7 Metoprolol Interactions You Should Know About
Key takeaways:
Metoprolol is available in two different forms. These include metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol XL). Both forms have similar interactions.
Examples of metoprolol interactions include digoxin (Lanoxin), certain antidepressants, and clonidine (Catapres, Kapvay).
Make sure your prescriber and pharmacist have your current medication list. This will help them review for potential metoprolol interactions ahead of time.
There are ways to save on metoprolol tartrate and metoprolol succinate ER — especially the generic versions. GoodRx can also help you access brand-name Toprol XL at an exclusive cash price as low as $39.
Table of contents
Metoprolol (Lopressor, Toprol XL) is one of the most popular beta blockers in the U.S. It’s available in both immediate-release (Lopressor) and extended-release (Toprol XL) forms. You may be taking it for heart failure, chest pain, or another heart-related condition.
Metoprolol can potentially interact with other medications you’re taking. And alcohol can be a risky combination, too. Some metoprolol interactions are common. These are often managed with dose adjustments or monitoring. Here we’ll review seven important ones you should know about.
1. Monoamine oxidase inhibitors (MAOIs)
Monoamine oxidase inhibitors (MAOIs) are used to treat depression and Parkinson’s disease. Examples include selegiline (Zelapar, Emsam) and rasagiline (Azilect). The antibiotic linezolid (Zyvox) also falls into this category.
MAOIs can interact with metoprolol. They can increase the risk of low blood pressure (hypotension) and low heart rate (bradycardia). Your prescriber may recommend an alternative that’s less likely to interact.
In some cases, your prescriber may say this combination is OK. If so, let them know if you experience symptoms of low blood pressure or low heart rate. These can include feeling lightheaded or dizzy, which may cause you to pass out and/or fall.
Keep in mind that MAOIs stick around in your body for a while after you’ve stopped taking them. So, this interaction can still happen if you take metoprolol within 14 days of an MAOI.
Metoprolol tips: Pharmacists discuss the best time to take metoprolol and other tips to help you get the best results.
What to expect: Learn more about how long metoprolol takes to work, and how to know if it’s working for you.
How they compare: Metoprolol belongs to a class of medications known as beta blockers. But there are some key differences between beta blockers, including which ones may be preferred for certain health conditions.
2. Antidepressants like Prozac
Some antidepressants can interact with metoprolol. Examples include fluoxetine (Prozac) and paroxetine (Paxil).
When taken together, this combination can increase metoprolol levels in your blood. This can make metoprolol side effects, such as hypotension and bradycardia, more likely.
If possible, your prescriber may want you to avoid this combination altogether. But if that’s not possible, let them know if you’re feeling lightheaded or dizzy during treatment. They may need to adjust your metoprolol dosage.
3. Diphenhydramine
Diphenhydramine (Benadryl, ZzzQuil) is a convenient remedy for allergies, cold symptoms, or sleep. But before you grab some off the pharmacy shelf, know that it can also interact with metoprolol.
This combination can increase the risk of metoprolol side effects, such as dizziness. What’s more, Bendaryl can cause dizziness on its own. Dizziness may be worse when metoprolol and Benadryl are combined.
You may only take Benadryl for a short period of time. Even so, check with your healthcare team first. They can let you know if it’s safe for you to take it with metoprolol.
4. Digoxin
Digoxin (Lanoxin, Digitek) is used to treat heart failure and abnormal heart rhythms. It primarily works by slowing down your heart rate. Metoprolol also has this effect. When taken together, your heart rate might drop too low.
As mentioned above, metoprolol is also used to treat heart failure. And it’s used off-label for abnormal heart rhythms, too. So in some cases, your prescriber may recommend taking metoprolol with digoxin. Let them know if you develop symptoms of low heart rate, like dizziness, chest pain, or shortness of breath.
5. Clonidine
Clonidine (Catapres) is a medication used to treat high blood pressure. Kapvay is an ER version for attention-deficit hyperactivity disorder (ADHD).
Clonidine can slow down your heart rate. When taken with metoprolol, your heart rate might slow down too much. Tell your prescriber if you have lightheadedness or dizziness with this combination. They may adjust your dose or have you stop taking one of these medications.
