Metoprolol for Anxiety (A brief guide)

In this guide we will discuss metoprolol for anxiety, what it is, side effects, dosage, interactions with other drugs, precautions, overdose, and considerations.

Metoprolol for anxiety: what is it?

Metoprolol for anxiety treatment is considered an off-label prescribed treatment.

It is classed as a beta-blocker and is the generic form of the brand-name drug Lopressor prescribed to treat high blood pressure and prevent chest pain (angina).

Metoprolol works by relaxing blood vessels and slowing your heart rate, subsequently improving blood flow and lowering blood pressure.

It has also been associated increase the probability of survival after a heart attack.

The long-acting form of the drug (Toprol XL) is prescribed to treat heart failure.

Additionally, metoprolol is also used to treat migraine or moving disorders caused by drugs used to treat mental illnesses. 

How does metoprolol work?

Beta-blockers are beta-adrenergic blocking agents, which prevent adrenaline (stress hormone) from communicating with the beta receptors located in your heart, consequently preventing your heart from increased heart rate.

Some of the most common beta-blockers are:

• Acebutolol (Sectral)
• Bisoprolol (Zebeta)
• Carvedilol (Coreg)
• Propanolol (Inderal)
• Atenolol (Tenormin)

Considerations

• Metoprolol is not a cure for high blood pressure or chest pain, it only keeps it under control.
• It can take a few weeks before you experience the full benefits of taking Metoprolol.
• If you have allergies, you may have worse reactions when taking metoprolol and can decrease the chance of responding to your usual dose of epinephrine. 
• If you have asthma, a slow heart rate or heart failure you should not use any beta-blockers, including metoprolol.
• For the elderly and people with diabetes, your doctor should prescribe it with caution.
• Tell your doctor if you have a slow heart rate or problems with blood circulation before taking this medicine.
• Tell your doctor if you have asthma or any other lung condition, liver disease, diabetes, hyperthyroidism, congestive heart failure or certain types of irregular heartbeats.
• Let your doctor know if you have pheochromocytoma (a rare tumor that develops on a gland near your kidneys).
• Let your doctor know if you have any planned surgeries or dental surgeries.

How can metoprolol help as an anxiety treatment?

Like many beta-blockers, sometimes metoprolol gets prescribed off-label to control anxiety, including occasional performance anxiety and other anxiety disorders.

However, it will not treat the underlying causes of your anxiety but they can certainly alleviate your physical symptoms. 

This type of medicine can be used short-term for anxiety treatment under certain situations, as an example, you could have a presentation tomorrow and have metoprolol prescribed to help you with your symptoms but it is not recommended long-term. 

Talk to your doctor before taking metoprolol or any other drug for anxiety.

There may be another medication that’s safer and better suited to manage your anxiety as it is the case of benzodiazepines. 

Additionally, remember the reaction to each drug varies from one person to the other, what works for someone else may not work for you. 

Metoprolol and pregnancy

According to Everyday Health, here are some recommendations:

If you are pregnant, breastfeeding or might become pregnant tell your doctor before starting metoprolol.

There’s not enough evidence to say that metoprolol is safe during pregnancy, and pregnant women should take it only if there is a clear need.

Metoprolol could also pass into breast milk, so ask your doctor about breastfeeding before taking metoprolol.

There’s no evidence that metoprolol is safe or effective in children younger than 6 years old.

Metoprolol side effects

Common side effects of metoprolol may include:

• Dizziness or lightheadedness
• Tiredness
• Depression
• Nausea
• Dry mouth
• Stomach pain
• Vomiting
• Gas or bloating
• Heartburn
• Constipation
• Rash or itching
• Cold hands and feet
• Runny nose

Serious side effects 

If you have any of these side effects, stop taking metoprolol and call your doctor right away:

• Shortness of breath
• Wheezing
• Swelling of the hands, feet, ankles, or lower legs
• Unusual weight gain
• Fainting
• Rapid, pounding, or irregular heartbeat

Metoprolol interaction with other drugs

There are certain drugs that interact with metoprolol reducing its effectiveness.

It is important to let your doctor know about any other drugs you may have been taking, even illegal substances and any over-the-counter (OTC) vitamins, herbs, or dietary supplements, rich in 5-HTP.

