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Metoprolol succinate, a commonly prescribed beta blocker for heart failure, can cause underrecognized central nervous system (CNS) effects such as hallucinations, delirium, and sleep disturbances. The likelihood of these effects depends on the drug's lipophilicity. We report a heart failure patient who developed new-onset visual hallucinations after starting metoprolol succinate. Once the association between beta blockers induced hallucinations was recognized, metoprolol was discontinued leading to resolution of symptoms. This case highlights the importance of recognizing this potential adverse effect of beta blocker induced hallucinations, as well as understanding the differences among agents within this drug class.