If you’re taking clonidine and your prescriber recommends stopping it, it’s important to take some precautions, especially if you’re taking metoprolol at the same time. Your blood pressure can get dangerously high if you abruptly stop taking clonidine. And if you’re taking metoprolol, a dangerous increase in blood pressure is more likely. So follow your healthcare team’s instructions for discontinuing any medications. Don’t try to stop them on your own.
6. Certain calcium channel blockers
Diltiazem (Cardizem) and verapamil are calcium channel blockers. They’re used for high blood pressure, chest pain, and/or abnormal heart rhythms. Both medications work by slowing down your heart and relaxing your blood vessels.
When taken with metoprolol, these medications may slow your heart down too much. Tell your prescriber if you’re dizzy or lightheaded with this combination. They may need to adjust how much you’re taking of either medication.
7. Alcohol
It’s a good idea to minimize how much alcohol you drink if you’re taking blood pressure medications. In some cases, alcohol is thought to make these medications less effective. This includes beta blockers such as metoprolol.
What’s more, alcohol can make you dizzy and lightheaded. Metoprolol can cause similar side effects, which may be worse with alcohol.
If you want to know how much alcohol is safe for you to drink, talk to your healthcare team. They can give you a recommendation based on your specific situation. For some people, this could mean avoiding alcohol completely.
Frequently asked questions about metoprolol interactions
You may have additional questions about potential metoprolol interactions that haven’t been covered above. Here, we’ll answer a few frequently asked questions.
No. Metoprolol isn’t known to interact with grapefruit. But other medications that you may be taking along with metoprolol, such as certain calcium channel blockers and statins, can interact with grapefruit. Your healthcare team can tell you if grapefruit is a problem with your medications.
Generally, yes. It’s OK to eat bananas with metoprolol. But it’s best to eat potassium-rich foods such as bananas in moderation with metoprolol. That’s because beta blockers can potentially increase potassium levels in the blood. While uncommon, it’s possible for potassium levels to get too high.
Your healthcare team can provide diet-specific recommendations for your situation. You may have a higher risk of increased potassium levels due to health conditions, age, or other medications you take.
Yes. Ibuprofen can raise your blood pressure, especially if you take it regularly. This can counteract some of the benefits of metoprolol. Ibuprofen can also cause your body to hang onto more water and salt, which can worsen heart failure symptoms being treated by metoprolol.
In general, it’s recommended to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen with health conditions treated by metoprolol. These include heart failure, high blood pressure, and after a heart attack. Your healthcare team can recommend safer options.
When should you contact your prescriber about a metoprolol interaction?
Let your prescriber or pharmacist know if you’re concerned about a metoprolol interaction. They’re likely already aware of interactions with medications you’re taking. But it’s important that they have your current medication list for review.
Many metoprolol interactions involve a slowed heart rate. This can result in dizziness, lightheadedness, and fainting. Let your prescriber know if you experience these side effects. It could be a sign that your dose needs to be adjusted.
But if any symptoms feel severe or life-threatening, call 911 or go to the nearest emergency room.
How to save on metoprolol
Metoprolol tartrate and metoprolol succinate ER are both available as generic- and brand-name medications. GoodRx can help you find ways to save.
Generic metoprolol tartrate’s price at certain pharmacies is as low as $3.60 for a 30-day supply with a free GoodRx discount. And a 30-day supply of generic metoprolol succinate ER may cost as little as $6.30 with a free GoodRx discount.
What's more, anyone with a valid prescription can use GoodRx to purchase a 30-day supply of Toprol XL at an exclusive cash price as low as $39.
The bottom line
Metoprolol can interact with medications and other substances. Examples include digoxin, diphenhydramine, and certain calcium channel blockers. It can also interact with clonidine, certain antidepressants, and alcohol.
Most commonly, you may experience dizziness and lightheadedness from a metoprolol interaction. Let your prescriber know if these symptoms develop. Seek immediate medical attention if they feel severe or life-threatening.
Why trust our experts?
References
Bryant Ranch Prepack. (2024). Metoprolol succinate extended-release tablets [package insert].
Chang, A. R., et al. (2016). Antihypertensive medications and the prevalence of hyperkalemia in a large health system. Hypertension.
ClinCalc. (n.d.). Metoprolol: Drug usage statistics, United States, 2013 - 2021.
NuCare Pharmaceuticals, Inc. (2024). Metoprolol tartrate [package insert].
Varga, Z., et al. (2017). Cardiovascular risk of nonsteroidal anti-inflammatory drugs: An under-recognized public health issue. Cureus.
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