Metoprolol Succinate ER Side Effects

Generic Name: metoprolol

Note: This page contains information about the side effects of metoprolol. Some of the dosage forms included on this document may not apply to the brand name Metoprolol Succinate ER.

Not all side effects for Metoprolol Succinate ER may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to metoprolol: oral tablet, oral tablet extended release

Other dosage forms:

In addition to its needed effects, some unwanted effects may be caused by metoprolol (the active ingredient contained in Metoprolol Succinate ER). In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when 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
  • shortness of breath
  • 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 fatigue
  • 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
  • troubled breathing
  • tunnel vision
  • unusual weight gain or loss
Rare
  • Bluish color 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

If any of the following symptoms of overdose occur while taking metoprolol, get emergency help immediately:

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 heart
  • unconsciousness
  • very drowsy or sleepy

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

Less common
  • Belching
  • bloated
  • decreased interest in sexual intercourse
  • difficulty having a bowel movement (stool)
  • discouragement
  • dry mouth
  • excess air or gas in stomach or intestines
  • feeling of constant movement of self or surroundings
  • feeling of indigestion
  • feeling sad or empty
  • full feeling
  • 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 of 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 tablet, oral tablet extended release

General

Metoprolol is generally well-tolerated. Ninety-four percent of patients from a large study reported "excellent" or "good" tolerability of metoprolol (the active ingredient contained in Metoprolol Succinate ER) Approximately 27% of patients experience at least one side effect from long-term studies, but they are usually mild and transient. Side effects may be more likely and more severe in patients who are slow metabolizers of metoprolol.

In a review of heart failure trials, beta-blockers (i.e., carvedilol, metoprolol, bisoprolol) were associated with increased risks of hypotension, dizziness, and bradycardia, but not fatigue compared with placebo. In addition, beta-blocker therapy was associated with fewer overall all-cause withdrawals and less heart failure deterioration than placebo.

Nervous system

Nervous system side effects have included general fatigue in 1% to 10%, dizziness in 1% to 10%, headache in 0.3% to 4.0%, insomnia in 2%, nightmares in 1%, mental confusion, short-term memory loss, and somnolence. Anxiety, nervousness, hallucinations, headache, tinnitus, and paresthesias have been associated with extended release preparations of metoprolol (the active ingredient contained in Metoprolol Succinate ER) in postmarketing use.

Cardiovascular

Cardiovascular side effects reported in 3% of patients have included bradycardia and dyspnea. AV heart block, syncope, chest pain, hypotension, cold extremities, palpitations, peripheral edema, coronary artery spasm, congestive heart failure, and arterial insufficiency (usually of the Raynaud type) have been reported in 1% of patients. Very rarely, gangrene has been reported in patients with severe preexisting peripheral circulatory disorders. Cardiogenic shock has been reported in patients with acute myocardial infarction in postmarketing studies.

A 53-year-old male with hyperlipidemia, hypertension, single-vessel coronary artery disease, and tobacco abuse developed documented right coronary artery spasm inducible by intravenous ergonovine and made more inducible with intravenous metoprolol. The authors believe that, since beta-blockade may result in unopposed alpha stimulation, metoprolol (and other beta-blockers) are controversial in patients with coronary artery spasm (variant angina pectoris).

Gastrointestinal

Approximately four cases of retroperitoneal fibrosis, often presenting as a bowel or ureteral obstruction have been associated with the use of metoprolol (the active ingredient contained in Metoprolol Succinate ER) The mechanism by which beta-blockers cause this problem is unknown.

Gastrointestinal side effects have included diarrhea (5%). Nausea, dry mouth, gastric pain, constipation, flatulence, digestive tract disorders, and heartburn have been reported in 1% of patients. Vomiting has been reported frequently. Retroperitoneal fibrosis has also been reported, although a causal relationship to metoprolol has not been established.

Psychiatric

Psychiatric problems include depression in 2% to 5% of patients.

Respiratory

Small studies in patients with asthma reveal significant decreases in maximal midexpiratory flow (MMEF), forced vital capacity (FVC), and forced expiratory volume in 1 second (FEV1) associated with metoprolol (the active ingredient contained in Metoprolol Succinate ER) relative to placebo.

