 beats per minute) (up to 15.9%),

Common (1% to 10%): Cold extremities, arterial insufficiency, palpitation, first degree heart block (P-R interval 0.26 seconds or greater), second or third degree heart block, postural disorders

Uncommon (0.1% to 1%): Cardiogenic shock in patients with acute myocardial infarction

Rare (0.01% to 0.1%): Disturbances of cardiac conduction, cardiac arrhythmia

Very rare (less than 0.01%): Intermittent claudication increased

Frequency not reported: Claudication

Gastrointestinal

Common (1% to 10%): Diarrhea, nausea, dry mouth, gastric pain, constipation, flatulence, heartburn, abdominal pain, vomiting

Frequency not reported: Retroperitoneal fibrosis

Other

Common (1% to 10%): Tiredness, peripheral edema, accident and/or injury, death, fatigue

Uncommon (0.1% to 1%): Edema, precordial pain

Frequency not reported: Lactic dehydrogenase elevated

Postmarketing reports: Chest pain

Nervous system

Common (1% to 10%): Dizziness, vertigo, stroke, headache

Uncommon (0.1% to 1%): Paresthesia, somnolence, impaired concentration

Rare (0.01% to 0.1%): Alertness decreased

Very rare (less than 0.01%): Amnesia/memory impairment, tinnitus, taste disturbance

Frequency not reported: Short-term memory loss

Postmarketing reports: Syncope

Respiratory

Common (1% to 10%): Shortness of breath, wheezing, dyspnea

Rare (less than 0.1%): Rhinitis

Dermatologic

Common (1% to 10%): Pruritus, rash

Uncommon (0.1% to 1%): Sweating increased

Rare (0.01% to 0.1%): Loss of hair

Very rare (less than 0.01%): Photosensitivity reactions, psoriasis aggravated, gangrene in patients with preexisting severe peripheral circulatory disorders, hyperhidrosis, alopecia

Psychiatric

Common (1% to 10%): Depression

Uncommon (0.1% to 1%): Insomnia, nightmare

Rare (0.01% to 0.1%): Nervousness, anxiety

Very rare (less than 0.01%): Confusion, hallucination, personality disorder, disturbances of libido

Frequency not reported: Sleep disturbance

Musculoskeletal

Uncommon (0.1% to 1%): Muscle cramps

Very rare (less than 0.01%): Arthralgia, arthritis

Frequency not reported: Musculoskeletal pain

Metabolic

Uncommon (0.1% to 1%): Weight gain

Frequency not reported: Unstable diabetes

Postmarketing reports: Blood triglycerides increased, high density lipoprotein (HDL) decreased

Ocular

Rare (less than 0.1%): Visual disturbance, dry and/or irritated eyes, conjunctivitis

Frequency not reported: Blurred vision

Hepatic

Rare (0.01% to 0.1%): Liver function test abnormalities

Very rare (less than 0.01%): Hepatitis

Frequency not reported: Transaminase elevated, alkaline phosphatase elevated

Postmarketing reports: Jaundice, non-specific hepatic dysfunction

Genitourinary

Rare (0.01% to 0.1%): Impotence/sexual dysfunction

Very rare (less than 0.01%): Peyronie's disease

Immunologic

Rare (less than 0.1%): Positive antinuclear antibodies

Hematologic

Very rare (less than 0.01%): Thrombocytopenia

Frequency not reported: Agranulocytosis