What are the main uses of metoprolol. How does metoprolol work in the body. What are the most common side effects of taking metoprolol. When should you seek immediate medical attention while on metoprolol. How can patients manage common side effects of metoprolol. What precautions should be taken when using metoprolol. Are there any drug interactions to be aware of with metoprolol.

Understanding Metoprolol: A Versatile Beta-Blocker Medication

Metoprolol is a widely prescribed medication that belongs to the class of drugs known as beta-blockers. It plays a crucial role in treating various cardiovascular conditions by affecting the way the heart responds to certain nerve impulses. This medication works by slowing down the heart rate and reducing the workload on the heart, making it an essential tool in managing several heart-related issues.

Primary Uses of Metoprolol

Metoprolol is FDA-approved for treating several cardiovascular conditions:

• Angina (chest pain)
• Heart failure
• Myocardial infarction (heart attack)
• Atrial fibrillation/flutter
• Hypertension (high blood pressure)

Additionally, metoprolol has off-label uses, including the treatment of supraventricular tachycardia and other conditions where reducing heart rate and blood pressure is beneficial.

How Does Metoprolol Work?

Metoprolol primarily works by blocking the effects of epinephrine (adrenaline) on beta-1 receptors in the heart. This action results in:

• Decreased heart rate
• Reduced force of heart contractions
• Lowered blood pressure
• Decreased oxygen demand by the heart muscle

By modulating these cardiovascular parameters, metoprolol helps in managing various heart conditions and improving overall heart health.

Common Side Effects of Metoprolol and How to Manage Them

While metoprolol is generally well-tolerated, like all medications, it can cause side effects. Understanding these potential effects and knowing how to manage them can greatly improve the patient experience.

Headaches

Headaches are a common side effect, especially during the initial stages of treatment. To manage this:

• Ensure adequate rest and hydration
• Limit alcohol consumption
• Use over-the-counter painkillers as recommended by a pharmacist

Typically, headaches subside after the first week of treatment. If they persist or become severe, consult your healthcare provider.

Fatigue and Dizziness

Feeling tired, dizzy, or weak is another common side effect. To cope with these symptoms:

• Avoid sudden movements when changing positions
• Rest when feeling dizzy or weak
• Avoid driving or operating machinery if affected
• Limit alcohol intake

Cold Hands or Feet

Metoprolol can cause peripheral vasoconstriction, leading to cold extremities. To manage this:

• Use warm water to improve circulation
• Massage affected areas
• Wear warm clothing, especially mittens and socks
• Avoid smoking and caffeine, which can worsen symptoms

Gastrointestinal Issues

Nausea and stomach pain may occur. To alleviate these symptoms:

• Eat simple, non-spicy meals
• Take metoprolol after eating
• Use heat therapy for stomach pain
• Eat smaller, more frequent meals

If gastrointestinal symptoms persist or become severe, consult your healthcare provider.

Recognizing Serious Side Effects and When to Seek Help

While rare, some individuals may experience serious side effects when taking metoprolol. It’s crucial to be aware of these potential reactions and know when to seek immediate medical attention.

Respiratory Issues

Seek medical help if you experience:

• Shortness of breath
• Wheezing
• Tightening of the chest

These symptoms could indicate lung problems and require prompt medical evaluation.

Cardiovascular Complications

Contact a healthcare provider immediately if you notice:

• Shortness of breath with worsening cough during exercise
• Swollen ankles or legs
• Irregular heartbeat

These symptoms may signify heart problems that need immediate attention.

Thyroid Issues

Watch for signs of thyroid hormone imbalance, such as:

• Fast heart rate
• High temperature
• Trembling
• Confusion

These symptoms could indicate an overactive thyroid and require medical evaluation.

Liver Problems

Be alert for signs of liver issues, including:

• Yellowing of the eyes or skin (jaundice)
• Unexplained bruising or bleeding

These symptoms may indicate liver problems or low platelet counts and should be reported to a healthcare provider immediately.

Emergency Situations: When to Seek Immediate Medical Care

Certain symptoms require immediate emergency care. Call emergency services or go to the nearest emergency department if you experience:

• Chest pain that doesn’t subside after a few minutes or is new/worsening
• Heavy bleeding or bleeding that doesn’t stop within 10 minutes
• Signs of a severe allergic reaction (anaphylaxis), including:
  • Skin rash (itchy, red, swollen, blistered, or peeling)
  • Wheezing
  • Tightness in the chest or throat
  • Difficulty breathing or talking
  • Swelling of the mouth, face, lips, tongue, or throat

These symptoms could indicate a heart attack, severe bleeding disorder, or anaphylaxis, all of which require immediate medical intervention.

