What are the common side effects of metoprolol. How can patients manage headaches and dizziness caused by metoprolol. When should you seek immediate medical attention while taking metoprolol. What are the signs of a serious allergic reaction to metoprolol.

Understanding Metoprolol and Its Impact on the Body

Metoprolol is a widely prescribed beta-blocker medication used to treat various cardiovascular conditions. While it’s effective in managing heart-related issues, it’s essential to be aware of potential side effects. This article provides a comprehensive overview of metoprolol’s side effects, ranging from common to severe, and offers guidance on managing them effectively.

Common Side Effects of Metoprolol: What to Expect

Metoprolol, like all medications, can cause side effects. It’s important to note that not everyone experiences these effects, and many people tolerate the medication well. Common side effects occur in more than 1 in 100 people taking metoprolol. These include:

• Headaches
• Fatigue, dizziness, or weakness
• Cold hands or feet
• Nausea
• Stomach pain

Do these side effects persist indefinitely? Typically, these effects improve as your body adjusts to the medication. However, if they persist or become bothersome, it’s crucial to consult your healthcare provider.

Managing Headaches While on Metoprolol

Headaches are a common side effect of metoprolol, particularly during the initial stages of treatment. To alleviate this discomfort:

• Ensure adequate rest and hydration
• Limit alcohol consumption
• Use over-the-counter pain relievers as recommended by your pharmacist

When should you be concerned about headaches? If they are severe or persist beyond the first week of treatment, it’s advisable to consult your doctor.

Coping with Fatigue and Dizziness

Feeling tired, dizzy, or weak can be challenging side effects of metoprolol. To manage these symptoms:

• Stop activities and rest when feeling dizzy or weak
• Avoid driving or operating machinery when experiencing these effects
• Limit alcohol consumption, as it may exacerbate symptoms

Is it safe to continue daily activities while experiencing these side effects? It’s crucial to prioritize safety and avoid activities that could be dangerous if you’re feeling dizzy or fatigued.

Dealing with Cold Extremities

Cold hands and feet are common complaints among metoprolol users. To improve circulation and warmth:

• Warm hands and feet under running water
• Massage extremities and keep them moving
• Avoid smoking and caffeine, which can constrict blood vessels
• Wear warm, insulating clothing like mittens and thick socks

Can lifestyle changes help mitigate this side effect? Indeed, maintaining an active lifestyle and ensuring proper circulation can help alleviate cold extremities.

Managing Nausea and Stomach Pain

Gastrointestinal discomfort is not uncommon with metoprolol use. To ease nausea and stomach pain:

• Stick to simple, bland meals
• Consider taking metoprolol after eating
• Use heat therapy for stomach discomfort
• Eat smaller, more frequent meals

When should you seek medical advice for stomach issues? If these symptoms persist or become severe, consult your healthcare provider.

Recognizing Serious Side Effects: When to Seek Immediate Help

While rare, some individuals may experience serious side effects while taking metoprolol. It’s crucial to be aware of these potential reactions and seek immediate medical attention if they occur. Serious side effects may include:

• Shortness of breath or wheezing
• Signs of heart problems (e.g., irregular heartbeat, swollen ankles)
• Symptoms of thyroid issues
• Indicators of liver problems
• Unusual bruising or bleeding

How quickly should you respond to these serious side effects? If you experience any of these symptoms, it’s essential to contact a healthcare provider immediately or seek emergency medical care.

Respiratory Concerns: Shortness of Breath and Wheezing

Respiratory issues can be a sign of serious complications. If you experience:

• Sudden shortness of breath
• Wheezing
• Tightening of the chest

These symptoms may indicate lung problems and require immediate medical evaluation.

Cardiovascular Red Flags

Certain symptoms may indicate heart-related complications. Be alert for:

• Shortness of breath with exercise
• Swollen ankles or legs
• Irregular heartbeat
• Chest pain that doesn’t subside

What should you do if you experience chest pain? If you have new or worsening chest pain that doesn’t stop after a few minutes, seek emergency medical care immediately, as this could be a sign of a heart attack.

Thyroid and Liver Concerns

Metoprolol can occasionally affect thyroid and liver function. Watch for:

• Fast heart rate, high temperature, trembling, and confusion (signs of thyroid issues)
• Yellowing of the eyes or skin (signs of liver problems)

How often should liver function be monitored while on metoprolol? Your healthcare provider will determine the appropriate frequency of liver function tests based on your individual health status and risk factors.

