Can Metoprolol Cause Coughing? Understanding Beta-Blocker Side Effects

October 9, 2025 •

4 min read

According to the National Institutes of Health, while ACE inhibitors are more commonly known to cause cough, beta-blockers like metoprolol can also induce respiratory symptoms, including coughing, especially in sensitive individuals. This side effect is a critical distinction in pharmacology and depends largely on a person's underlying health conditions.

Quick Summary

Metoprolol can induce coughing, particularly in patients with asthma or COPD, due to its potential to cause bronchoconstriction at higher doses. Unlike the more common dry cough from ACE inhibitors, this is a less frequent side effect stemming from an effect on lung receptors.

Key Points

Metoprolol Can Cause Coughing: Although less common than with ACE inhibitors, metoprolol can induce a cough in sensitive individuals, primarily by causing bronchospasm.
Risk is Higher with Respiratory Issues: People with pre-existing conditions like asthma or COPD are at the highest risk for developing breathing problems, including cough, while on metoprolol.
Dose Matters: Metoprolol is cardioselective, but at higher doses, this selectivity can be lost, affecting beta-2 receptors in the lungs and causing airway constriction.
Distinct from ACE Inhibitor Cough: The mechanism is different; metoprolol causes bronchoconstriction, whereas ACE inhibitors cause a cough due to bradykinin accumulation.
Medical Consultation is Crucial: Never stop metoprolol on your own. If you suspect it is causing your cough, consult your doctor to explore other options or dose adjustments.
Alternative Medications Exist: If metoprolol is the cause, your doctor may switch you to a different beta-blocker or a different class of medication, such as an ARB, to alleviate the cough.

Is Metoprolol to Blame for Your Cough?

Metoprolol is a widely prescribed medication belonging to a class of drugs known as beta-blockers. It is used to treat a variety of heart-related conditions, including high blood pressure, angina (chest pain), and heart failure. Unlike ACE inhibitors, which are famously associated with a chronic dry cough, metoprolol is not typically identified as a primary cause of coughing. However, it can and does cause cough in a subset of patients, especially those with pre-existing respiratory conditions like asthma or COPD. Understanding the mechanism behind this is key to determining if your medication is the culprit.

The Mechanism: Beta-Blockers and Your Lungs

To understand why metoprolol can cause a cough, it's important to understand how beta-blockers work. The body contains two main types of beta-adrenergic receptors: beta-1 and beta-2. Metoprolol is a cardioselective beta-blocker, meaning it is designed to primarily block beta-1 receptors, which are most concentrated in the heart. By blocking these receptors, it helps slow the heart rate and reduce blood pressure. Beta-2 receptors, on the other hand, are found primarily in the lungs, and their stimulation causes the airways to open up (bronchodilation).

While metoprolol is selective for beta-1 receptors, this selectivity is not absolute. At higher doses, or in individuals with particular sensitivities, the drug's selectivity is lost, and it can begin to block beta-2 receptors in the lungs. This blocking action can lead to bronchoconstriction, or the narrowing of the airways. For someone with healthy lungs, this effect might be minor or unnoticeable. However, for a person with asthma or another obstructive lung disease, it can trigger or worsen symptoms, including wheezing, shortness of breath, and a persistent cough. This is the key reason why a respiratory symptom like a cough can appear after starting metoprolol.

Metoprolol Cough vs. ACE Inhibitor Cough: A Comparison

It's crucial to differentiate a cough caused by metoprolol from one caused by an ACE inhibitor, as the underlying mechanisms and management strategies are different. ACE inhibitor-induced cough is much more common and typically described as a persistent, dry, tickling cough that can begin weeks or even months after starting the medication. Beta-blocker cough is less common and is often associated with other breathing issues like wheezing.


Characteristic	Metoprolol (Beta-Blocker) Cough	ACE Inhibitor Cough
Incidence	Less common; typically associated with pre-existing respiratory disease.	More common; affects a larger percentage of users.
Mechanism	Bronchoconstriction due to beta-2 receptor blockade in the lungs.	Accumulation of bradykinin in the airways.
Onset	Can occur anytime, but is often linked to dose increases or underlying lung conditions.	Can start hours to months after starting treatment.
Symptoms	Often includes wheezing, chest tightness, and shortness of breath.	Typically a dry, persistent, and non-productive cough.
Resolution	Usually resolves upon stopping the medication, but may take some time.	Can take weeks to months to completely resolve after discontinuation.