Precautions and Considerations When Using Metoprolol

To ensure safe and effective use of metoprolol, certain precautions should be taken:

Medical History Disclosure

Inform your healthcare provider about your complete medical history, especially if you have:

• Asthma or other lung diseases
• Diabetes
• Thyroid disorders
• Liver or kidney problems
• Peripheral artery disease

Pregnancy and Breastfeeding

Discuss the use of metoprolol with your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The medication can pass into breast milk and may affect the nursing infant.

Gradual Discontinuation

Never stop taking metoprolol abruptly without consulting your doctor. Sudden discontinuation can lead to serious side effects, including worsening of angina or heart attack.

Regular Monitoring

Regular check-ups and blood tests may be necessary to monitor your response to the medication and adjust the dosage if needed.

Drug Interactions and Considerations

Metoprolol can interact with various medications and substances. It’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you are taking.

Potential Interactions

Be particularly cautious with:

• Other blood pressure medications
• Certain antidepressants
• Medications for diabetes
• Drugs that affect heart rhythm
• NSAIDs (non-steroidal anti-inflammatory drugs)

Alcohol and Metoprolol

Alcohol can enhance the blood pressure-lowering effect of metoprolol and increase the risk of side effects. It’s advisable to limit alcohol consumption while taking this medication.

Dietary Considerations

While no specific dietary restrictions are associated with metoprolol, maintaining a heart-healthy diet can complement its effects. This includes:

• Reducing sodium intake
• Eating plenty of fruits and vegetables
• Limiting saturated and trans fats
• Moderating caffeine consumption

Long-Term Use and Lifestyle Adjustments

For many patients, metoprolol is a long-term medication. Understanding how to integrate it into your lifestyle is crucial for optimal health outcomes.

Consistent Dosing

Take metoprolol at the same time each day to maintain consistent blood levels. If you miss a dose, take it as soon as you remember, unless it’s close to the time for your next dose. Never double up on doses.

Exercise Considerations

Metoprolol can affect your heart rate response to exercise. Consult your doctor about appropriate exercise regimens and how to monitor your exertion levels while on this medication.

Regular Health Check-ups

Schedule regular appointments with your healthcare provider to monitor your progress, adjust dosages if necessary, and address any concerns or side effects.

Lifestyle Modifications

Complement metoprolol therapy with heart-healthy lifestyle changes:

• Maintain a healthy weight
• Engage in regular physical activity as advised by your doctor
• Manage stress through relaxation techniques or counseling
• Quit smoking if applicable

These lifestyle adjustments can enhance the effectiveness of metoprolol and improve overall cardiovascular health.

Side effects of metoprolol – NHS

Like all medicines, metoprolol can cause side effects, but many people have no side effects or only minor ones.

Side effects often improve as your body gets used to the medicine.

Common side effects

These common side effects of metoprolol happen in more than 1 in 100 people. There are things you can do to help cope with them:

Headaches

Make sure you rest and drink plenty of fluids. It’s best not to drink too much alcohol. Ask your pharmacist to recommend a painkiller.

Headaches usually go away after the first week of taking metoprolol. Talk to your doctor if the headaches are severe or last longer than a week.

Feeling tired, dizzy or weak

If metoprolol makes you feel dizzy or weak, stop what you’re doing, and sit or lie down until you feel better. Do not drive, ride a bike or use tools or machinery if you’re feeling tired. Try not to drink alcohol, as it may make your symptoms worse.

Cold hands or feet

Put your hands or feet under warm running water, massage them, and wiggle your fingers and toes. Try not to smoke or have drinks with caffeine in – these can make your blood vessels narrower and restrict your blood flow. Smoking also makes your skin colder. Try wearing mittens (they’re warmer than gloves) and warm socks. Do not wear tight watches or bracelets.

Feeling sick (nausea)

Stick to simple meals and avoid rich or spicy food. It might help to take your metoprolol after you have eaten.

Stomach pain

Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help.

