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I am on 25 mg Metoprolol Succinate ER (1/2 tablet

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Posted on Mon, 11 Mar 2019
Question: I am on 25 mg Metoprolol Succinate ER (1/2 tablet every 12 hours) and I have recently noticed that I am starting to get numbness/prickling and mild tremors in my left hand. Is this normal to expect with this medication? My feet/toes are also extremely sensitive to cold now which the doctor told me is a normal side effect and so I have been wearing thermal socks, shoes in the house and have had to keep a space heater near my feet when it is very cold out. Is this normal as well? My blood pressure is usually in the low 100s (sometimes is high 90s) systolic and 60s or 70s diastolic which my doctor says is a normal range. I was put on the medication a couple days after having a reaction to the flu shot (pulse went up to 165 at rest that night) starting at 40 mg which caused extreme fatigue to the point where I could barely function so it was decreased to 25 mg. The hope is to have me off the medication in a couple months, I have always had a rapid pulse and my resting heart rate is sometimes in the low 90s or 100s. Echo and holter monitor results were normal, EKG is always normal and blood work from back in November (including thyroid are normal). Unfortunately I just have not felt "normal" since the day of the flu shot (i.e. fatigue, occasional dizziness and then the numbness/tingling), could this be related to the medication? The doctor said being on the extended release version will increase the chances of side effects especially fatigue. Before all this my pulse was usually in the 70's during doctor visits but cardiologist said that is too high (my pulse does go up during visits, have family history of that) but I have always had to avoid any cold/flu medications or decongestants/codeine because they have always caused my pulse to go up.
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
I am on 25 mg Metoprolol Succinate ER (1/2 tablet every 12 hours) and I have recently noticed that I am starting to get numbness/prickling and mild tremors in my left hand. Is this normal to expect with this medication? My feet/toes are also extremely sensitive to cold now which the doctor told me is a normal side effect and so I have been wearing thermal socks, shoes in the house and have had to keep a space heater near my feet when it is very cold out. Is this normal as well? My blood pressure is usually in the low 100s (sometimes is high 90s) systolic and 60s or 70s diastolic which my doctor says is a normal range. I was put on the medication a couple days after having a reaction to the flu shot (pulse went up to 165 at rest that night) starting at 40 mg which caused extreme fatigue to the point where I could barely function so it was decreased to 25 mg. The hope is to have me off the medication in a couple months, I have always had a rapid pulse and my resting heart rate is sometimes in the low 90s or 100s. Echo and holter monitor results were normal, EKG is always normal and blood work from back in November (including thyroid are normal). Unfortunately I just have not felt "normal" since the day of the flu shot (i.e. fatigue, occasional dizziness and then the numbness/tingling), could this be related to the medication? The doctor said being on the extended release version will increase the chances of side effects especially fatigue. Before all this my pulse was usually in the 70's during doctor visits but cardiologist said that is too high (my pulse does go up during visits, have family history of that) but I have always had to avoid any cold/flu medications or decongestants/codeine because they have always caused my pulse to go up.
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Follow up: Dr. Dorina Gurabardhi (8 minutes later)
Forgot to mention that the tremors/numbness/prickling worsen when I'm exposed to cold temperatures
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
Forgot to mention that the tremors/numbness/prickling worsen when I'm exposed to cold temperatures
doctor
Answered by Dr. Dorina Gurabardhi (33 minutes later)
Brief Answer:
Probably side effects of Metoprolol, follow the advice below.

Detailed Answer:
Hello dear and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

Your symptoms seem to be related to the use of Metoprolol.

Some of the common side effects of Metoprolol can be:

-Dizziness and tiredness

-Tingling of the hands or feet

-Tingling or pain in the fingers or toes when exposed to cold temperatures

These side effects usually go away during the treatment.

I would recommend regular measure of the blood pressure.

If the blood pressure decreases, we should reconsider the dose of Metoprolol that you are taking.

In this case I may recommend to take 1/2 tablet every 24 hours.

I recommend to consult your doctor before this change.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dorina Gurabardhi (0 minute later)
Brief Answer:
Probably side effects of Metoprolol, follow the advice below.

Detailed Answer:
Hello dear and welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

Your symptoms seem to be related to the use of Metoprolol.