Allergic Reactions: Identifying and Responding to Anaphylaxis

Although rare, severe allergic reactions (anaphylaxis) to metoprolol can occur. Recognizing the signs of anaphylaxis is crucial for prompt intervention. Symptoms may include:

• Sudden swelling of lips, mouth, throat, or tongue
• Rapid or labored breathing
• Tightness in the throat or difficulty swallowing
• Skin color changes (blue, grey, or pale)
• Sudden confusion or dizziness
• Loss of consciousness

What immediate action should be taken in case of a severe allergic reaction? If you suspect anaphylaxis, call emergency services immediately. This condition requires urgent medical treatment.

Blood-Related Side Effects: Understanding the Risks

Metoprolol can, in rare cases, affect blood components. Be aware of signs such as:

• Unexplained bruising
• Increased susceptibility to bruising
• Heavy bleeding or bleeding that doesn’t stop easily

These symptoms may indicate low platelet counts (thrombocytopenia) and require prompt medical evaluation.

Monitoring and Managing Bleeding Risks

If you notice any unusual bleeding patterns:

• Monitor the duration and severity of bleeding
• Seek immediate medical care for heavy bleeding or bleeding that doesn’t stop within 10 minutes
• Inform healthcare providers about your metoprolol use before any surgical procedures

How does metoprolol affect blood clotting? While metoprolol itself doesn’t directly affect blood clotting, it can interact with other medications that do, making regular monitoring important.

Long-Term Use of Metoprolol: What to Consider

For many patients, metoprolol is a long-term medication. When using metoprolol over extended periods:

• Attend regular check-ups with your healthcare provider
• Monitor blood pressure and heart rate consistently
• Report any new or changing side effects promptly
• Discuss any concerns about long-term use with your doctor

Can metoprolol lose its effectiveness over time? While tolerance to metoprolol is not common, your doctor may need to adjust your dosage over time to maintain its effectiveness.

Lifestyle Considerations for Metoprolol Users

To optimize the benefits of metoprolol and minimize side effects:

• Maintain a healthy diet and exercise regimen
• Avoid sudden changes in physical activity levels
• Be cautious with alcohol consumption
• Stay hydrated, especially in hot weather or during exercise

How does lifestyle impact the effectiveness of metoprolol? A healthy lifestyle can complement the effects of metoprolol, potentially leading to better overall cardiovascular health.

Interactions and Precautions: Navigating Metoprolol Use Safely

Metoprolol can interact with various substances and medical conditions. It’s essential to:

• Inform all healthcare providers about your metoprolol use
• Disclose all medications, including over-the-counter drugs and supplements
• Be cautious with certain foods and beverages that may interact with metoprolol
• Discuss any pre-existing medical conditions with your doctor

What common medications should be avoided while taking metoprolol? Certain calcium channel blockers, antiarrhythmics, and other beta-blockers may interact with metoprolol. Always consult your healthcare provider or pharmacist before starting any new medication.

Special Considerations for Specific Groups

Certain populations may require special attention when using metoprolol:

• Pregnant or breastfeeding women
• Elderly patients
• Individuals with diabetes
• Patients with respiratory conditions like asthma

How should diabetic patients monitor their condition while on metoprolol? Metoprolol can mask some symptoms of low blood sugar, making regular glucose monitoring even more crucial for diabetic patients.

Reporting Side Effects and Seeking Support

Ongoing communication with healthcare providers is crucial for safe and effective metoprolol use. To ensure optimal care:

• Report any side effects to your healthcare provider
• Keep a log of symptoms and their frequency
• Utilize patient support resources provided by your healthcare system
• Consider joining support groups for individuals on similar medications

Where can patients report side effects of metoprolol? In addition to informing your healthcare provider, you can report side effects to your country’s drug regulatory agency, such as the FDA in the United States or the MHRA in the UK.

Understanding the potential side effects of metoprolol empowers patients to make informed decisions about their health. While side effects can occur, many are manageable with proper guidance and care. Always consult with your healthcare provider for personalized advice and never discontinue or alter your medication regimen without professional medical guidance. By staying informed and vigilant, patients can maximize the benefits of metoprolol while minimizing potential risks.

