Lisa asked
Currently taking Metoprolol for Postural Orthostatic Tachecardia Syndrome. This was the replacement following the Atenolol shortage. I have noticed off and on constipaton sine then. I split the 25 mg tablet half in the morning and half at dinner. I should also mention I have gastroparesis, for which I take ginger and Protonix. Other meds: Amitryptaline, Nasocort, Microgestrin FE.
Answer
With gastroparesis, any changes in diet or medications may potentially cause an exacerbation, or worsening, of the symptoms associated with the condition. Atenolol and metoprolol are both in the beta-blocker class and have a similar side effect profile. Metoprolol is not known for causing GI adverse effects, however, it may cause diarrhea, nausea, vomiting, and constipation occasionally. Constipation, abdominal pain, and gastric pain is only reported in about 1% of patients.
Unfortunately, drug shortages have created a significant impact on patient care throughout the United States. Most of the shortages have impacted hospitals and have included IV drugs like fluids, antibiotics, and opioids. For example, another gastroparesis medication, erythromycin IV, has been on shortage off and on for at least a year. Occasionally, shortages impact outpatient therapies such as Tamiflu suspension and atenolol. Many manufacturers of atenolol have back-ordered the product, but it may be available through some manufacturers and wholesalers. Some pharmacies may have a limited supply if atenolol seemed to work better.
Per the American College of Gastroenterology, tricyclic antidepressants such as amitriptyline may be considered for nausea and vomiting in gastroparesis. However, amitriptyline does display anticholinergic effects which slows gastric emptying. This can cause constipation, especially in patients with gastroparesis. Depending on the indication for this medication, it may be worth discussing with your physician your alternative options.
Due to current shortages, patient therapy has been
significantly impacted across the nation. Switching medication can be difficult
and cause untoward side effects. Although metoprolol is not likely to cause
constipation, any change for gastroparesis patients can cause a problem. Amitriptyline
is one of the medications that can worsen gastroparesis. Discuss your options
with your physician prior to making any changes to your medication regimen.
Sources: Lopressor
package insert, Amitriptyline
package insert
