Metoprolol Drug Interactions

Metoprolol can have adverse effects when taken in combination with other medications. For example, interactions with other medicines can reduce the effectiveness of metoprolol, dangerously increase its level in the body, cause serious side effects or have a completely different effect altogether.

Drugs That Reduce Metoprolol's Effectiveness

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, etodolac, ibuprofen, indomethacin, ketoprofen, ketorolac, nabumetone, naproxen (aleve) or naproxen sodium, oxaprozin, celecoxib (celebrex) and meloxicam may reduce the ability of metoprolol to lower the patient’s blood pressure. Patients who are being prescribed metoprolol should therefore inform their healthcare provider if they’re taking any NSAID. Such patients must have their blood pressure closely monitored whilst taking metoprolol and NSAIDs concomitantly.

Significant Metoprolol Drug Interactions

Catecholamine-depleting medications, such as guanethidine or reserpine, can have an additive effect when taken with beta-blocking agents like metoprolol. Individuals treated with metoprolol tartrate in conjunction with a catecholamine depletor must therefore be closely observed for signs of hypotension or marked bradycardia, which potentially leads to conditions such as vertigo, syncope, or postural hypotension. In some cases, metoprolol and catecholamine-depleting drugs must not be combined at all.

Other Drugs That Can Potentially Interact With Metoprolol

There are several other groups of drugs that may interact adversely with this medication, including:

• Fellow beta blockers such as atenolol, bisoprolol, labetalol, nadolol, nebivolol, propranolol, sotalol and timolol
• Alpha blockers such as alfuzosin, carvedilol, doxazosin, labetalol, phenoxybenzamine, phentolamine, prazosin, tamsulosin and terazosin
• Calcium channel blockers such as amlodipine, diltiazem, felodipine, isradipine, nisoldipine, nicardipine, nifedipine, nimodipine and verapamil
• Some antidepressants such as bupropion, citalopram, desipramine, duloxetine (cymbalta), escitalopram (lexapro), fluoxetine (prozac), imipramine, paroxetine, sertraline (zoloft) and tranylcypromine
• Some antipsychotic medications such as chlorpromazine, haloperidol and thioridazine
• Some arrhythmia medications, such as amiodarone, disopyramide, lidocaine, propafenone, quinidine and sotalol
• Miscellaneous drugs such as cimetidine, clonidine, digoxin, diphenhydramine and hydroxychloroquine

This is by no means a comprehensive list of metoprolol drug interactions. Patients should always consult their doctor on potential interactions with their current medications before starting metoprolol. The patient’s current prescription medicines should be taken into account along with over-the-counter medications, vitamins and nutritional and herbal supplements.