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 call 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)

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 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of 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

Side effects, dosage, uses, and more

1. Metoprolol oral tablet is available as generic drugs and as brand-name drugs. Brand names: Lopressor and Toprol XL.
2. Metoprolol comes as immediate-release and extended-release tablets, and an extended-release capsule. It also comes in an injectable form that’s only given by a healthcare provider.
3. Metoprolol is a drug called a beta-blocker. It’s used to treat conditions such as high blood pressure, heart failure, and angina (chest pain).

Metoprolol is a prescription drug. It comes as immediate-release and extended-release oral tablets, and extended-release oral capsules. It also comes in an injectable form that’s only given by a healthcare provider.

Metoprolol oral tablets are available as the brand-name drugs Lopressor and Toprol XL. They’re also available as generic drugs. Generic drugs usually cost less than the brand-name versions. In some cases, they may not be available in all strengths or forms as the brand-name drugs.

The two brand-name forms of metoprolol (as well as the different generic forms) are different versions of the medication. They’re both metoprolol, but they contain different salt forms. Lopressor is metoprolol tartrate, while Toprol-XL is metoprolol succinate. The different salt forms enable the drugs to be used to treat different conditions.

Metoprolol succinate is an extended-release version of metoprolol, so it remains in your bloodstream for a longer time. Metoprolol tartrate is an immediate-release version of metoprolol.

Why it’s used

Both forms of metoprolol — metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol-XL) — are used to:

• lower high blood pressure
• reduce chest pain (angina)

However, metoprolol tartrate is also used to treat and prevent heart attacks, while metoprolol succinate is also used to treat heart failure.

Metoprolol may be used as part of a combination therapy. That means you may have to take it with hydrochlorothiazide or chlorthalidone.

How it works

Both versions of metoprolol belong to a class of drugs called beta-blockers. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

Blood pressure is often raised because blood vessels are tightened. This puts a strain on the heart and increases the body’s oxygen demand.

Beta-blockers work by preventing norepinephrine (adrenalin) from acting on beta receptors in blood vessels and in the heart. This causes blood vessels to relax. By relaxing the blood vessels, beta-blockers help to lower the heart rate and decrease the heart’s demand for oxygen. This in turn helps decrease blood pressure and reduce chest pain.

Metoprolol oral tablet can cause certain side effects.

More common side effects

The more common side effects that can occur with metoprolol include:

• tiredness
• dizziness
• diarrhea
• constipation
• breathing problems such as shortness of breath, cough, and wheezing
• bradycardia (heart rate that’s slower than normal)
• reduced interest in sex
• rash

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Low blood pressure (hypotension). Symptoms can include:
  • severe dizziness
  • lightheadedness
  • fainting
• Cold hands and feet. Symptoms can include
  • hands and feet that are cold and may be painful
• Very slow heart rate (severe bradycardia)
• Extreme fatigue. Symptoms can include:
  • feeling more tired than usual
  • tiredness that gets progressively worse each day
• Serious depression. Symptoms can include:
  • continuous feelings of sadness or anxiety
  • feelings of hopelessness or worthlessness
  • lack of interest in hobbies you once enjoyed
  • eating too much or too little
  • trouble concentrating

Metoprolol oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with metoprolol are listed below.

Mental health drugs

Taking metoprolol with reserpine and monoamine oxidase inhibitors (MAOIs) may increase or add to the effects of metoprolol. They may also increase lightheadedness or slow your heart rate more. MAOIs can continue to interact with metoprolol for up to 14 days after taking them. Examples of MAOIs include:

• isocarboxazid
• phenelzine
• selegiline
• tranylcypromine

Heart rhythm drugs

Taking heart rhythm drugs with metoprolol can slow down your heart rate too much. Examples of these drugs include:

• digoxin
• quinidine
• propafenone

Calcium channel blockers

Like metoprolol, these drugs are used to treat high blood pressure and several other heart problems. Combined with metoprolol, calcium channel blockers may slow your heart rate even more. Doctors sometimes use this combination under close supervision.