Some of the common side effects of Metoprolol can be:

-Dizziness and tiredness

-Tingling of the hands or feet

-Tingling or pain in the fingers or toes when exposed to cold temperatures

These side effects usually go away during the treatment.

I would recommend regular measure of the blood pressure.

If the blood pressure decreases, we should reconsider the dose of Metoprolol that you are taking.

In this case I may recommend to take 1/2 tablet every 24 hours.

I recommend to consult your doctor before this change.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dorina Gurabardhi (3 hours later)
Thank you Doctor. My blood pressure was 102/61 (4 hours after taking meds) at the doctor about two weeks ago and 117/77 (3 hours after taking meds) at last week's ER visit for a sinus infection (was 144/82 when I first got there but they attributed that to nervousness), then was 118/75 (4 hours after taking meds) at the doctor visit a week ago. At what numbers should I start being concerned? Two different doctors have told me that systolic in the 90's is not a problem and even 90 is still okay as long as I'm able to function. The cardiologist told me to check it at home twice a week within a 2 hour timeframe of taking the meds and keep track of where it stays. I was on 12.5 mg in the morning to start 2 months ago a few days after the reaction to the flu shot but my pulse was still high so the cardiologist increased it to 12.5 mg every 12 hours. My pulse was still over 120 at rest a few days after so he then increased it to 25 mg in the morning and 12.5 at night but that only lasted a couple weeks before the fatigue became too much and I have been on the 12.5 every 12 hours since a few days before Christmas. The fatigue and dizziness/tiredness are better on certain days, just depends. I am getting ready to travel to Florida this week and I will be curious to see if the feeling cold/tremors get any better with the warmer temperatures. Also, I am due for my menstrual cycle on Saturday, can that increase the fatigue as well?
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
Thank you Doctor. My blood pressure was 102/61 (4 hours after taking meds) at the doctor about two weeks ago and 117/77 (3 hours after taking meds) at last week's ER visit for a sinus infection (was 144/82 when I first got there but they attributed that to nervousness), then was 118/75 (4 hours after taking meds) at the doctor visit a week ago. At what numbers should I start being concerned? Two different doctors have told me that systolic in the 90's is not a problem and even 90 is still okay as long as I'm able to function. The cardiologist told me to check it at home twice a week within a 2 hour timeframe of taking the meds and keep track of where it stays. I was on 12.5 mg in the morning to start 2 months ago a few days after the reaction to the flu shot but my pulse was still high so the cardiologist increased it to 12.5 mg every 12 hours. My pulse was still over 120 at rest a few days after so he then increased it to 25 mg in the morning and 12.5 at night but that only lasted a couple weeks before the fatigue became too much and I have been on the 12.5 every 12 hours since a few days before Christmas. The fatigue and dizziness/tiredness are better on certain days, just depends. I am getting ready to travel to Florida this week and I will be curious to see if the feeling cold/tremors get any better with the warmer temperatures. Also, I am due for my menstrual cycle on Saturday, can that increase the fatigue as well?
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Follow up: Dr. Dorina Gurabardhi (6 minutes later)
I have my next doctor appointment on Valentine's Day so I'll see what the numbers are then. My primary ideally wants me off the medication due to side effects and pulse stabilizing but is leaving the decision up to the cardiologist.
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
I have my next doctor appointment on Valentine's Day so I'll see what the numbers are then. My primary ideally wants me off the medication due to side effects and pulse stabilizing but is leaving the decision up to the cardiologist.
doctor
Answered by Dr. Dorina Gurabardhi (9 hours later)
Brief Answer:
Follow up query explained below in details.

Detailed Answer:
Hi again dear,

The levels of blood pressure that you mentioned in the follow up query are normal.

I agree with your doctor that the systolic pressure of 90 mm Hg is normal.

If the systolic blood pressure is lower that 90 mm Hg you can reconsider the medications that you are taking.

The pulse rate 120 beats per minute is higher than normal.

So,I would recommend to continue using Metoprolol 12.5 mg in the morning and in the evening.

It will help in maintaining the pulse rate under control.

I also recommend regular measurement of the blood pressure and pulse rate.