Metoprolol was associated with an increase in the number of obstructive breathing patterns in 5 of 12 obese male patients with hypertension.

Respiratory side effects reported in 1% of patients have included wheezing, bronchospasm, and dyspnea. Rhinitis has also been reported.

Metabolic

Metabolic side effects have included significant increases in VLDL cholesterol and total serum triglycerides, and significant decreases in HDL cholesterol. A case of hyperkalemia has been reported. At least one case of metoprolol-associated hypoglycemia has been reported. Very rarely, weight gain has also been reported.

Metabolic side effects have included weight gain.

Severe and symptomatic hyperkalemia associated with metoprolol has been reported in a 45-year-old male with diabetes, hypertension, and dialysis-dependent diabetic nephropathy. Cellular potassium channels are beta-receptor mediated.

The mechanism by which metoprolol induces weight gain is unknown. Some investigators have reported a 4% to 9% reduction in total energy expenditure and a 25% reduction in thermogenic response to food during beta-blocker treatment.

Hypersensitivity

Hypersensitivity side effects reported in 5% of patients have included pruritus and rash. Very rarely, worsening of psoriasis has also been reported.

A 72-year-old woman with a history of myocardial infarction, noninsulin-dependent diabetes mellitus, hypertension, chronic renal insufficiency, gout, and ACE inhibitor sensitivity was hospitalized for chest pain accompanied by pulmonary edema. During the first day of hospitalization, while intubated, she developed emergent hypertension, and was given metoprolol 5 mg IV. Within one hour, the patient developed profound tongue and lip swelling. Wheezing was absent. She was successfully treated with methylprednisolone and diphenhydramine. Besides ACE inhibitor sensitivity, there was no personal or family history of allergies, anaphylaxis, or atopic diathesis.

Genitourinary

Genitourinary side effects have included a decrease free and total testosterone, decreased libido, and male impotence.

Dermatologic

Dermatologic side effects reported very rarely have included worsening of psoriasis. A case of generalized psoriasiform lesions has been reported. Urticaria has also been reported in postmarketing experience.

A 62-year-old man with ischemic heart disease developed a generalized, chronic, nummular, psoriasiform, erythematous rash that disappeared after metoprolol was withheld. Subsequent skin patch testing revealed sensitivity to metoprolol.

Musculoskeletal

There are approximately five case reports of severe myalgias/arthralgias in patients without a history of arthritis. In one, a 60-year-old male with hypertension developed a microcytic anemia, weight loss, myalgias, anorexia and fatigue within seven years after starting metoprolol (the active ingredient contained in Metoprolol Succinate ER) and furosemide. The patient's signs and symptoms resolved within two months after discontinuing metoprolol. A review of the literature reveals that the most commonly affected joints are the knees. Associated complaints may include fever and chills.

Musculoskeletal side effects have been reported extremely rarely. Cases of a polymyalgia rheumatica-like syndrome and arthralgia have been reported. Very rarely, arthritis has also been reported.

Hepatic

A 56-year-old female with a history of migraine headaches developed seronegative hepatitis associated with metoprolol (the active ingredient contained in Metoprolol Succinate ER) Her signs and symptoms resolved within 48 hours after discontinuing metoprolol, and were reproducible on rechallenge.

Hepatic toxicity is reported in at least one case report.

Endocrine

Endocrine side effects including slightly decreased T3 concentrations (without changes in T4 concentrations) have been reported among patients with hyperthyroidism.

Ocular

Ocular side effects reported rarely have included blurred vision and dry eyes. Very rarely, photosensitivity has been reported.

Other

Other side effects including tinnitus and alopecia have been reported rarely. Photosensitivity and increased sweating have been associated with extended release preparations of metoprolol (the active ingredient contained in Metoprolol Succinate ER) in postmarketing use.

Hematologic

Hematologic side effects including agranulocytosis, nonthrombocytopenic purpura and thrombocytopenic purpura have been associated with beta-blocking agents in general.

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