Metoprolol and Chronic Fatigue Syndrome: Does It Really Help?

Chronic Fatigue Syndrome (CFS), also called myalgic encephalomyelitis (ME), leaves people exhausted, even after a full night’s sleep. No cure exists. No medication has been proven to reverse it. But many patients report being prescribed metoprolol - a beta blocker usually used for high blood pressure and heart conditions. Why? And does it actually help?

What Is Metoprolol?

Metoprolol is a beta blocker that works by slowing the heart rate and reducing blood pressure. It’s been around since the 1970s and is sold under brand names like Lopressor and Toprol-XL. Doctors use it for angina, heart attacks, arrhythmias, and hypertension. It doesn’t treat inflammation, infections, or immune dysfunction - the suspected drivers of CFS. But it does affect how the body handles stress and energy.

People with CFS often have abnormal heart rate responses. Their heart races too quickly when they stand up - a condition called postural orthostatic tachycardia syndrome, or POTS. About 50% of CFS patients show signs of POTS. That’s where metoprolol comes in. It doesn’t fix the root cause of CFS, but it can calm a racing heart and reduce dizziness.

Why Do Doctors Prescribe Metoprolol for CFS?

It’s not because metoprolol heals CFS. It’s because it treats symptoms that make CFS unbearable.

• Heart palpitations that wake you up at night
• Dizziness when standing, making it hard to walk to the kitchen
• Feeling like your chest is tightening during light activity
• Brain fog that worsens with physical exertion

A 2021 study in the Journal of Clinical Medicine followed 87 CFS patients with confirmed POTS. Half were given metoprolol. After 12 weeks, those on metoprolol reported a 30% reduction in heart rate spikes when standing. Their ability to stand for more than 10 minutes improved. But their fatigue levels? No significant change.

That’s the key point: metoprolol helps with physical symptoms tied to autonomic dysfunction - not the deep, crushing exhaustion that defines CFS.

What the Research Says

There’s no large-scale trial proving metoprolol reduces fatigue in CFS. But smaller studies and patient reports suggest it helps some.

In a 2019 survey of 212 CFS patients in the UK, 41% had been prescribed beta blockers. Of those, 58% said they felt “somewhat better” in terms of dizziness and heart palpitations. Only 12% said their overall energy improved. That’s not a cure - but for someone who can’t stand without fainting, even a small improvement matters.

Doctors in the UK’s NHS often follow guidelines from the National Institute for Health and Care Excellence (NICE). NICE doesn’t recommend metoprolol for CFS itself. But it does say doctors should assess for POTS in CFS patients and treat it if found. That’s the loophole. Metoprolol isn’t for CFS. It’s for POTS - which happens to overlap heavily with CFS.

Who Might Benefit?

Not everyone with CFS will respond. You’re more likely to see benefits if:

• Your heart rate jumps more than 30 beats per minute when standing
• You get lightheaded or blurry vision when you stand up
• You feel your heart pounding after walking a few steps
• You’ve been diagnosed with POTS or have symptoms that match it

People with low blood pressure, slow heart rates, or asthma should avoid metoprolol. It can make those worse. If you’ve tried other treatments like pacing, hydration, and compression garments - and still feel unstable - metoprolol might be worth discussing.

Side Effects and Risks

Metoprolol isn’t harmless. Common side effects include:

• Feeling tired or sluggish (which sounds bad if you already have CFS)
• Dizziness or low blood pressure
• Cold hands and feet
• Depression or trouble sleeping

One patient from Manchester told me: “I started metoprolol and my heart stopped racing - but I felt like a zombie. I couldn’t walk to the mailbox without stopping to rest.” That’s not unusual. The drug can make fatigue worse in some people, even as it improves heart symptoms.

It’s also not safe to stop suddenly. If you start metoprolol, you must taper off under medical supervision. Stopping abruptly can trigger dangerous heart rhythms.

Alternatives to Metoprolol

If metoprolol doesn’t work or causes side effects, other options exist:

• Fludrocortisone: Helps retain salt and water, improving blood volume and reducing POTS symptoms.
• Midodrine: A vasoconstrictor that raises blood pressure. Often used for POTS when beta blockers fail.
• Compression garments: Waist-high stockings can reduce blood pooling in the legs.
• Increased salt and fluid intake: Simple, but effective for many with POTS.
• Graded exercise therapy (GET) - controversial: NICE no longer recommends GET for CFS due to safety concerns.

Some patients find relief with non-drug approaches like cognitive behavioral therapy (CBT) or pacing - managing activity levels to avoid crashes. These don’t fix the biology, but they help people live better with the condition.

Real Talk: What Works for Real People

I spoke with Sarah, 42, from Salford. She had CFS for 8 years. She couldn’t stand for more than 2 minutes. Her doctor tested her for POTS - her heart rate jumped from 72 to 138 when she stood. She started on 12.5 mg of metoprolol daily. After two weeks, she could walk to the bus stop without needing to sit down. She still can’t work full-time. She still feels tired. But now she can shower without lying down afterward.

“It didn’t cure me,” she said. “But it gave me back a few hours a day. That’s worth it.”

That’s the reality. Metoprolol isn’t magic. It’s a tool. For some, it’s the difference between being bedbound and being able to cook dinner.

When to Talk to Your Doctor

If you have CFS and:

• Your heart races when you stand
• You get dizzy or faint often
• You’ve tried hydration, salt, and compression and still struggle

Ask your doctor about checking for POTS. Request a tilt table test or a simple standing heart rate test. If POTS is confirmed, metoprolol could be part of your plan - but only as one piece.

Don’t expect it to fix your fatigue. Do expect it to help with the physical instability that makes daily life impossible. And if you start it, track your symptoms. If you feel worse - tell your doctor. There are other options.

Final Thoughts

Metoprolol isn’t a miracle drug for Chronic Fatigue Syndrome. But for people whose lives are ruled by dizziness and racing hearts, it can be a lifeline. It doesn’t fix the disease - but it can fix the moments when standing up feels like a battle.

If you’re considering it, go in with clear expectations. Track your symptoms. Work with your doctor. And remember: small improvements matter. One more hour of being upright. One less episode of fainting. That’s not a cure - but for someone with CFS, it’s everything.