Examples of calcium channel blockers include:

• amlodipine
• diltiazem
• felodipine
• isradipine
• nicardipine
• nifedipine
• nimodipine
• nisoldipine
• verapamil

Drugs processed in the same way as metoprolol

Drugs used to treat depression and other mood disturbances are processed in your body by the same systems as metoprolol. Using these drugs with metoprolol could increase the levels of metoprolol in your body. Examples of these drugs include:

• fluoxetine
• fluvoxamine
• paroxetine
• sertraline
• bupropion
• clomipramine
• desipramine
• chlorpromazine
• fluphenazine
• haloperidol
• thioridazine

Other drugs that are processed in the body the same way as metoprolol include:

• the antiretroviral ritonavir
• antihistamines, including diphenhydramine
• antimalarial drugs, such as hydroxychoroquine and quinidine
• antifungal drugs, such as terbinafine
• the blood pressure drug hydralazine

These drugs can all increase the level of metoprolol in the body.

Alpha-blockers

Alpha-blockers also lower blood pressure. They may decrease blood pressure too much when combined with metoprolol. Examples of these drugs include:

• reserpine
• alpha-methyldopa
• clonidine
• prazosin

Clonidine must be carefully managed if it’s combined with metoprolol. Stopping the drug suddenly while also taking metoprolol can cause a big jump in blood pressure.

Ergot alkaloids

Ergot alkaloids, such as dihydroergotamine, narrow blood vessels to treat headaches. If you take them at the same time as metoprolol, they may cause dangerous narrowing of blood vessels.

Dipyridamole

Dipyridamole is used for heart testing. Because metoprolol affects your heart rate, you should stop taking it before you’re given dipyridamole to help ensure an accurate test result.

All possible dosages and forms may not be included here. Your dosage, form, and how often you take the drug will depend on:

• your age
• the condition being treated
• how severe your condition is
• other medical conditions you have
• how you react to the first dose

Dosage for high blood pressure

Generic: Metoprolol

• Form: immediate-release oral tablet (metoprolol tartrate)
• Strength: 25 mg, 37. 5 mg, 50 mg, 75 mg, and 100 mg
• Form: extended-release oral tablet (metoprolol succinate)
• Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Brand: Lopressor

• Form: immediate-release oral tablet (metoprolol tartrate)
• Strength: 50 mg and 100 mg

Brand: Toprol XL

• Form: extended-release oral tablet (metoprolol succinate)
• Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Adult dosage (ages 18–64 years)

Immediate-release tablets

• Typical starting dosage: 100 mg daily in a single or divided doses. This may be gradually increased if needed.
• Typical maintenance dosage: 100–450 mg per day.
• Maximum dosage: 450 mg per day.

Extended-release tablets

• Typical starting dosage: 25–100 mg daily in a single dose. This may be gradually increased if needed.
• Maximum dosage: 400 mg per day.

Child dosage (ages 6–17 years)

Extended-release tablets

• Typical starting dosage: 1 mg/kg once daily (maximum initial dose should not exceed 50 mg once daily). This dosage may be gradually increased if needed.
• Maximum dosage: 2 mg/kg (or 200 mg) once daily.

Immediate-release tablets

These tablets are not approved for use in this age group.

Child dosage (ages 0–5 years)

Dosage for people younger than 6 years hasn’t been established.

Senior dosage (ages 65 years and older)

Your body may process this drug more slowly. Your doctor may start you on a lowered dosage so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous.

Dosage for angina (chest pain)

Generic: Metoprolol

• Form: immediate-release oral tablet (metoprolol tartrate)
• Strength: 25 mg, 37. 5 mg, 50 mg, 75 mg, and 100 mg
• Form: extended-release oral tablet (metoprolol succinate)
• Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Brand: Lopressor

• Form: immediate-release oral tablet (metoprolol tartrate)
• Strength: 50 mg and 100 mg

Brand: Toprol XL

• Form: extended-release oral tablet (metoprolol succinate)
• Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Adult dosage (ages 18–64 years)

Immediate-release tablets

• Typical starting dosage: 50 mg, taken twice a day. This may be gradually increased as needed.
• Typical maintenance dosage: 100–400 mg per day.
• Maximum dosage: 400 mg per day.

Extended-release tablets

• Typical starting dosage: 100 mg taken once a day. This may be gradually increased if needed.
• Maximum dosage: 400 mg per day.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Senior dosage (ages 65 years and older)

Your body may process this drug more slowly. Your doctor may start you on a lowered dosage so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous.