If you’re in a lot of pain, speak to your pharmacist or doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or lasts more than a few days.

Serious side effects

It’s rare, but some people have serious side effects when taking metoprolol.

Call a doctor or contact 111 straight away if:

• you get shortness of breath, wheezing and tightening of the chest – these can be signs of lung problems
• you get shortness of breath with a cough that gets worse when you exercise (like walking up stairs), swollen ankles or legs, or an irregular heartbeat – these are signs of heart problems
• you have a fast heart rate, high temperature, trembling and confusion – these are signs of too much thyroid hormone in the blood
• the whites of your eyes turn yellow, or your skin turns yellow although this may be less obvious on brown or black skin – these can be signs of liver problems
• you get unexplained bruising, or you bruise more easily than usual – these can be signs of low numbers of platelets in your blood (thrombocytopenia)

Go to 111. nhs.uk or call 111.

Immediate action required: Go to A&E or call 999 now if:

• you have any heavy bleeding or bleeding that you cannot stop, such as cuts or nosebleeds that do not stop within 10 minutes

Immediate action required: Call 999 now if:

• you get chest pain that does not stop after a few minutes or is new or worse if you already have angina

Chest pain is a possible sign of a heart attack and needs to be checked out as soon as possible.

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to metoprolol.

Immediate action required: Call 999 or go to A&E now if:

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you’re wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

You could be having a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of metoprolol. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 9 March 2022

Next review due: 9 March 2025

Metoprolol – StatPearls – NCBI Bookshelf

Continuing Education Activity

Metoprolol is FDA-approved to treat angina, heart failure, myocardial infarction, atrial fibrillation/flutter, and hypertension. Off-label uses include supraventricular tachycardia and thyroid storm. Both oral and intravenous preparations are available. There are immediate and extended-release preparations available orally. There is controversy regarding the selection of beta-blockers in the management of the above conditions. There is also conflicting evidence regarding the optimal choice of a particular beta-blocker in treating each specific disease. This activity will highlight the mechanism of action, adverse event profile, pharmacology, monitoring, and relevant interactions of metoprolol, pertinent for members of the interprofessional team in the treatment of patients with conditions where it is of clinical value.

Objectives:

• Identify the mechanism of action of metoprolol.

• Describe the adverse effects of metoprolol.

• Summarize the contraindications of metoprolol.

• Employ interprofessional team strategies for enhancing care coordination and communication to advance the safe use of metoprolol and improve outcomes.

Access free multiple choice questions on this topic.

Indications

Metoprolol is FDA-approved to treat angina, heart failure, myocardial infarction, atrial fibrillation/flutter, and hypertension. Off-label uses include supraventricular tachycardia and thyroid storm. Both oral and intravenous preparations are available. There are immediate and extended-release preparations available orally. There is controversy regarding the selection of beta-blockers in the management of the above conditions. There is also conflicting evidence regarding the optimal selection of a particular beta-blocker in treating each specific disease.[1] The role of beta-blockers as initial therapy for hypertension, particularly in the absence of compelling indications, has been questioned.[2][3] 

Several randomized trials in the 1980s showed a mortality benefit for beta-blockers in acute myocardial infarction.[4][5][6] The Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) trial specifically showed a benefit of metoprolol over diuretics regarding sudden cardiac death as well as myocardial infarction.[7] A large randomized trial of over 50,000 patients in the 1990s showed metoprolol to reduce mortality and re-infarction when used chronically after myocardial infarction. [8] Beta-blockers have demonstrated prognostic benefit and reduce mortality in the treatment of chronic heart failure. The carvedilol or metoprolol European trial (COMET) enrolled patients with stable heart failure and compared each drug head-to-head. Carvedilol was associated with a statistically significantly lower risk of all-cause death.[9] However, recent trials have had conflicting evidence on whether selective beta-1 blockers such as metoprolol have any benefit over other beta-blockers like carvedilol.[1]

Mechanism of Action

Metoprolol is a cardioselective beta-1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors at oral doses of less than 100 mg in adults. It decreases cardiac output by negative inotropic and chronotropic effects. Metoprolol does not exhibit membrane stabilizing or intrinsic sympathomimetic activity. Administration of metoprolol to normal subjects results in a reduction in heart rate and cardiac output; this appears to be related to the dose and concentration of the drug. Metoprolol is mainly lipophilic, and distribution is typical of a basic lipophilic drug. Based on animal studies, it appears to be almost completely absorbed from the gastrointestinal (GI) tract when taken orally.

