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metoprolol

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Metoprolol may cause weight gain (rare).

This drug may also cause the following symptoms that are related to weight gain:

Medical Source Information
Yellow highlights indicate symptoms related to weight gain.

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.

Patients receiving metoprolol should be advised to avoid abrupt discontinuation of the drug, as severe exacerbation of angina and myocardial infarction have occurred. When discontinuing metoprolol, particularly in patients with ischemic heart disease, the dosage should be reduced gradually over a 1 to 2 week period and the patient should be closely monitored. If angina worsens or acute coronary insufficiency develops, metoprolol should be reinstated quickly, at least temporarily, and other appropriate measures for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of treatment without consulting the physician. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol treatment abruptly even in patients treated only for hypertension.

Heart failure patients should be advised to consult their physician if they experience symptoms of worsening heart failure such as weight gain or increasing shortness of breath.

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.

Side Effects to Watch
Watch closely for the following side effects and notify your physician immediately should any of these develop:

Abnormal bruising or signs of bleeding such as bleeding from the gums, nose, digestive tract, vagina (females), faintness, dizziness, loss of consciousness, or rash (signs of problems with blood clot formation)
weight gain, congestive heart failure, worsening of congestive heart failure or shortness of breath

Lab and Diagnostic Tests
If certain symptoms develop, ask your physician whether you need the following lab tests or other diagnostic tests (if you've not already had them):

monitor for [coronary artery disease|heart disease that involves a blockage of the blood supply to the heart], [decreased oxygen to the heart due to blockage of the coronary arteries|blood vessels that supply the heart], liver problems or chest discomfort/angina
Monitor alkaline phosphatase and lactate dehydrogenase
Blood tests to assess normal clotting - in people who develop signs of bleeding such as abnormal bruising or signs of bleeding including bleeding from the gums, nose, digestive tract, vagina (females), faintness, dizziness, loss of consciousness, or rash

References

Hypoglycemia associated with preoperative metoprolol administration. Brown DR, Brown MJ Anesth Analg 2004;99:1427-8.
Weight change associated with the use of migraine-preventive medications. Taylor FR Clin Ther 2008;30:1069-80.
Effect of oxprenolol and metoprolol on serum lipid concentration. Ferrara LA, Marotta T, Scilla A, et al Eur J Clin Pharmacol 1984;26:331-4.
Product Information. Lopressor (metoprolol). Anonymous Novartis Pharmaceuticals, East Hanover, NJ. PROD;
Atenolol 50 mg or metoprolol 200 mg: a comparison of antihypertensive efficacy, side effects and lipoprotein changes. Weiner L, Rossner S Acta Med Scand 1983;677:153-7.
Metoprolol-induced hyperkalemia in a diabetic with advanced renal failure. Ashouri OS Arch Intern Med 1985;145:578.
Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects. Rossner S, Weiner L Eur J Clin Pharmacol 1983;24:573-7.

Multum version: 154.0 (Jun 16, 2010)

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