Dosage for after a heart attack

Generic: Metoprolol

• Form: immediate-release oral tablet (metoprolol tartrate)
• Strength: 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg

Brand: Lopressor

• Form: immediate-release oral tablet (metoprolol tartrate)
• Strength: 50 mg and 100 mg

Adult dosage (ages 18–64 years)

Immediate-release tablets

Treatment with this drug is often started in the hospital with the intravenous formulation as soon as possible after a heart attack. Treatment with the oral medication as noted below is begun if your body tolerates the intravenous dosing.

• Typical starting dosage: 50 mg every 6 hours starting 15 minutes after the last intravenous dose and continuing for 48 hours.
• Typical maintenance dosage: 100 mg twice daily.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Senior dosage (ages 65 years and older)

Your body may process this drug more slowly. Your doctor may start you on a lowered dosage so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous.

Dosage for heart failure

Generic: Metoprolol

• Form: extended-release oral tablet (metoprolol succinate)
• Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Brand: Toprol XL

• Form: extended-release oral tablet (metoprolol succinate)
• Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Adult dosage (ages 18–64 years)

Extended-release tablets

• Typical starting dosage: For people with NYHA Class II heart failure, it’s 25 mg once daily for 2 weeks. For people with more severe heart failure, it’s 12.5 mg once daily.
• Typical maintenance dosage: Your doctor can double the dosage every 2 weeks to the highest dosage level your body will tolerate, or up to 200 mg per day.

Child dosage (ages 0–17 years)

Dosage for people younger than 18 years hasn’t been established.

Senior dosage (ages 65 years and older)

Your body may process this drug more slowly. Your doctor may start you on a lowered dosage so that too much of this drug does not build up in your body. Too much of the drug in your body can be dangerous.

Special dosage considerations

For people with liver disease: Liver disease may affect your dosage. Your doctor can tell you more.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

FDA warning: Don’t stop taking metoprolol suddenly

• This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.
• Don’t stop taking metoprolol suddenly. If you do, you may experience worse chest pain, a jump in blood pressure, or even have a heart attack. Stopping metoprolol is not recommended. If you need to stop taking the drug, first talk to your doctor. Your dosage should be gradually decreased under a doctor’s supervision.

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Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your throat or tongue

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with asthma or COPD: Generally, people with asthma or chronic obstructive pulmonary disease (COPD) shouldn’t take metoprolol. A doctor may still prescribe it, but with careful monitoring. At higher doses, metoprolol can block different receptors on the breathing passages. This narrows the passages, which worsens asthma or COPD.

For people with diabetes: Metoprolol may eliminate tremors and reduce heart rate. Tremors and an increased heart rate are signs of low blood sugar. Without these signals, it becomes more difficult to recognize low blood sugar levels.

For people with poor circulation: If you have poor circulation in your feet and hands, it may become worse when taking metoprolol. Because metoprolol reduces blood pressure, you may get even less blood to these parts of your body.

Warnings for other groups

For pregnant women: Metoprolol is a category C pregnancy drug. That means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans.

If you’re pregnant and have high blood pressure, speak with your healthcare provider about your treatment options during pregnancy.

For women who are breastfeeding: Metoprolol enters the breast milk and could be passed to your baby if you breastfeed while taking this drug. Talk to your healthcare provider before breastfeeding.

For seniors: Seniors may need a smaller dosage of metoprolol at first. The dosage may then increase gradually.

For children: The immediate-release form of the drug has not been established as safe or effective in children. The extended-release form of this drug can be used to treat high blood pressure in children 6 years of age or older.

Metoprolol oral tablet can be used either as a short-term drug or a long-term drug. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all: You risk:

• increasing your blood pressure
• damaging your blood vessels or main organs, such as your lungs, heart, or liver
• increasing your risk of a heart attack

Also, if you suddenly stop taking metoprolol for high blood pressure, chest pain, or after a heart attack, you raise your risk of heart attack.

If you miss doses or don’t take the drug on schedule: Not taking metoprolol every day, skipping days, or taking doses at different times of day also come with risks. Your blood pressure might fluctuate too often. That might increase your risk for a heart attack.

If you take too much: You could have dangerous levels of the drug in your body. Symptoms of an overdose of this drug can include:

• severe low blood pressure
• heart rhythm changes
• nausea
• vomiting

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: If you miss a dose, just take the next dose as planned. Don’t double your dose.

How to tell if the drug is working:

• For high blood pressure or heart failure: You may not be able to tell if this drug is working. Your doctor can do tests to determine if the drug is helping to treat your condition.
• For angina: Your chest pain should be reduced.

