Hi everyone this is Shahzad what to avoid if you’re taking metoprolol and other beta blockers so in this question we’re going to talk about dietary interactions we’re also going to talk about medication interactions and we’re also talking about some other interactions that can occur when taking metoprolol and those would be best to avoid or at least try to reduce so let’s first talk about what metoprolol is so is also known as low pressure it is medication used to reduce blood pressure and heart rate and it’s used to treat

hypertension so high blood pressure is used to treat anginal chest pain congestive heart failure acute myocardial infarctions and arrhythmias like atrial fibrillation it is a beta blocker so it reduces blood pressure by blocking beta adrenergic receptors and more specifically it’s going to be blocking beta1 receptors in the heart so cardiac beta1 receptors it has little activity on beta2 receptors but primarily is going to be walking beta 1 receptors in the heart and what this does is that in blocking beta1 receptors

it’s going to prevent catecholamines like epinephrine and norepinephrine from binding to the beta-1 receptor and in blocking beta-1 receptors it helps reduce the heart rate and reduces renin release and both of these effects are going to lead reduced blood pressure so this is how metoprolol can have its effects now the problem is that copperol can cause a variety of mild and or severe side effects including bradycardia which is too low of a heart rate hypotension or low blood pressure dizziness and headache there are a

wide variety of different factors that can interact with metoprolol in other beta blockers to increase their side effects so we’ll talk about those and why they do as we go through this lesson before we talk about what to avoid when taking metoprolol it’s best to understand how metoprolol is metabolized now metoprol like many other medications is metabolized in the liver and it’s metabolized by an enzyme called cyp 2d6 and this enzyme is going to break down metoprolol into its metabolites and metoprolol has a three to four hour

halfway Half-Life so it’s important to understand that metoprolol is metabolized by this particular enzyme because this is going to help us understand why certain things can interact with metoprolol to increase or worsen side effects now let’s talk about what to avoid when taking metoprolol so the first one is alcohol or ethanol so this is going to be beverages like beer and wine and others ethanol has a vasodilative property meaning that it can increase the dilation of blood vessels because this it can lead to reductions in blood

pressure now as mentioned before metoprolol can also reduce blood pressure so if you’re taking both metoprolol and alcohol then you can actually reduce your blood pressure too much so you can have issues with hypotension or low blood pressure in dizziness so this is the reason why alcohol should be reduced or avoided when taking metoprolol another substance that can interact with metoprolol is marijuana or cannabis so and related products can increase levels in activity of metoprolol this occurs due to cannabis induced changes to cyp 2d6

metabolism so because metoprolol is metabolized through this enzyme cannabis seems to cause alterations in activation of cyp-2d6 so this can lead to higher levels of metoprolol so because this be best to reduce or avoid marijuana cannabis use when taking metoprolol we can also see interactions with SSRI antidepressants so selective serotonin reuptake Inhibitors there are a large list of ssris that can interact with metoprolol these include fluoxetine or Prozac paroxetine or Paxil Duloxetine Cymbalta venlafaxine or Effexor

Citalopram and Sertraline or Zoloft class of medications the ssris affects cip2d6 metabolism so we essentially can get stronger effects of metoprolol so again higher levels of metoprol leading to lower blood pressure and heart rate among many other side effects as well and then because metoprolol is a beta blocker it’s best to avoid other beta blockers so other beta in concurrent use with metoprolol can cause issues these beta blockers include Atenolol bisciprolol Carvedilol ismolol labetalol natalol and Propranolol so the

wall medications so they have an additive effect on reducing heart rate and blood pressure and again it exacerbates those side effects we talked about before we can also see issues with NSAID use as well so NSAIDs are non-steroidal anti-inflammatory drugs examples include ibuprofen naproxen diclofenac aspirin and ketorolac using these together with metoprolol can increase potassium levels in the blood metoprolol on its own can lead to increases in potassium and can lead to mild increases in potassium levels but

using these medications as well especially if you’re using a lot of NSAIDs or non-steroidal anti-inflammatory drugs can also increase potassium levels so if you’re using both of these we can have even higher or more significant increases in blood potassium levels so again this is something to think about as well we can also see interactions with diphenhydramine so diphenhydramine is also known as benadryls an antihistamine used to treat allergies and it can cause increased levels of metoprolol via inhibition of clip 2d6 metabolism so

diphenhydramine inhibits cip2d6 metabolism inhibiting the metabolism of metoprolol leading to higher levels of metoprolol and again increasing side effects we can also see metoprol interacting with other heart medications including anti-arythmia medications and these include deltaism so deltaism is a medication that acts to reduce heart rate in combination with metabolism it will worsen bradycardia they’re both doing the same thing through a different mechanism but they’re both reducing the heart rate so they can worsen bradycardia or a lower

heart rate quinidine can also interact with metoprololosol this is a antiarrhythmic medication it’s also an anti-malarial medication so it can be used to treat malaria and quinitine suppresses clip 2d6 metabolism thus leading to increased levels of metabol and increased risk of metoprol related side effects so it can especially lead to excessive heart rate and blood pressure reduction digoxin is also another medication that can interact with metoprolol this is another antiarrhythmic medication digoxin can increase metoprol levels and related

side effects through an unknown mechanism and then Verapamil is also another anti rhythmic medication that can interact with metoprolol it’s a calcium channel blocker and they both will increase levels of each other so there can be increased levels of Verapamil and increased levels of metoprolol leading to increased side effects from both and the top roll can interact with a variety of other medications including clonidine clonidine is an alpha 2 adrenergic Agonist it’s used to treat hypertension or a high blood pressure drug withdrawal

attention deficit hyperactivity disorder ADHD and post-traumatic stress disorder PTSD both metoprolol and clonidine can interact to increased levels of each other so there can be increased side effects from both of them and then there are a wide variety of other medications that can interact with metoprolol including cimetidine furosemide amiodarone chlorpromazine right tonavir and many others and generally they’re all very mild interactions so metoprol can interact with many different medications generally speaking they’re

going to again be very mild interactions I talked about the more severe ones that can occur in this lesson along with the medications that people more commonly use if you want to learn about metoprol side effects please check out my lesson on that topic and if you haven’t already please thanks so much for reading and hope to see you next time.