Does metoprolol cause weight gain?

In this article:

• Metoprolol weight gain
• Losing weight on metoprolol
• Tips for weight management
• Alternatives

In this article

• Metoprolol weight gain
• Losing weight on metoprolol
• Tips for weight management
• Alternatives

Lopressor and Toprol-XL are brand names of metoprolol, a beta blocker prescribed for high blood pressure, angina (chest pain), and heart problems. It is also used in combination with other drugs to treat heart failure and improve the chance of survival after a heart attack. It slows down the heart rate and relaxes blood vessels, making it easier for blood to flow through the body. It reduces blood pressure, which helps put less strain on the heart. Metoprolol, like most beta blockers, has the potential to cause weight gain.

Can metoprolol cause weight gain?

Metoprolol is a second-generation beta blocker. This type of “beta blocker can cause weight gain by affecting metabolism and increasing fluid retention,” explains Rohit Vuppuluri, DO, a double-board certified interventional cardiologist at Chicago Heart & Vascular Specialists. Newer, third-generation beta blockers, such as carvedilol and nebivolol, are less likely to cause this side effect.

Pamela Tambini, MD, is an internist and medical director at Engage Wellness. She agrees that metoprolol can cause weight gain but notes that it’s typically only about two to four pounds. “The weight gain tends to happen in the first few months of starting the medication and then levels off,” she says. “The weight gain isn’t usually dramatic, but it can feel frustrating if you’re not expecting it.”

Please note that if you experience sudden weight gain while taking metoprolol, it’s important to contact a healthcare professional. This could mean fluid is building up, a possible indicator of worsening heart failure. Monitor any weight changes while taking metoprolol and report them to your healthcare team.

A study in The American Journal of Medicine found that metoprolol tartrate (Lopressor) use was associated with weight gain in people with hypertension and Type 2 diabetes who were not on insulin. The average weight gain was 2.6 pounds. Another systemic analysis in Hypertension found similar results (a median of 2.6 pounds gained) when evaluating eight randomized trials that each lasted over six months.

“The reason behind the weight gain isn’t entirely clear,” says Dr. Tambini. “Still, it’s likely related to metoprolol slightly slowing metabolism, causing mild fluid retention, and possibly reducing energy levels, which might lead to less physical activity.”

“While not everyone taking metoprolol will experience this side effect, it’s something worth keeping in mind and discussing with your provider if it becomes a concern,” advises Dr. Tambini.

Does metoprolol make it hard to lose weight?

Because metoprolol slows your metabolism, it stands to reason that it may make it harder to lose weight. Studies have shown this to be the case while taking metoprolol or other traditional beta blockers. A study in the Journal of Nutrition and Metabolism found that people who were using second-generation beta blockers (such as metoprolol and atenolol) experienced a lower percentage of weight loss than the control group, those taking third-generation beta blockers (such as carvedilol and labetalol), and those taking other antihypertensive drugs. These results held when evaluated 24 months later.

Tips for managing your weight on metoprolol

“When patients share concerns about weight gain from metoprolol, I make sure to listen and validate their feelings because weight changes can be frustrating and disheartening,” says Dr. Tambini. “I remind them that while weight gain is a possible side effect, it’s usually modest and manageable. I explain why they’re taking the medication in the first place—beta blockers play a crucial role in protecting their heart, lowering blood pressure, and preventing serious complications.”

While beta blockers may cause weight gain, there are ways to mitigate and prevent those few extra pounds. “The best way to counteract potential weight gain from beta blockers is to focus on consistent, healthy habits,” says Dr. Tambini.

1. Get regular exercise

“Regular exercise is important to maintain a person’s metabolism in the appropriate range,” says Dr. Vuppuluri. It’s especially true when taking a medication like metoprolol that affects metabolism. Cardiovascular exercise, specifically, is key when it comes to managing body weight. The American Heart Association recommends that adults get 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity each week. However, that doesn’t mean you can’t participate in lower-impact cardiovascular exercise to get that number of minutes up. “Even light activities like walking, swimming, or cycling can help keep your metabolism active,” notes Dr. Tambini.