Keep these considerations in mind if your doctor prescribes metoprolol oral tablet for you.

General

• Take metoprolol with food. This drug may cause nausea. Taking it with food will allow your stomach to digest it better. Take it either with a meal or right after a meal.
• Don’t crush the extended-release tablet. However, you can cut the tablet along the score marks (the groove on the tablet) if your doctor recommends a smaller dose.
• You can cut the immediate-release tablet.

Storage

• Store at room temperature between 68°F and 77°F (20°C and 25°C). You may briefly store the drug at temperatures as low as 59°F (15°C) and as high as 86°F (30°C).
• Keep this drug away from light.
• Don’t store this medication in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is not refillable.You or your pharmacy will have to contact your doctor for a new prescription if you need this medication refilled.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

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Metoprolol succinate (Metoprolol succinate). Substance-powder Reference book of medicines. Tomsk

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Packaging

Substance-powder

Pharmacological action

Selective beta-blocker without internal sympathomimetic activity. Due to the peculiarities of the dosage form, a constant concentration of metoprolol in the blood plasma is maintained and a stable clinical effect is provided for 24 hours. The drug is characterized by better beta-selectivity compared to traditional metoprolol.

Indications for use

Selective beta-blocker without internal sympathomimetic activity. Due to the peculiarities of the dosage form, a constant concentration of metoprolol in the blood plasma is maintained and a stable clinical effect is provided for 24 hours. The drug is characterized by better beta-selectivity compared to traditional metoprolol.

Presentation form

substance-powder; package (bag) polyethylene two-layer 0.1 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 0.5 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 1.2.5 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 10.15.20.25 kg fiber drum 1;

substance-powder; package (bag) polyethylene two-layer 10,15,20,25,30 and 35 kg cardboard container 1;

Pharmacodynamics

Selective beta-blocker without internal sympathomimetic activity. Due to the peculiarities of the dosage form, a constant concentration of metoprolol in the blood plasma is maintained and a stable clinical effect is provided for 24 hours. The drug is characterized by better beta-selectivity compared to traditional metoprolol.

Reduces the risk of side effects (bradycardia, weakness). To a lesser extent, it affects the smooth muscles of the bronchi, the release of insulin, carbohydrate metabolism and the activity of the cardiovascular system. Application for arterial hypertension leads to a decrease in blood pressure for more than 24 hours. At the beginning of treatment, an increase in OPSS is noted, with prolonged use, OPSS decreases.

Pharmacokinetics

Bioavailability – 30-40%. The release rate depends on the acidity of the medium. Communication with proteins – 5-10%. T1 / 2 – 3.5 hours. Biotransformation – in the liver by oxidation. It is excreted in the urine as metabolites, about 5% unchanged.

Use during pregnancy

Possible if the expected effect of therapy outweighs the potential risk to the fetus. At the time of treatment should stop breastfeeding.

Contraindications for use

AV block II and III degree, sinoatrial block, SSSU, arterial hypotension, CHF in the stage of decompensation, cardiogenic shock, suspected acute MI with a heart rate of less than 45 bpm, peripheral circulatory disorders, i/ in the introduction of calcium channel blockers (with simultaneous intravenous administration of verapamil, the risk of cardiac arrest should be borne in mind), age up to 18 years, hypersensitivity to metoprolol.

Side effects

At the beginning of therapy, weakness, fatigue, dizziness, headache, muscle cramps, a feeling of coldness and paresthesia in the extremities are possible. Also possible are bradycardia, hypotension, AV conduction disturbances, the appearance of symptoms of heart failure, a decrease in the secretion of lacrimal fluid, conjunctivitis, rhinitis, depression, sleep disturbances, nightmares, dry mouth, hypoglycemic conditions in patients with diabetes mellitus, vomiting, diarrhea, constipation. Predisposed patients may develop symptoms of bronchial obstruction. Individual cases of liver dysfunction, thrombocytopenia have been noted.

Method of administration and dosage

In arterial hypertension, the initial dose is 50-100 mg 1 r / day. With angina pectoris, the daily dose is 50-100 mg 1 r / day.

With maintenance treatment of MI, the drug is prescribed at 200 mg 1 r / day. The minimum duration of the course of treatment is 3 months. With supraventricular tachycardia and extrasystole, the drug is prescribed at 100-100 mg 1 r / day.

