From the Guidelines
Metoprolol can cause dizziness without orthostatic hypotension due to its direct effects on the central nervous system and reduction in cardiac output. This beta-blocker commonly causes dizziness as a side effect, independent of blood pressure changes when moving from sitting to standing. According to the 2018 ESC guidelines for the diagnosis and management of syncope 1, patients may experience symptoms such as dizziness, light-headedness, weakness, fatigue, and lethargy, which can be related to the use of beta-blockers like metoprolol.
Key Points to Consider
- Metoprolol works by blocking beta-adrenergic receptors, which reduces heart rate and cardiac output, potentially leading to decreased blood flow to the brain and resulting in dizziness.
- The medication can directly affect the central nervous system, contributing to dizziness, fatigue, and lightheadedness, as noted in the context of orthostatic intolerance 1.
- Patients taking metoprolol should be aware that dizziness may occur at any time during treatment, particularly when starting the medication or increasing the dose.
- If dizziness becomes severe or persistent, patients should consult their healthcare provider, who may adjust the dosage or consider alternative medications.
Management and Prevention
- Staying well-hydrated and avoiding sudden position changes can help minimize dizziness symptoms while taking metoprolol.
- Healthcare providers should monitor patients for signs of dizziness and orthostatic intolerance, and adjust treatment plans accordingly, considering the potential for metoprolol to contribute to these symptoms 1.
From the FDA Drug Label
Central Nervous System Tiredness and dizziness have occurred in about 10 of 100 patients.
Myocardial Infarction ... dizziness ... have also been reported, but a drug relationship is not clear
Dizziness is reported as an adverse reaction in the metoprolol drug label 2. However, there is no direct information that specifies whether this dizziness is related to orthostatic hypotension or not. Since the label does mention hypotension and dizziness separately, it can be inferred that dizziness may occur without orthostatic hypotension, but this is not explicitly stated.
- Key points:
- Dizziness is a reported adverse reaction.
- No direct link to orthostatic hypotension is provided.
- Hypotension is mentioned as a separate adverse reaction.
From the Research
Metoprolol and Dizziness
- Metoprolol, a beta-blocker, is not generally associated with symptomatic postural hypotension, as stated in the study 3.
- However, dizziness is reported as an adverse event in patients taking metoprolol, as seen in the study 4, which compared nebivolol with other antihypertensive agents, including metoprolol.
- The study 4 found that the overall incidence of adverse events was greater with metoprolol than with nebivolol, although the specific incidence of dizziness without orthostatic hypotension is not explicitly stated.
- Another study 5 found that beta-blockers, including metoprolol, were associated with increased odds of orthostatic hypotension, but it does not provide information on dizziness without orthostatic hypotension.
Orthostatic Hypotension and Beta-Blockers
- The study 6 investigated the association between long-term use of beta-blocker eye drops and falls, dizziness, or orthostatic hypotension in older patients, but found no significant association.
- The study 7 discussed drug-related orthostatic hypotension, including the role of beta-blockers, but did not provide specific information on metoprolol and dizziness without orthostatic hypotension.
- The study 5 found that beta-blockers were associated with increased odds of orthostatic hypotension, but the relationship between beta-blockers and dizziness without orthostatic hypotension is not clear.
Conclusion on Available Evidence
- While there is evidence that metoprolol can cause dizziness, it is not clear if this occurs without orthostatic hypotension.
- Beta-blockers, including metoprolol, may be associated with increased odds of orthostatic hypotension, but the specific relationship between metoprolol and dizziness without orthostatic hypotension is not well established in the available evidence 3, 4, 5.