If the pulse rate will be stabilised the doctor can reconsider to lower the dose of Metoprolol.

The fact that you are due the menstrual cycle can also increase the fatigue.

So, I suggest a lot of rest.

Feel free to contact me again for further clarification.

Take care dear,

Dr.Dorina Gurabardhi
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Dorina Gurabardhi (0 minute later)
Brief Answer:
Follow up query explained below in details.

Detailed Answer:
Hi again dear,

The levels of blood pressure that you mentioned in the follow up query are normal.

I agree with your doctor that the systolic pressure of 90 mm Hg is normal.

If the systolic blood pressure is lower that 90 mm Hg you can reconsider the medications that you are taking.

The pulse rate 120 beats per minute is higher than normal.

So,I would recommend to continue using Metoprolol 12.5 mg in the morning and in the evening.

It will help in maintaining the pulse rate under control.

I also recommend regular measurement of the blood pressure and pulse rate.

If the pulse rate will be stabilised the doctor can reconsider to lower the dose of Metoprolol.

The fact that you are due the menstrual cycle can also increase the fatigue.

So, I suggest a lot of rest.

Feel free to contact me again for further clarification.

Take care dear,

Dr.Dorina Gurabardhi
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Dorina Gurabardhi (15 days later)
Hello doctor,
The side effects such as cold feet as well as the prickling in my legs got much better in Florida, was so nice not to have to wear thermal socks all the time! Even the AC didn't bother me and I was actually able to go without socks in my tennis shoes one night going out to dinner. However the fatigue is not any better and has actually gotten worse, it's to the point where I can barely function especially in the evening and I constantly have to walk around doing things without nearly collapsing with fatigue and wanting to sleep all the time. Even just sorting through some photographs yesterday afternoon made me extremely tired to the point where I felt like I had to take a nap and that's not normal for me. This is how I felt before when I was still on 25 mg in the morning and 12.5 at night so that's when the cardiologist reduced it down to 12.5 twice a day. I had talked to him recently about reducing or eliminating the medication altogether but he was not very receptive and suggested my primary do blood work to rule out causes of fatigue, everything is normal and I have not been bleeding in my urine or stool so they know my hemoglobin is fine. Saw my primary today and she agrees that I'm being over-medicated and wants me to stop the evening dose for the next 3 days to see how I feel, during those three days I would just be doing 12.5 mg in the morning and then if I feel better after 3 days she wants me to completely stop the 12.5 mg in the morning. Is this a safe approach to safely wean? I'm concerned about rebound tachycardia as both of my parents experienced that completely stopping their beta blockers although they were on much higher doses and did not wean. My primary said because I'm on such a low dose this is a safe approach but I wanted to get your opinion first. I have also been reading about the medication and have experienced other side effects that have been reported such as constant muscle cramps in my legs, pain in my left knee, bulging veins, shortness of breath and occasional shoulder or arm pain. Never experienced any of these before going on the medication.
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
Hello doctor,
The side effects such as cold feet as well as the prickling in my legs got much better in Florida, was so nice not to have to wear thermal socks all the time! Even the AC didn't bother me and I was actually able to go without socks in my tennis shoes one night going out to dinner. However the fatigue is not any better and has actually gotten worse, it's to the point where I can barely function especially in the evening and I constantly have to walk around doing things without nearly collapsing with fatigue and wanting to sleep all the time. Even just sorting through some photographs yesterday afternoon made me extremely tired to the point where I felt like I had to take a nap and that's not normal for me. This is how I felt before when I was still on 25 mg in the morning and 12.5 at night so that's when the cardiologist reduced it down to 12.5 twice a day. I had talked to him recently about reducing or eliminating the medication altogether but he was not very receptive and suggested my primary do blood work to rule out causes of fatigue, everything is normal and I have not been bleeding in my urine or stool so they know my hemoglobin is fine. Saw my primary today and she agrees that I'm being over-medicated and wants me to stop the evening dose for the next 3 days to see how I feel, during those three days I would just be doing 12.5 mg in the morning and then if I feel better after 3 days she wants me to completely stop the 12.5 mg in the morning. Is this a safe approach to safely wean? I'm concerned about rebound tachycardia as both of my parents experienced that completely stopping their beta blockers although they were on much higher doses and did not wean. My primary said because I'm on such a low dose this is a safe approach but I wanted to get your opinion first. I have also been reading about the medication and have experienced other side effects that have been reported such as constant muscle cramps in my legs, pain in my left knee, bulging veins, shortness of breath and occasional shoulder or arm pain. Never experienced any of these before going on the medication.
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Follow up: Dr. Dorina Gurabardhi (1 hour later)
Can this medication cause shortness of breath, mild chest discomfort and occasional shoulder or arm pain? This didn't happen until going on the medication so that's why I wanted to check, I have read articles from other patients who did experience these side effects including a couple who said their asthma symptoms got worse until they stopped the medication
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
Can this medication cause shortness of breath, mild chest discomfort and occasional shoulder or arm pain? This didn't happen until going on the medication so that's why I wanted to check, I have read articles from other patients who did experience these side effects including a couple who said their asthma symptoms got worse until they stopped the medication
doctor
Answered by Dr. Dorina Gurabardhi (13 hours later)
Brief Answer:
I agree with the dose of 12.5 mg in the morning as suggested by the doctor.