Who is at Increased Risk?

While anyone can theoretically experience a cough from metoprolol, certain individuals are at a much higher risk. These include:

Individuals with pre-existing respiratory conditions: People with a history of asthma, COPD, or other obstructive lung diseases are the most vulnerable. For these individuals, a beta-blocker can aggravate their condition, leading to a noticeable cough.
Patients on higher doses: Since metoprolol's cardio-selectivity diminishes at higher doses, patients requiring a higher daily intake may have a greater chance of experiencing beta-2 receptor blockade in the lungs.
Those with individual sensitivity: Some people may simply be more sensitive to the effects of beta-blockers on their airways, even at standard dosages.

What to Do If Metoprolol is Causing a Cough

If you believe your metoprolol is causing a persistent cough, it's vital to speak with your doctor. Do not stop taking the medication on your own. Your doctor will need to evaluate your symptoms and other possible causes before making a decision. The management strategy often involves one of the following steps:

Medical Evaluation: Your doctor will assess your overall health, respiratory history, and rule out other potential causes of the cough, such as an infection, allergies, or an ACE inhibitor from another prescription.
Dose Adjustment: In some cases, a dosage reduction may be sufficient to alleviate the cough by restoring the drug's cardio-selectivity.
Alternative Beta-Blocker: Your doctor might switch you to a different cardio-selective beta-blocker, as the risk and patient sensitivity can vary between different agents.
Switching Medication Class: If the cough persists or is severe, the doctor may recommend switching to an entirely different class of medication, such as an Angiotensin II Receptor Blocker (ARB), which carries a significantly lower risk of causing a cough.
Symptom Management: For mild cases, your doctor may suggest supportive care with throat lozenges, humidifiers, or other home remedies. However, this is typically a temporary solution and does not address the underlying issue.

Conclusion: Navigating Medications and Respiratory Health

While metoprolol is an effective treatment for many heart conditions, it is not without potential side effects. A cough caused by metoprolol is less common than an ACE inhibitor cough but represents a real risk, particularly for those with pre-existing respiratory conditions. Recognizing the signs—often including wheezing and chest tightness—and communicating with your healthcare provider are the most important steps. A careful medical review can help determine if the medication is the cause and lead to a safe and effective management plan that protects both your heart and your respiratory health.

For more information on drug-induced cough, you can consult this resource from the NIH: Chronic cough: don't forget drug-induced causes.

Frequently Asked Questions

Coughing is a less common side effect of metoprolol compared to ACE inhibitors. While respiratory issues like shortness of breath and wheezing can occur, especially in patients with pre-existing lung conditions, a dry cough is not a typical manifestation of this drug.

Metoprolol is designed to target beta-1 receptors in the heart. At higher doses, its effects can become less selective and block beta-2 receptors in the lungs, which can lead to bronchoconstriction (narrowing of the airways) and cause symptoms like wheezing, shortness of breath, and cough.

If you are on metoprolol and experience a new, persistent cough, especially one accompanied by wheezing or chest tightness, it is a possibility. A cough from metoprolol is not typically a dry, tickling cough like one from an ACE inhibitor. Your doctor will evaluate your symptoms and medical history to determine the cause.

No, you should never stop taking metoprolol abruptly without consulting your healthcare provider. Doing so can cause serious health complications. It is essential to discuss any side effects with your doctor so they can safely manage your treatment plan.

Patients with asthma or other obstructive lung diseases may experience a worsening of their respiratory symptoms, including coughing and wheezing, if they take metoprolol, especially non-cardioselective beta-blockers or high doses of cardioselective ones. Close monitoring is required in these cases.

Your doctor may adjust your dosage or switch you to an alternative medication. This could include a different cardio-selective beta-blocker or a completely different class of medication, such as an Angiotensin II Receptor Blocker (ARB), which has a lower risk of causing cough.

If your doctor determines that metoprolol is the cause and you stop taking it, the cough should resolve. The time it takes can vary, but it may take several days to weeks for symptoms to completely subside as your body clears the medication.