In CHF, the dose is selected individually, the initial dose for the first 2 weeks is 12.5 mg 1 r / day, then the dose is increased to 25 mg 1 r / day, after 2 weeks – up to 50 mg 1 r / day, with good tolerance, the dose can be increased up to 200 mg 1 r / day. For the prevention of migraine attacks, the drug is used in a daily dose of 100-200 mg 1 r / day.

Overdose

Symptoms: arterial hypotension, acute heart failure, bradycardia, cardiac arrest, AV blockade, cardiogenic shock, bronchospasm, impaired breathing and consciousness / coma, nausea, vomiting, generalized convulsions, cyanosis (manifested 20 minutes – 2 hours after ingestion ).

Treatment: gastric lavage, symptomatic therapy: the introduction of atropine sulfate (in / in quickly 0.5-2 mg) – with bradycardia and impaired AV conduction; glucagon (1-10 mg IV, then IV drip 2-2.5 mg/h) and dobutamine – in case of decreased myocardial contractility; adrenomimetics (norepinephrine, adrenaline, etc.) – with arterial hypotension; diazepam (in / in slowly) – to eliminate seizures; inhalation of beta-adrenergic agonists or intravenous jet administration of aminophylline for the relief of bronchospastic reactions; pacing.

Interaction with other drugs

Class I antiarrhythmic drugs – summation of negative inotropic action. The content of metoprolol in the blood plasma increases with the simultaneous use of antacids, diphenhydramine, hydralazines, oral contraceptives, ranitidine and, apparently, cimetidine. Reception of rifampicin reduces the concentration of metoprolol in the blood plasma.

Storage conditions

List B.: In a place protected from light, in sealed packaging, at a temperature not exceeding 30 °C.

Expiration date

36 months

Metoprolol – instructions for use, indications, composition

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Instruction provided by the state. register of medical preparations of Ukraine

Official instruction

Composition:

Dosage form:

tablets

Basic physical and chemical properties:

round tablets with a flat surface, white or white with a creamy tint, with two perpendicular intersecting lines and a chamfer.

Producer:

Kievmedpreparat, PAO

Location of the manufacturer:

Ukraine, 01032, Kyiv, st. Saksaganskogo, 139

Pharmacotherapeutic group:

Selective blockers of beta-adrenergic receptors. Metoprolol.

Pharmacological properties:

Indications for use:

Contraindications:

Application features:

When taking metoprolol tartrate, as with other β-blockers, it is necessary to monitor heart rate (HR) and blood pressure (BP) (at first daily, then 1 time per month).

Patients taking β-blockers should not be given verapamil-type calcium antagonists.

In patients receiving β-blockers, epinephrine may increase blood pressure and cause (reflex) bradycardia; this reaction is less likely with selective β-blockers.

Metoprolol may exacerbate existing bradycardia.

Since metoprolol must be discontinued prior to surgery, withdrawal should be made no later than 48 hours prior to surgery, except in special cases such as thyrotoxicosis or pheochromocytoma.

However, in some cases, the administration of β-blockers before surgery may be useful, as they can reduce arrhythmogenic effects and reduce coronary circulation during surgical stress, resulting in an advantage in sympathetic tone. If, for these reasons, a β-blocker is used in a patient, an anesthetic with a weak negative isotropic effect should be selected to reduce the risk of myocardial depression.

Before performing general anesthesia, the anesthesiologist must be informed that the patient is using metoprolol. It is not recommended to stop treatment during surgery.

Very rarely, pre-existing moderate atrioventricular conduction disturbances may worsen, sometimes with the development of atrioventricular block.

Bioavailability of metoprolol may be increased in liver cirrhosis.

As a rule, in the treatment of patients with bronchial asthma,

β2-agonists (tablets or aerosols). In cases where these patients start taking the drug, it may be necessary to increase the dose of β2-agonists. The risk that the drug will act on β2 receptors is lower than in the case of the use of conventional non-selective β1-blockers in tablets.

Especially careful medical supervision is necessary in the treatment of patients with diabetes mellitus (blood glucose control), patients with unstable blood sugar levels, when using a strict fasting diet. During treatment with metoprolol, there is a minimal risk of affecting sugar metabolism or masked hypoglycemia compared with treatment with non-selective β-blockers.