Detailed Answer:
Hi again dear,

I am sorry for my late response.

I read carefully your follow up query.

I see that you have reduced the dose to 12.5 mg in the morning as prescribed by your doctor.

I agree with this approach.

If during these three days the blood pressure and the heart rate will be at normal range you may try to stop the medication.

Of course, I suggest you to monitor frequently the blood pressure and heart rate.

Difficulty in moving the arms, legs, or facial muscles, inability to speak, irregular breathing are also side effects of this medication.

If you have a rebound tachycardia your doctor may switch to another medication such as Atenolol.

In my daily practice, I see that it is the alternative of beta blocker with less side effects.

You should consult your doctor about this alternative in case of a rebound tachycardia.

Hope my answer was helpful.

Take care dear,

Dr.Dorina Gurabardhi

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dorina Gurabardhi (0 minute later)
Brief Answer:
I agree with the dose of 12.5 mg in the morning as suggested by the doctor.

Detailed Answer:
Hi again dear,

I am sorry for my late response.

I read carefully your follow up query.

I see that you have reduced the dose to 12.5 mg in the morning as prescribed by your doctor.

I agree with this approach.

If during these three days the blood pressure and the heart rate will be at normal range you may try to stop the medication.

Of course, I suggest you to monitor frequently the blood pressure and heart rate.

Difficulty in moving the arms, legs, or facial muscles, inability to speak, irregular breathing are also side effects of this medication.

If you have a rebound tachycardia your doctor may switch to another medication such as Atenolol.

In my daily practice, I see that it is the alternative of beta blocker with less side effects.

You should consult your doctor about this alternative in case of a rebound tachycardia.

Hope my answer was helpful.

