Fatigue And Low Energy On Lisinopril And Metoprolol

Thanks so much for reaching out to us! I'm so sorry to hear about the side effects your dad is experiencing on his blood pressure medications (lisinopril and metoprolol succinate).

Now, essentially all blood pressure medications can cause the side effects you mentioned in your question:

• Fatigue
• Low-energy
• Nausea
• Dizziness
• Headaches

The incontinence you stated that is also occurring, would be a far less common side effect.

Neither the prescribing information for lisinopril (an ACE-Inhibitor) nor the information for metoprolol succinate (a beta-blocker) lists this as a reported side effect. That doesn't mean the medications aren't the potential cause, it would just be very uncommon.

You didn't mention in your question what condition your dad is being treated for, but we can't rule out the possibility that these effects could be related to the disease state (for example, in those with heart failure, incontinence can occur at a higher rate than those without heart failure) rather than the medications, especially since he has been on them so long.

Fatigue & Low Energy On BP Meds

As mentioned, fatigue and low energy are extremely common side effects for the medications you listed (lisinopril and metoprolol succinate).

Per the prescribing information for lisinopril, between 2% and 4% of individuals experience fatigue, and an even higher percentage experience headache and dizziness (>5%).

These rates are far higher for metoprolol succinate (~10%), which is classified as a beta-blocker.

Focusing on beta-blockers, there are many available on the market and they all have different properties. One of their defining properties is whether or not they are 'lipophilic'.

Lipophilic beta-blockers cross the blood-brain barrier readily and tend to cause far more sedative effects than non-lipophilic ones.

Metoprolol succinate is a lipophilic beta-blocker and has been reported to cause more sedation than other beta-blockers (which, as a class, is already strongly associated with fatigue and sedative effects relative to other blood pressure medications).

Beta-blockers, especially lipophilic ones, are even associated with depression and sexual dysfunction.

Having said all this, these side effects don't appear to be as prevalent as once was thought. One source states the following on the subject:

Thus, although beta blockers appear to cause small increases in the risk of fatigue and sexual dysfunction, the risk is much lower than previously thought, and beta blockers should not be withheld based upon concerns about developing these adverse effects.

What To Do

So, what can you do about these side effects?

First and foremost, they tend to decrease in severity over time. In other words, they tend to be most severe when you first start taking them and get better the longer you take them. This is common with many classes of medication.

In your case, however, you stated your father has been on these for two years. After this period of time, it's unlikely these side effects will get better if it is the meds that are causing them.

You don't mention if these effects are something your father has been dealing with since starting the meds, or if they are a relatively new problem. If the side effects are new, I'd first recommend seeing the doctor. You want to make sure they aren't associated with another medical condition your father has.

If it turns out the meds are the culprit, looking into adjusting the dosages, or even potential alternatives could be an option. There are beta-blockers that are less likely to cause fatigue for example, but this would need to be weighed against what the optimal medication therapy is for your father (i.e. some beta-blockers are recommended over others in terms of efficacy).

There are also several other ACE-Inhibitors that could be options as well.

Outside of a medication change, taking the meds at night can help with the associated fatigue... if this side effect happens to be stronger right after taking a dose. There aren't any, unfortunately, tried and true methods to help much with the other side effects aside from taking the meds with food, but this could at least help with nausea and headaches.

I wish you luck and please reach out with any further questions!