What to Avoid When Taking Metoprolol: A Comprehensive Guide

October 7, 2025 •

4 min read

Metoprolol is a widely used beta-blocker prescribed for conditions like high blood pressure and angina [1.6.1]. To ensure its effectiveness and your safety, understanding what to avoid when taking metoprolol is crucial for managing your health.

Quick Summary

Taking metoprolol requires caution with certain foods, drinks, and other medications. Key items to limit or avoid include alcohol, caffeine, potassium-rich foods, and specific over-the-counter drugs to prevent adverse effects.

Key Points

Alcohol: Avoid alcohol as it can dangerously lower your blood pressure and increase dizziness when combined with metoprolol [1.3.4].
OTC Cold & Pain Meds: Avoid NSAIDs (like ibuprofen) and decongestants (like pseudoephedrine) as they can counteract metoprolol's effects [1.2.6].
Caffeine: Limit caffeine intake from coffee, tea, and soda, as it can reduce the effectiveness of metoprolol [1.3.2].
Other Medications: Inform your doctor about all other drugs you take, especially other heart medications, antidepressants (MAOIs, SSRIs), and diabetes medication [1.4.1, 1.4.4].
Potassium: Be mindful of, but don't necessarily eliminate, foods high in potassium like bananas and spinach, as beta-blockers can raise blood potassium levels [1.4.1].
Abrupt Stoppage: Never stop taking metoprolol suddenly without a doctor's guidance, as this can cause severe chest pain or a heart attack [1.5.7].
Herbal Supplements: Avoid herbal supplements like St. John's wort and ginseng, as their interactions with metoprolol are not well understood [1.2.2].

Metoprolol is a cardioselective beta-blocker used to treat high blood pressure (hypertension), chest pain (angina), heart failure, and to improve survival after a heart attack [1.6.1, 1.6.2]. It works by blocking the action of certain natural chemicals in your body, like epinephrine, on the heart and blood vessels. This effect relaxes blood vessels, slows the heart rate, and reduces the heart's workload [1.6.1, 1.6.7].

There are two main forms: metoprolol tartrate (Lopressor®), an immediate-release tablet often taken multiple times a day, and metoprolol succinate (Toprol-XL®), an extended-release version usually taken once daily [1.6.6]. While highly effective, metoprolol's performance and safety can be affected by other substances. It's vital to know what to avoid to prevent potentially harmful interactions and ensure you get the full benefit of the medication.

Foods and Beverages to Approach with Caution

While metoprolol doesn't have a long list of strict food contraindications, certain dietary choices can influence its effects.

Alcohol

Doctors strongly advise against drinking alcohol while taking metoprolol [1.3.4]. Both substances lower blood pressure, and combining them can cause your blood pressure to drop to a dangerously low level (hypotension) [1.3.4]. This can lead to increased dizziness, lightheadedness, and fainting, raising the risk of injury [1.2.2, 1.5.2]. For some extended-release capsules like Kapspargo Sprinkle®, alcohol can cause the medication to be released too quickly, increasing the risk of side effects [1.4.1, 1.4.6].

Caffeine

Caffeine can counteract the effects of beta-blockers like metoprolol. It can narrow blood vessels and increase blood pressure and heart rate, which is the opposite of what metoprolol aims to do [1.2.6, 1.3.2]. It is advisable to limit or avoid caffeine-containing foods and beverages (coffee, tea, soda, energy drinks) while on this medication [1.2.2, 1.3.1].

Potassium-Rich Foods

Beta-blockers can increase potassium levels in the blood, a condition known as hyperkalemia [1.2.7]. While it's generally okay to eat potassium-rich foods like bananas, spinach, sweet potatoes, and lima beans in moderation, excessive intake could raise your risk, especially if you have kidney problems or are taking other drugs that also affect potassium, such as ACE inhibitors [1.4.1, 1.4.5].

Grapefruit Juice

Some reports suggest that grapefruit juice can interfere with how the body processes certain beta-blockers, though the interaction with metoprolol is not as well-established as with other drugs [1.2.7, 1.3.8]. Grapefruit can affect drug-metabolizing enzymes and transporters, potentially altering the amount of medication in your bloodstream [1.3.8]. It's wise to discuss grapefruit consumption with your doctor.

Drug and Supplement Interactions

Metoprolol can interact with a wide range of prescription medications, over-the-counter (OTC) drugs, and even herbal supplements. Always inform your doctor of everything you take.

Other Heart and Blood Pressure Medications

Calcium Channel Blockers (e.g., diltiazem, verapamil): Combining these with metoprolol can have an additive effect, leading to a very slow heart rate (bradycardia) and excessively low blood pressure [1.4.1, 1.4.7].
Digoxin (Lanoxin): Both drugs slow the heart rate, and taking them together increases the risk of bradycardia [1.4.1].
Clonidine: Taking these together can increase the risk of low heart rate and blood pressure. Furthermore, stopping clonidine while still on metoprolol, or vice versa, requires a specific, gradual tapering schedule managed by a doctor to avoid a dangerous spike in blood pressure [1.4.1, 1.4.7].
ACE Inhibitors: Can also increase potassium levels, so co-administration requires monitoring [1.4.1].