There is significant hepatic first-pass elimination, which results in around 50% of the oral dose reaching the systemic circulation. It is 11% bound to serum albumin. The half-life of metoprolol is about 3 to 4 hours in most patients for non-extended release tabs. Metoprolol excretion principally occurs via the kidneys.[10] Metoprolol succinate produces more level drug concentrations as compared to metoprolol tartrate, which has more peak-to-trough variation. However, despite these differences in pharmacokinetics, studies have concluded that both agents produce similar clinical effects, both acute and chronic.[11]

Administration

Metoprolol may administration can be either oral or intravenous. The immediate-release oral formulation is to be administered with or immediately following food intake. The administration of the short-acting formulation of metoprolol tartrate is usually twice daily. It may be effective for hypertension when taken once per day; however, lower doses may not control blood pressure for 24 hours. Patients may take the extended-release metoprolol succinate formulation without regard to meals.[12]

Adverse Effects

The primary adverse effects of metoprolol include heart failure exacerbation, fatigue, depression, bradycardia or heart block, hypotension, bronchospasm, cold extremities, dizziness, decreased libido, diarrhea, tinnitus, decreased exercise tolerance, glucose intolerance, and may mask hypoglycemia. Abrupt cessation of the drug may lead to a withdrawal syndrome that could cause angina or myocardial infarction. Tachycardia and hypertension are both common in withdrawal syndrome.[13]

Contraindications

Metoprolol is contraindicated in patients with sick sinus syndrome, second or third-degree heart block (in the absence of pacemaker),  decompensated heart failure, hypotension, and documented hypersensitivity to the drug or components. Also, caution is necessary for patients with a history of noncompliance as the abrupt cessation of the drug can lead to withdrawal syndromes, including angina and myocardial infarction. Patients who have ingested cocaine or methamphetamine have traditionally had a contraindication to the use of selective beta-blocker such as metoprolol. This observation has its basis on case reports, and there is no strong evidence that they cause any deleterious effects. Regardless, agents such as labetalol, which have alpha and beta activity, or calcium channel blockers should be used in these cases. Metoprolol is a pregnancy risk factor Category C drug.[14]

Monitoring

The onset of action for oral immediate-release tablets is within 1 hour, with a duration of effect variable depending on the dose given. The extended-release preparation has a similar onset of action and a duration of up to 24 hours. Metabolism of metoprolol is hepatic with excretion in the urine. If there is renal impairment, there is no dosage adjustment necessary. If there is a history of hepatic impairment, slowly increasing titrated doses to effect should be used. With the use of intravenous (IV) administration, cardiac monitor, including ECG heart rate and blood pressure, should be constant. Oral administration heart rate rhythm and blood pressure require monitoring.[14]

Toxicity

Treatment will vary based on the amount of metoprolol amount taken, comorbidities, age, and other co-investments. On arrival, assess ABCs and monitor appropriate blood work, including coingestants, ECG, large-bore IVs, and pregnancy status if female. Consult poison control/toxicology early in the course. Treatment choices include volume resuscitation, activated charcoal, whole bowel irrigation, nasogastric lavage, atropine, glucagon, calcium gluconate/calcium chloride, high-dose insulin, vasopressors, Intralipid, transcutaneous, or transvenous pacemaker. Cardiac status and a current fluid balance will guide volume resuscitation. Activated charcoal is typically given 1 g/kg and usually only has efficacy if dosed within 1 to 2 hours of ingestion. [15] If the patient has any altered mentation, caution is necessary to the possibility of aspiration. Whole bowel irrigation should be a consideration for extended-release preparations or large quantity ingestion.