Take care dear,

Dr.Dorina Gurabardhi

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Dorina Gurabardhi (2 days later)
Thank you Doctor. I completed the 3 days of eliminating the evening dose and my pulse has remained stable in the 70s and 80s sometimes even in the 60s so the cardiologist is fine with just keeping me on the morning dose for the next 2 weeks, however if my pulse drops below 40 that's a concern. If all continues to go well he said we can discuss eliminating the medication altogether. He cautioned me to take a 12.5 mg dose immediately if my pulse goes over 130 at rest but we're not anticipating that to happen, also said to keep checking the BP a few times a week and it's too low if systolic goes below 80 and too high if it goes above 190. He said to expect fatigue, shortness of breath and chest discomfort to continue for the next 2 weeks as it will take up to that long for my body to adjust, however he advised me to push through the fatigue and keep track of when I feel it the most. My recent holter monitor results came back and everything was fine, it did record some PVCs but cardiologist assured me everyone has those and some can feel it more than others (I have been feeling some fluttering on occasion). Can weaning off the drug cause insomnia? I've unfortunately suffered from that the past couple of nights although last night I went out to a birthday celebration and ate a couple of items I normally wouldn't at the same time (gluten-free French fries and gluten-free dessert) so I figured that might have disrupted my sleep.
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Follow up: Dr. Dorina Gurabardhi (0 minute later)
Thank you Doctor. I completed the 3 days of eliminating the evening dose and my pulse has remained stable in the 70s and 80s sometimes even in the 60s so the cardiologist is fine with just keeping me on the morning dose for the next 2 weeks, however if my pulse drops below 40 that's a concern. If all continues to go well he said we can discuss eliminating the medication altogether. He cautioned me to take a 12.5 mg dose immediately if my pulse goes over 130 at rest but we're not anticipating that to happen, also said to keep checking the BP a few times a week and it's too low if systolic goes below 80 and too high if it goes above 190. He said to expect fatigue, shortness of breath and chest discomfort to continue for the next 2 weeks as it will take up to that long for my body to adjust, however he advised me to push through the fatigue and keep track of when I feel it the most. My recent holter monitor results came back and everything was fine, it did record some PVCs but cardiologist assured me everyone has those and some can feel it more than others (I have been feeling some fluttering on occasion). Can weaning off the drug cause insomnia? I've unfortunately suffered from that the past couple of nights although last night I went out to a birthday celebration and ate a couple of items I normally wouldn't at the same time (gluten-free French fries and gluten-free dessert) so I figured that might have disrupted my sleep.
doctor
Answered by Dr. Dorina Gurabardhi (2 hours later)
Brief Answer:
Metoprolol can cause insomnia and trouble sleeping.

Detailed Answer:
Hi again dear,

I read carefully your follow up query.

I agree completely with the recommendations of your doctor.

I recommend to continue measuring regularly the blood pressure and the heart rate.

Regarding your question, Metoprolol can cause insomnia and trouble sleeping.

I suggest to take over the counter Melatonin supplement.

It is the same hormone that the body produces at sleep time and it works really well.

It does not interact with other medications.

One 3 mg pill or capsule will take effect in about half an hour.

Hope I helped you.

Take care dear,

Dr.Dorina Gurabardhi


Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dorina Gurabardhi (0 minute later)
Brief Answer:
Metoprolol can cause insomnia and trouble sleeping.

Detailed Answer:
Hi again dear,

I read carefully your follow up query.

I agree completely with the recommendations of your doctor.

I recommend to continue measuring regularly the blood pressure and the heart rate.

Regarding your question, Metoprolol can cause insomnia and trouble sleeping.

I suggest to take over the counter Melatonin supplement.

It is the same hormone that the body produces at sleep time and it works really well.

It does not interact with other medications.

One 3 mg pill or capsule will take effect in about half an hour.

Hope I helped you.

Take care dear,

Dr.Dorina Gurabardhi


Above answer was peer-reviewed by : Dr. Raju A.T
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Dr. Dorina Gurabardhi

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Practicing since :2013

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I am on 25 mg Metoprolol Succinate ER (1/2 tablet

I am on 25 mg Metoprolol Succinate ER (1/2 tablet every 12 hours) and I have recently noticed that I am starting to get numbness/prickling and mild tremors in my left hand. Is this normal to expect with this medication? My feet/toes are also extremely sensitive to cold now which the doctor told me is a normal side effect and so I have been wearing thermal socks, shoes in the house and have had to keep a space heater near my feet when it is very cold out. Is this normal as well? My blood pressure is usually in the low 100s (sometimes is high 90s) systolic and 60s or 70s diastolic which my doctor says is a normal range. I was put on the medication a couple days after having a reaction to the flu shot (pulse went up to 165 at rest that night) starting at 40 mg which caused extreme fatigue to the point where I could barely function so it was decreased to 25 mg. The hope is to have me off the medication in a couple months, I have always had a rapid pulse and my resting heart rate is sometimes in the low 90s or 100s. Echo and holter monitor results were normal, EKG is always normal and blood work from back in November (including thyroid are normal). Unfortunately I just have not felt "normal" since the day of the flu shot (i.e. fatigue, occasional dizziness and then the numbness/tingling), could this be related to the medication? The doctor said being on the extended release version will increase the chances of side effects especially fatigue. Before all this my pulse was usually in the 70's during doctor visits but cardiologist said that is too high (my pulse does go up during visits, have family history of that) but I have always had to avoid any cold/flu medications or decongestants/codeine because they have always caused my pulse to go up.