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Metoprolol is a cardioselective beta-1-adrenergic blocker. It is frequently prescribed for cardiovascular conditions but is associated with potential central nervous system adverse effects, including hallucinations and nightmares. We discuss the case of an 84-year-old female with mixed aortic valve disease who experienced hallucinations and nightmares after starting metoprolol medication. Her symptoms improved after she stopped using metoprolol, indicating a likely causative link. This example emphasizes the significance of rapidly diagnosing and addressing adverse medication reactions, especially in elderly patients who may have underreported symptoms. Understanding the pharmacological properties of lipophilic beta-blockers and their effects on neurological function is critical for improving patient care and reducing negative outcomes
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