Concerns With Metoprolol Causing Alopecia (Hair Loss)

In our latest question and answer, the pharmacist discusses a concern a reader has about metoprolol causing hair loss.

Question

I am on amlodipine for blood pressure. It caused heart palpitations, so they added metoprolol. Around the time I was put on the metoprolol (which did help the palpitations), my hair fell out - all of it. (By the way, I am female.) So now I'm on oral and topical minoxidil. After eliminating everything else besides just bad luck, my dermatologist agreed that the metoprolol could be causing the hair loss. I was wondering if you'd have a suggested medication change, and if so, to what?

Asked by CAZ On Apr 14, 2024

Answered by
Medical Content Reviewed By HelloPharmacist Staff

Published Apr 16, 2024
Last updated May 19, 2024

Answer

I'm sorry to hear about the hair loss you are experiencing with metoprolol!

Like you said, it may just be bad luck, but hair loss with metoprolol is a rarely reported side effect. It's certainly not common and has only been seen in post-marketing surveillance (i.e., after the drug has come to market). According to the prescribing information for Toprol (metoprolol):

There have been rare reports of reversible alopecia, agranulocytosis, and dry eyes.
Toprol Prescribing Information

Metoprolol belongs to a class of drugs known as beta-blockers, and alopecia is listed as a potential side effect for most of them. For example, a similar statement appears in the prescribing information for atenolol, a different beta blocker:

During postmarketing experience with TENORMIN [atenolol], the following have been reported in temporal relationship to the use of the drug: elevated liver enzymes and/or bilirubin, hallucinations, headache, impotence, Peyronie's disease, postural hypotension which may be associated with syncope, psoriasiform rash or exacerbation of psoriasis, psychoses, purpura, reversible alopecia...
Atenolol Prescribing Information

Alternative Beta-Blockers To Avoid Hair Loss

You stated in your question you are taking metoprolol to treat palpitations. Although palpitations are usually managed as part of a larger condition, such as an arrhythmia, beta-blockers like metoprolol can specifically address palpitations by regulating the heart rate and reducing the sensation of them.

It's unclear if you are taking a beta-blocker solely for palpitations or for another condition. Sometimes, a specific beta-blocker is recommended for a particular condition. For this answer, I'll consider all beta-blockers as potential options for you.

As mentioned, most beta-blockers, including metoprolol, list alopecia as a potential side effect.

It's unknown if one beta-blocker is more likely than another to cause alopecia. It likely depends on an individual's response to a specific beta-blocker so it's tough to make a definitive recommendation.

There are a few beta-blockers similar to metoprolol that do not list alopecia as a side effect in their prescribing information, such as nebivolol (generic for Bystolic). You could discuss with your doctor if a different beta-blocker, like nebivolol, could be an option for you.

Additionally, propranolol, although it does list alopecia as a potential side effect, is commonly used for palpitations on an as-needed basis. It may be worth discussing with your doctor whether you need a daily medication to treat your palpitations or if taking something just on an as needed basis when symptoms occur would be sufficient. Taking a medication less frequently may reduce the severity of the hair loss you are experiencing.

The good news is that alopecia due to beta-blocker use appears to be reversible based on clinical studies, so if you discontinue metoprolol, it's likely your alopecia will start resolving.

As a final note in this answer, here is a list of beta-blockers that are most similar to metoprolol, which could be options for you:

  • Atenolol
  • Betaxolol
  • Bisoprolol
  • Nebivolol

I say these are most similar as they are all classified as 'cardio-selective' beta-blockers, meaning they preferentially interact with beta-1-adrenergic receptors, which are primarily found in the heart. Other beta blockers affect a broader range of receptors.

Final Words

I hope you found this information helpful! Please reach out if you have any more questions.

References

  • Bystolic Prescribing Information, AccessFDA
  • Tenormin Prescribing Information, AccessFDA
  • ZEBETA Prescribing Information, AccessFDA
  • Inderal Prescribing Information, AccessFDA
  • Metoprolol Succinate Prescribing Information, AccessFDA
  • Metoprolol and alopecia, PubMed
  • [Drug-induced alopecia: review of the literature], PubMed

About the Pharmacist

Dr. Brian Staiger, PharmD

Dr. Brian has been practicing pharmacy for over 13 years and has wide-ranging experiences in many different areas of the profession. From retail, clinical, program development, and administrative responsibilities, he's your knowledgeable and go-to source for all your pharmacy and medication-related questions! Dr. Brian Staiger also has herbalist training and educational certificates in the field of medical ethnobotany. Feel free to send him an email at [email protected]! You can also connect with Dr. Brian Staiger on LinkedIn.

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