Plus, exercise has a number of other benefits for overall health aside from weight management, such as reducing the overall risk of heart conditions, heart disease, heart attack, Type 2 diabetes, high blood pressure, dementia, and Alzheimer’s. It can also help lower blood pressure and improve sleep, cognition, and bone health while reducing symptoms of anxiety and depression.

2. Eat a balanced diet

Dr. Tambini recommends a diet that includes “plenty of fruits, vegetables, lean proteins, and whole grains.” The Dietary Guidelines for Americans specifically suggest adults consume two-and-a-half cups of vegetables and two cups of fruit, six ounces of grains, three cups of dairy products, and five-and-a-half ounces of protein each day. For heart health, any protein sources must be healthy and lean. According to the Centers for Disease Control and Prevention (CDC), this includes seafood, lean meats and poultry, eggs, legumes (beans and peas), soy products, nuts, and seeds. If you have questions about what to include in your diet while taking metoprolol, consult with a dietitian or your healthcare provider.

3. Avoid processed foods and excess sodium

“Avoiding processed foods or excessive sodium can help reduce fluid retention,” says Dr. Tambini. The American Heart Association recommends no more than 1,500 mg of sodium per day for adults, particularly for those taking medication for high blood pressure, such as metoprolol. To keep sodium intake as low as possible, look for ways to reduce salt consumption. This includes eating fresh, frozen, or canned foods that don’t have any added sauces or salt, opting for low sodium choices when selecting packaged food, and trying to avoid protein that is cured, smoked, or processed.

4. Monitor portion sizes

At the end of the day, weight gain comes down to calories consumed versus calories burned. It may sound simple, but it’s the biggest factor in maintaining a healthy weight. The American Heart Association recommends keeping a food diary to track your portion sizes. You can show the food diary to your healthcare provider to discuss any changes you could make to mitigate weight gain related to taking metoprolol. It is also important to differentiate between the serving size listed in the nutritional information and portion sizes that are appropriate for maintaining a weight that is healthy for you. A serving size is a suggestion, not a recommendation. Keep track of the amount of calories, fat, sodium, and carbohydrates you consume in order to pinpoint the appropriate amounts in conjunction with a nutritionist, dietitian, or your healthcare provider.

5. Stay hydrated

Dr. Tambini calls staying hydrated a “simple but effective strategy” in managing weight gain. Multiple studies point to water consumption as a powerful tool in losing weight and controlling appetite. Drinking water before eating food can help you feel more satiated and, therefore, likely to eat less during your meal. It also helps the body remove waste via the kidneys and burn fat, as water is required for this process.

If you notice you may be gaining weight while taking metoprolol, be sure to consult with a healthcare professional for medical advice before stopping the medication. You can discuss any concerns of weight gain or other side effects with them first. “If weight gain becomes a bigger concern, we can always discuss alternative medications or adjust the treatment plan,” says Dr. Tambini.

Other side effects of metoprolol

Aside from weight gain, metoprolol can cause the following serious side effects:

• Slow heartbeat
• Palpitations
• Shortness of breath
• Worsening or new chest pain
• Swelling of the hands, ankles, or feet

Less serious side effects include:

• Drowsiness
• Fatigue
• Low blood pressure
• Dizziness

Alternatives to metoprolol

“The benefits of beta blockers outweigh the risk of weight gain,” says Dr. Vuppuluri. “If weight gain occurs, we can find alternative medications for treatment.”

“Medications like carvedilol and nebivolol are often considered ‘weight-neutral’ and are generally better options for patients who are particularly sensitive to this side effect,” says Dr. Tambini. “These drugs work slightly differently than older beta blockers like metoprolol or atenolol, and they seem to have less impact on metabolism and fluid retention.”

Along with the newer beta blockers Dr. Tambini mentions, other blood pressure medications may be better for avoiding weight gain, including the prescription medications diuretics and alpha blockers (terazosin, prazosin, doxazosin). Calcium channel blockers (amlodipine and diltiazem), angiotensin-converting enzyme inhibitors (lisinopril), and angiotensin II receptor blockers (losartan and valsartan) are options that have been shown to be weight-neutral.

“If you’re ever concerned about side effects or how your medication is working for you, don’t hesitate to talk to your provider—they’re there to help find the best approach for your health,” says Dr. Tambini.