Nasogastric lavage is usually ineffective, except for large quantity ingestions. The clinician may consider atropine use, although it is typically ineffective in moderate-to-severe overdoses. Calcium administration to increase intracellular calcium at a dose of 60 mg/kg over 5 to 10 minutes of calcium gluconate. Calcium chloride at a dose of 10 to 20 mL of a 10% solution is an option if central access is obtained. Glucagon dosing is 50 mcg/kg as a bolus with titration of drip. High-dose insulin at a dose of 1 unit per kilogram bolus followed by 1 unit per kilogram per hour drip.[16]

Administration with dextrose with a drip titrating to euglycemia as well as potassium repletion as needed. Vasopressors with epinephrine or norepinephrine titrated rate and blood pressure. Intralipid IV lipid emulsion therapy can serve as a lipid sink that extracts the drug from the myocyte. It may also provide free fatty acids as a substrate. It should be noted that the use of this medication will affect some laboratory monitoring.[17] Consider a transcutaneous or transvenous pacemaker. Extracorporeal membrane oxygenation (ECMO) should be considered for refractory cases.[18] If the clinician is concerned about intentional overdose, they should order a mandatory psychiatric evaluation. There may also be a need for the possibility of co-ingestants and treatment of those as well. For non-extended or non-sustained-release preparations, 4 to 6 hours of observation without any derangement of mental status or vital signs is sufficient. Any extended-release or sustained-release preparation requires 12 to 24 hours of telemetry observation, depending on the preparation. Extra caution should be considered in the pediatric population as very low amounts, including one pill or even one-half pill, which can cause cardiovascular collapse and death. [19]

Enhancing Healthcare Team Outcomes

Metoprolol is an effective beta-blocker for many cardiac disorders. However, prescribers of this drug should be aware that specific indications for this drug are still lacking. While research has shown the drug to lower mortality in CHF patients, the same applies to several other beta-blockers. To ensure the safe use of the drug, all members of the interprofessional healthcare team, including clinicians (MDs, DOs, NPs, and PAs), specialists, nurses, and pharmacists, should be very familiar with the indications, administration, and potential adverse effects and drug interactions of metoprolol, as well as all members of the beta-blocker drug classification, including which agents are specific vs. beta-1 specific. This will result in improved patient outcomes with fewer adverse events. [Level 5]

Metoprolol can be administered orally or IV and works quickly. 

Review Questions

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References

1.

Fröhlich H, Zhao J, Täger T, Cebola R, Schellberg D, Katus HA, Grundtvig M, Hole T, Atar D, Agewall S, Frankenstein L. Carvedilol Compared With Metoprolol Succinate in the Treatment and Prognosis of Patients With Stable Chronic Heart Failure: Carvedilol or Metoprolol Evaluation Study. Circ Heart Fail. 2015 Sep;8(5):887-96. [PubMed: 26175538]

2.

Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. 2005 Oct 29-Nov 4Lancet. 366(9496):1545-53. [PubMed: 16257341]

3.

Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ. 2006 Jun 06;174(12):1737-42. [PMC free article: PMC1471831] [PubMed: 16754904]

4.

Hjalmarson A, Herlitz J, Holmberg S, Rydén L, Swedberg K, Vedin A, Waagstein F, Waldenström A, Waldenström J, Wedel H, Wilhelmsen L, Wilhelmsson C. The Göteborg metoprolol trial. Effects on mortality and morbidity in acute myocardial infarction. Circulation. 1983 Jun;67(6 Pt 2):I26-32. [PubMed: 6342837]

5.

Intravenous beta-blockade during acute myocardial infarction. Lancet. 1986 Jul 12;2(8498):79-80. [PubMed: 2873383]

6.

Sleight P. Use of beta adrenoceptor blockade during and after acute myocardial infarction. Annu Rev Med. 1986;37:415-25. [PubMed: 2871805]

7.

Wikstrand J, Warnold I, Tuomilehto J, Olsson G, Barber HJ, Eliasson K, Elmfeldt D, Jastrup B, Karatzas NB, Leer J. Metoprolol versus thiazide diuretics in hypertension. Morbidity results from the MAPHY Study. Hypertension. 1991 Apr;17(4):579-88. [PubMed: 2013485]

8.

Freemantle N, Cleland J, Young P, Mason J, Harrison J. beta Blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999 Jun 26;318(7200):1730-7. [PMC free article: PMC31101] [PubMed: 10381708]

9.

Remme WJ, Cleland JG, Erhardt L, Spark P, Torp-Pedersen C, Metra M, Komajda M, Moullet C, Lukas MA, Poole-Wilson P, Di Lenarda A, Swedberg K. Effect of carvedilol and metoprolol on the mode of death in patients with heart failure. Eur J Heart Fail. 2007 Nov;9(11):1128-35. [PubMed: 17716943]

10.

