In general no significant interaction appears to occur between
beta blockers and
SSRIs. The concurrent use of citalopram or escitalopram and metoprolol does not signifi- cantly affect heart rate and blood pressure. However, the
plasma levels of metoprolol are increased by up to 2-fold, which may decrease its cardioselectivity. Paroxetine significantly increases the AUC of metoprolol, which results in more sustained beta- blocking effects and a more pronounced reduction in exercise systolic blood pressure.
The
clinical significance of these potential interactions is unclear, but they seem more likely to be important in those given metoprolol for heart failure. Bear it in mind if the effects of metoprolol seem excessive.