The one side effect that does not seem to go away is hair loss! I shed like a golden retriever. Not all beta-blockers do this. I am reluctant after 2 1/2 years to switch. I tried others and I got intolerable g.i. side effects. On a low dose of 12.5mg twice a day and it controls my arrythmia. Metoprolol has also made my IBS-C worse. It doesnt just slow my heart rate....it slows my motility to a grinding halt. The fatigue and sleepiness disappeared in the early months of taking it as well as the low bp and heart rate. I do feel lucky that I have not yet had to increase the dosage and that my heart is behaving well so far.