Brogden RN, Heel RC, Speight TM, Avery GS. Metoprolol: a review of its pharmacological properties and therapeutic efficacy in hypertension and angina pectoris. Drugs. 1977 Nov;14(5):321-48. [PubMed: 201441]

11.

Kukin ML, Mannino MM, Freudenberger RS, Kalman J, Buchholz-Varley C, Ocampo O. Hemodynamic comparison of twice daily metoprolol tartrate with once daily metoprolol succinate in congestive heart failure. J Am Coll Cardiol. 2000 Jan;35(1):45-50. [PubMed: 10636257]

12.

Wikstrand J, Hjalmarson A, Waagstein F, Fagerberg B, Goldstein S, Kjekshus J, Wedel H., MERIT-HF Study Group. Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT-HF). J Am Coll Cardiol. 2002 Aug 07;40(3):491-8. [PubMed: 12142116]

13.

Helfand M, Peterson K, Christensen V, Dana T, Thakurta S. Drug Class Review: Beta Adrenergic Blockers: Final Report Update 4 [Internet]. Oregon Health & Science University; Portland (OR): Jul, 2009. [PubMed: 21089245]

14.

Ripley TL, Saseen JJ. β-blockers: a review of their pharmacological and physiological diversity in hypertension. Ann Pharmacother. 2014 Jun;48(6):723-33. [PubMed: 24687542]

15.

Graudins A, Lee HM, Druda D. Calcium channel antagonist and beta-blocker overdose: antidotes and adjunct therapies. Br J Clin Pharmacol. 2016 Mar;81(3):453-61. [PMC free article: PMC4767195] [PubMed: 26344579]

16.

Stellpflug SJ, Harris CR, Engebretsen KM, Cole JB, Holger JS. Intentional overdose with cardiac arrest treated with intravenous fat emulsion and high-dose insulin. Clin Toxicol (Phila). 2010 Mar;48(3):227-9. [PubMed: 20141425]

17.

Walter E, McKinlay J, Corbett J, Kirk-Bayley J. Review of management in cardiotoxic overdose and efficacy of delayed intralipid use. J Intensive Care Soc. 2018 Feb;19(1):50-55. [PMC free article: PMC5810865] [PubMed: 29456602]

18.

Chenoweth JA, Colby DK, Sutter ME, Radke JB, Ford JB, Nilas Young J, Richards JR. Massive diltiazem and metoprolol overdose rescued with extracorporeal life support. Am J Emerg Med. 2017 Oct;35(10):1581.e3-1581.e5. [PubMed: 28705745]

19.

Euwema MS, Swanson TJ. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 1, 2022. Deadly Single Dose Agents. [PubMed: 28722879]

Disclosure: Jason Morris declares no relevant financial relationships with ineligible companies.

Disclosure: Alexis Dunham declares no relevant financial relationships with ineligible companies.

What helps, analogs, prescription, dosage, mechanism of action

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS REQUIRED. 002 Diploma in Pharmaceutical Education: 105924 3510722 reg. number 31917

All authors

Article contents

• Metoprolol: mechanism of action
• Metoprolol: from what
• Metoprolol: prescription
• Metoprolol: dosage
• Metoprolol: analogues
• Metoprolol or Egiloc: which is better
• Anaprilin or Metoprolol: which is better
• Summary
• Ask an expert on the topic of the article

Hypertension is a chronic disease, the main manifestation of which is an increase in blood pressure. High blood pressure is responsible for 10 million deaths and 200 million disabilities worldwide. Symptoms of hypertension are either absent or nonspecific: headache, dizziness, palpitations.

Hypertension can and should be treated and controlled with medicines. We asked the pharmacist Alena Podoinitsyna to tell us about the drug Metoprolol: what it is prescribed for, in what dosages it is produced and what is the mechanism of action of the drug. They gave several examples of analogues of Metoprolol, and also compared it with Egilok and Anaprilin.

All products Metoprolol 20 reviews

Metoprolol: mechanism of action

Metoprolol is a medicine that is taken for high blood pressure. The drug blocks beta-adrenergic receptors. Blockade of beta-adrenergic receptors leads to a decrease in the number of heart contractions, contractility and speed of contraction of the heart muscle, while reducing myocardial oxygen demand.

Metoprolol: from what

We understand what Metoprolol tablets are from. The drug has antihypertensive, antianginal and antiarrhythmic effects. Metoprolol is a beta-blocker. It helps to reduce pressure at rest, during stress and physical exertion.