According to Everyday Health, the types of drugs that interact with metoprolol include:

• Antidepressants including bupropion (Wellbutrin), fluoxetine (Prozac, Sarafem), and paroxetine (Paxil)
• Antimalaria drugs such as hydroxychloroquine
• Medications used to treat heartburn or other stomach conditions, such as cimetidine (Tagamet) and ranitidine (Zantac)
• Some heart medications, including clonidine (Catapres), propafenone (Rythmol), and quinidine (Quinaglute, Quinidex)
• Antihistamines like diphenhydramine (Benadryl)
• Certain HIV drugs, including ritonavir (Norvir)
• Some antifungal medications, including terbinafine (Lamisil)
• Certain drugs used to treat mental illness, including thioridazine (Mellaril)

Can I drink alcohol while taking metoprolol?

Avoid alcohol intake when using metoprolol.

Since alcohol is a depressor of the nervous system it can make the side effect of making you feel drowsy even worse. 

How much metoprolol do I have to take?

• Forms of metoprolol include oral tablets of standard doses of 50 and 100 milligrams (mg).
• The drug is also available as an extended-release tablet in doses of 25, 50, 100, and 200 mg, in both the generic form and under the brand names Lopressor and Toprol XL.
• The usual first dose of metoprolol is 100 mg a day in one dose or divided into two doses. 
• It is possible that your doctor may gradually increase this dose. For people taking the long-acting Toprol XL tablets, the initial dose ranges from 25 to 100 mg once a day.
• Although you can split the long-acting tablets, swallow the pills whole. Don’t crush or chew metoprolol.

What happens if I overdose?

Do not take higher doses than the ones prescribed by your doctor.

If you take too much of Metoprolol, symptoms such as the following will manifest:

• Dizziness
• Fainting
• Trouble breathing or swallowing
• Swelling of the hands, feet, ankles, or lower legs

If you or someone has overdosed call emergency services immediately. 

What happens if I miss a dose?

If you forgot to take your dose, take your dose as soon as you remember.

If it is already time for you to take the next dose then skip the one you forgot and take the next one.

Do not double dose to compensate for the one you forgot. 

Metoprolol Succinate Er for anxiety

Metoprolol succinate Er is a beta-blocker used for anxiety, however, it can affect the heart and circulation. 

Succinate is used to treat angina (chest pain) and hypertension (high blood pressure).

It is also used to lower your risk of death or needing to be hospitalized for heart failure.

Metoprolol Succinate ER may also be used for other purposes not listed in this medication guide (Health Maintain Tips)

Tips when taking metoprolol from drugs.com

• Take metoprolol at the same time each day.
• Report any shortness of breath or facial swelling immediately to your doctor.
• Also, talk to your doctor if you develop a very slow heartbeat or cold feeling in your hands or feet.
• If you are diabetic, talk to your doctor about the possibility that metoprolol may reduce your symptoms of hypoglycemia.
• Talk to your doctor if you are having any side effects that are interfering with your quality of life. Do not stop taking metoprolol suddenly.
• Do not substitute metoprolol tartrate with metoprolol succinate and vice versa.
• Always check that your prescription is correct. There have been a number of dosing errors involving metoprolol tablets.
• Your doctor will need to regularly monitor your blood pressure and possibly other markers. Keep your appointments.
• Metoprolol may impair your thinking or reaction time and affect your ability to drive. Drinking alcohol may enhance these effects. Do not drive if you think your driving ability is being compromised by metoprolol.

Scientific research

A study conducted in 1996 evidenced that beta-blockers, particularly propranolol,  have adverse effects on mood.

However, exercise prescription was not compatible with beta-blockade, but a highly regarded adjuvant therapy.

A second recent study from 2017 found that metoprolol treatment tends to worsen the depressive and high burnout symptoms, but can have anxiolytic benefits independent of heart rate reduction in patients with chronic heart failure that additionally have a mental disorder.

Thus, it is recommended for physicians to be vigilant when prescribing metoprolol in chronic heart failure patients who in addition have a mental disorder. 

Why is this blog about metoprolol for anxiety important?

It is important to take into consideration that the main use for prescribing metoprolol is not anxiety, although sometimes it can get prescribed when the situation requires as it is the case of an oral presentation or performance but it should not be taken long-term.

We advise considering going to psychotherapy to help you treat your anxiety, free of side effects.

Additionally, it is important to talk to your doctor and consider other available options to treat your anxiety and weight the benefits and side effects of the treatment options.

Remember that this is considered a short-term treatment because it hasn’t been approved specifically to treat anxiety and studies have shown detrimental effects. 

Here we discussed the main reasons why metoprolol gets prescribed, usual doses, possible side effects, considerations, and precautions, but if there are additional questions or concerns you should tell consult them with your doctor. 

Frequently Asked Questions (FAQs) about Metoprolol for anxiety

References

Everyday Health

Healthline

Drugs.com

Health Maintain Tips