Over-the-Counter (OTC) Medications to Avoid

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Medications like ibuprofen (Advil, Motrin) and naproxen (Aleve) can increase blood pressure and cause the body to retain salt and water, potentially making metoprolol less effective [1.2.6, 1.4.5].
Decongestants: Ingredients like pseudoephedrine or phenylephrine, found in many cold and flu remedies, can raise blood pressure and work against metoprolol's effects [1.2.6, 1.4.4].
Antihistamines: Diphenhydramine (Benadryl) can inhibit the enzyme (CYP2D6) that metabolizes metoprolol, increasing its levels in the blood and the risk of side effects like low blood pressure and slow heart rate [1.4.1, 1.4.5].
Antacids with Aluminum: These can decrease the effects of beta-blockers [1.2.3]. It's recommended to separate administration by at least 2 hours [1.4.2].

Other Significant Drug Interactions

Antidepressants: Certain antidepressants, including MAOIs (phenelzine, tranylcypromine) and some SSRIs (fluoxetine, paroxetine), can interfere with metoprolol metabolism, leading to increased drug levels and a higher risk of side effects [1.4.1, 1.4.7].
Diabetes Medications (including insulin): Metoprolol can mask the symptoms of low blood sugar (hypoglycemia), such as a rapid heartbeat or tremors, making it harder to recognize a hypoglycemic episode [1.4.1, 1.6.5].
Herbal Supplements: Herbs like St. John's wort, kava, ginseng, and black licorice may interact with metoprolol [1.2.1, 1.2.2]. Their effects are not well-studied, so it is best to avoid them unless approved by your doctor [1.4.4].

Comparison of Metoprolol Interactions


Substance/Drug Class	Potential Interaction with Metoprolol	Level of Caution
Alcohol	Intensifies dizziness and low blood pressure; can cause dangerous drops in blood pressure [1.3.4].	High - Avoid
NSAIDs (Ibuprofen)	Can reduce the blood pressure-lowering effect of metoprolol and increase fluid retention [1.2.6].	High - Discuss with doctor; use safer alternatives.
Decongestants	Ingredients like pseudoephedrine can raise blood pressure, counteracting metoprolol's effects [1.2.6].	High - Avoid; seek safer cold remedies like saline sprays.
Other BP Meds	Additive effects can lead to severe bradycardia (slow heart rate) or hypotension (low blood pressure) [1.4.1].	High - Requires close medical supervision and dose management.
Caffeine	May decrease the effectiveness of metoprolol by raising heart rate and blood pressure [1.2.6].	Moderate - Limit intake.
Potassium-Rich Foods	May contribute to high blood potassium levels (hyperkalemia), especially with other risk factors [1.2.7].	Low to Moderate - Consume in moderation; discuss with doctor if you have kidney issues.

Conclusion

Managing your health while taking metoprolol goes beyond simply remembering to take your pill. Being mindful of what to avoid—from alcohol and certain OTC cold medicines to specific prescription drugs—is critical for both the medication's efficacy and your safety. Sudden discontinuation of metoprolol can also lead to serious heart problems, including a heart attack [1.5.7, 1.5.9]. Always follow your doctor's instructions for tapering off the medication. Maintaining an open dialogue with your healthcare provider and pharmacist about all medications, supplements, and significant lifestyle habits is the best strategy to ensure safe and effective treatment.

For more detailed patient information, you can consult resources like MedlinePlus. [1.6.1]

Frequently Asked Questions

It is best to limit or avoid coffee. Caffeine can increase blood pressure and heart rate, which may reduce the effectiveness of metoprolol [1.2.6, 1.3.2].

No, it is strongly advised to avoid alcohol. The combination can cause your blood pressure to drop to a dangerously low level, leading to severe dizziness and fainting [1.3.4].

Eating bananas in moderation is generally fine. However, since beta-blockers can increase potassium levels in the blood, excessive intake of potassium-rich foods could pose a risk, especially for those with kidney problems [1.2.7, 1.4.5].

You should avoid taking NSAIDs like ibuprofen if possible. They can make metoprolol less effective at lowering blood pressure and may worsen heart failure symptoms [1.2.6, 1.4.5].

Many cold medicines contain decongestants like pseudoephedrine that should be avoided. Talk to your doctor or pharmacist about safer alternatives, such as saline nasal sprays [1.2.6, 1.4.1].

There is some evidence that grapefruit juice can interfere with how certain beta-blockers are absorbed, potentially reducing their effectiveness [1.2.7]. It's best to discuss this with your healthcare provider.

Common side effects include dizziness, tiredness, depression, diarrhea, and cold hands or feet [1.5.1]. If these are severe or don't go away, talk to your doctor.