Antianginal effect is manifested in a decrease in heart rate and a decrease in the heart’s need for oxygen. The antiarrhythmic effect is expressed in the elimination of tachycardia, a decrease in the excitability of the heart and the conduction of nerve impulses in its tissues.

Metoprolol: indications for use

• high blood pressure
• angina pectoris
• complex therapy after a heart attack
• arrhythmia, tachycardia
• migraine prophylaxis
• hyperthyroidism

Prescription metoprolol

Metoprolol is a prescription drug. When buying it, a pharmacy employee will ask you to provide a prescription from a doctor. The drug is available by prescription, as when used in recommended doses, the patient can harm himself.

Metoprolol has side effects and contraindications. Only a doctor can evaluate the benefit-risk ratio of the drug. Therefore, the decision on the need for his appointment is also made by the doctor.

Metoprolol: contraindications for use

• hypersensitivity to any component of the preparation
• atrioventricular block II and III degree
• heart failure in the stage of decompensation
• patient therapy with nootropics acting on beta-adrenergic receptors
• decrease in heart rate below 60 beats per minute
• cardiogenic shock
• circulatory disorders in the organs, or the threat of gangrene
• low blood pressure
• acute myocardial infarction
• lactose intolerance, glucose-galactose malabsorption
• children under 18 years of age
• severe form of bronchial asthma and chronic obstructive pulmonary disease.
• concomitant use of certain groups of drugs
• lactation

Metoprolol: dosage

Metoprolol contains the active ingredient: metoprolol tartrate, at a dosage of 100 mg per 1 tablet. But we note that Metoprolol is produced on the basis of 2 active ingredients, or rather, salts. Each of them carries an action peculiar only to it.

• Metoprolol tartrate – the substance is contained in tablets of immediate action, these tablets must be taken several times a day.
• Metoprolol succinate – the substance is contained in tablets with a delayed release, respectively, such tablets are drunk 1 time per day.

Metoprolol: analogues

In order to choose metoprolol analogues and substitutes, a specialist consultation is necessary. Egilok, Serdol, Metocard, Betalok, Betalok ZOK contain metoprolol as an active substance. Metoprolol can be replaced with them without consulting a doctor. We recommend that you consult with a pharmacy employee or a pharmacist in the chat on our service. The specialist will help you choose the right dosage and dosage form.

The need to change to drugs with a different active substance is determined by the doctor. Metoprolol is part of the combined preparations. For example, Logimax, Implicor, Hypotef. They, in addition to metoprolol, contain other active ingredients. You can not replace them with a simple Metoprolol.

Do you want to understand the analogues of drugs in order to skillfully select drugs for your budget? Our manual from expert pharmacists “Analogues of popular drugs” will help you with this! Getting a training manual is easy: subscribe to our social networks and write “analogues” in the messages.

Megapharmacy in social networks: VKontakte, Telegram, OK, Viber

Metoprolol or Egilok: which is better

When choosing the best drug, you should first consult with your doctor. There are practically no differences between Metoprolol and Egilok. Preparations differ by manufacturers:

• Metoprolol is produced in Russia, Slovenia, Israel, Slovakia and Germany
• Egilok is produced only in Hungary.

Other characteristics, such as: mechanism of action, indications for use, contraindications, side effects and other special indications, are the same for both drugs. All characteristics depend on the active substance. In both preparations, it is metoprolol tartrate. Therefore, Egilok is a substitute for Metoprolol.

Anaprilin or Metoprolol: which is better

Both drugs belong to the same group of drugs – beta-blockers. But the active ingredients are different. Anaprilin contains propranolol hydrochloride.

The difference between active substances lies in the mechanism of their action.

• Metoprolol is a non-selective adrenoblocker and acts on beta1-adrenergic receptors
• Anaprilin is selective and acts on beta1- and beta2-adrenergic receptors.

Thus, Anaprilin has more side effects and contraindications than Metoprolol. For example: both drugs should be taken with caution in diabetes mellitus. Metoprolol is also with caution in: chronic obstructive pulmonary disease and bronchial asthma, and Anaprilin is completely contraindicated.

Preparations and manufacturers differ.

• Anaprilin is produced by Russia and Ukraine
• Metoprolol is produced by Russia and 4 other countries.

Follow your doctor’s advice to select the best drug.

All products Egilok 20 reviews

All products Anaprilin 21 reviews

Summary

• Metoprolol is an antihypertensive drug that is often prescribed for the treatment of hypertension, coronary heart disease and arrhythmias.
• Metoprolol is a prescription drug and is available only on prescription.
• The active substance of metoprolol is the salt of metoprolol succinate or tartrate.
• Metoprolol lowers blood pressure by reducing the heart’s need for oxygen and reducing the heart rate.
• Metoprolol has 4 analogues with which it can be substituted.
• When comparing Metoprolol with Egilok, differences were found only in manufacturers.
• Anaprilin differs from Metoprolol not only in producing companies, but also in the active substance.

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Evaluation of the effectiveness of sustained release metoprolol in patients with arterial hypertension with circadian rhythm disturbances in blood pressure | Tikhonov

1. 2003 European Society of Hypertension–European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21:1011-53.

2. Mazur N.A. Prevention of cardiovascular complications in patients with arterial hypertension. Moscow “Med-practice-M” 2003.

3. Crawford MH. Current diagnosis and treatment in cardiology. McGraw-Hill 2003.

4. Gogin E.E. Hypertonic disease. Moscow 1997.

5. Recommendations for the treatment of hypertension by WHO and the International Society of Arterial Hypertension. Klin pharmacol ter 1999; 3:18-22.

6. Recommendations for the prevention, diagnosis and treatment of arterial hypertension. Arter hypert 2001; 7(app. 1): 1-16.

7. Kobalava Zh.D., Kotovskaya Yu.V. Blood pressure monitoring: methodological aspects and clinical significance. Moscow 1999.

8. O’Brien ET, Coats A, Owens P, et al. Use and interpretation of ambulatory blood pressure monitoring: recommendations of the British Hypertension Society. BMJ2000; 320:1128-34.

9. Uzu T, Kimura G. Diuretics and circadian rhythm of blood pressure. J Clin Hypertens 2000; 2(4): 273-8.

10. Uzu T, Kimura G. Diuretics shift circadian rhythm of blood pressure from nondipper to dipper in essential hypertension. Circuit 1999; 100(15): 1635-8.

11. Chazova I.E., Ratova L. G., Dmitriev V.V. Effect of long-term therapy with a combination of losartan and hydrochlorothiazide on the daily blood pressure profile and left ventricular hypertrophy in patients with mild to moderate arterial hypertension. Cardiology 2003; 10:60-4.

12. Frisina N, Pedulla M, Mento G, et al. Frequency domain of heart rate and blood pressure variability in essential hypertensive patients during sleep: differences between dippers and nondippers. Blood Press Monitor 1996; 1(5): 425-31.

13 Hojo Y, Noma S, Ohki T, et al. Autonomic nervous system activity in essential hypertension: a comparison between dippers and non-dippers. J Hum Hypertens 1997; 11:665-71.

14. Narkiewicz K, Winnicki M, Schroeder K, et al. Relationship between muscle sympathetic nerve activity and diurnal blood pressure profile. Hypertension 2002; 39(1): 168-72.

15. Tikhonov P.P., Sokolova L.A. Correlation between circadian rhythm disturbances in blood pressure and heart rate variability in patients with arterial hypertension according to bifunctional monitoring data. Problems of health promotion and disease prevention. Materials of the scientific-practical conference. St. Petersburg 2004; 288-9.

16. 1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. Bull World Health Organ 1993; 71(5): 503-17.

17. Mathias CJ. Role of sympathetic efferent nerves in blood pressure regulation and in hypertension. Hypertension 1991; 18:22-30.

18. Folkow B. Autonomic nervous system in hypertension. Oxford 1994.

19. Shimada K, Kario K. Altered circadian rhythm of blood pressure and cerebrovascular damage. Blood Press Monitor 1997; 2(6): 333-8.

20. Sander D, Winbeck K, Klingelhofer J, et al. Extent of cerebral white matter lesions is related to changes of circadian blood pressure rhythmicity. Arch Neurol 2000; 57(9): 1302-7.

21. Kukla C, Sander D, Schwarze J, et al. Changes of circadian blood pressure patterns are associated with the occurrence of lacunar infarction. Arch Neurol 1998; 55(5): 683-8.