Metroprolol may mask some of the clinical manifestations of thyrotoxicosis (eg, tachycardia). Abrupt withdrawal of the drug for patients with thyrotoxicosis is contraindicated due to a possible increase in symptoms.

Patients who are being treated for heart failure should be treated before and during treatment with metoprolol.

Very rarely, mild pre-existing AV conduction disorders can aggravate and lead to more severe AV block. Patients with first degree AV block should be treated with this drug very carefully.

Use metoprolol with caution in patients with myasthenia gravis.

If bradycardia develops (heart rate less than 50-55 bpm) during treatment with metoprolol, the dose should be reduced and / or the drug should be gradually discontinued.

Due to its antihypertensive effect, the drug may increase the symptoms of peripheral circulatory disorders, such as intermittent claudication.

If the drug is used in patients with pheochromocytoma, an α-sympatholytic drug should be used in parallel.

If it is necessary to stop treatment and, when possible, it should be stopped within 10-14 days with a daily dose reduction of 25 mg per day for the last 6 days. During this period, special attention should be paid to patients with coronary heart disease. The risk of heart attacks, including sudden death, may increase when treatment with β-blockers is discontinued.

Metoprolol may cause a slight increase in triglycerides and a decrease in free fatty acids in the blood. In some cases, a slight decrease in low-density lipoprotein (LDL) levels was observed, and it was significantly less compared with non-selective β2-blockers. However, there is evidence that one study showed a significant reduction in total cholesterol levels after treatment with metoprolol for several years.

Insufficient experience with the use of metoprolol in patients with heart failure and such concomitant factors: unstable heart failure (NYHA IV) acute myocardial infarction or unstable angina in the previous 28 days impaired renal and hepatic function; the patient’s age is from 80 years and less than 40 years of hemodynamically expressed valve diseases; hypertrophic obstructive cardiomyopathy; during or within 4 months after cardiac surgery. Treatment of such patients should be carried out by doctors with special skills and experience.

In patients with Prinzmetal’s angina, the frequency and severity of angina attacks may increase due to α-receptor mediated coronary vasoconstriction. Therefore, such patients should not be prescribed non-selective β-blockers, selective β1-blockers should be used with caution.

Anaphylactic shock is severe in patients treated with β-blockers.

Patients with a history of severe allergic reactions should be treated with metoprolol very carefully. Particular attention should also be paid to patients with allergic reactions who are being treated with vaccines (desensitization therapy). The effect of the introduction of conventional doses of adrenaline may be absent.

Patients using contact lenses should be aware that the drug may reduce the secretion of lacrimal fluid.

Patients with a history of psoriasis or depressive illness should only be treated with metoprolol after careful consideration of the benefit-to-risk ratio.

Patients with severely impaired renal function, with serious acute conditions accompanied by metabolic acidosis and patients receiving combined treatment with digitalis preparations should be given special attention.

This product contains lactose and should not be used in patients with hereditary lactase deficiency, galactose intolerance or impaired glucose/galactose metabolism.

Use during pregnancy or lactation:

The ability to influence the reaction rate when driving
by road:

Dizziness and fatigue may occur during treatment. Patients whose activities are associated with attention strain, namely: driving a car and working with mechanisms, should be warned about the possibility of such effects.

Children:

The drug is contraindicated in children.

Method of application and dose:

Overdose:

Symptoms: an overdose of metoprolol can lead to a strong decrease in blood pressure, sinus bradycardia, atrioventricular block I-III degree, prolongation of the QT interval, asystole, insufficient peripheral perfusion, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, depression or stop respiration, increased fatigue, impairment or loss of consciousness, fluttery tremor, convulsions, excessive sweating, paresthesia, coma, nausea, vomiting, spasms of the esophagus, hypoglycemia (especially in children), hyperglycemia, cyanosis, hypokalemia, hyperkalemia, confusion, negative effects on kidney and temporary myasthenic syndrome.

Concomitant use of alcohol, antihypertensive drugs, quinidine or barbiturates may worsen the patient’s condition. The first signs of an overdose may occur 20 minutes to 2 hours after an overdose.

Treatment is carried out in an intensive care unit. Reception of activated carbon, if necessary – gastric lavage. In the case of severe forms of hypotension, bradycardia or the threat of heart failure, a β1-agonist should be administered intravenously (for example, prenalterol) at intervals of 2-5 minutes or by infusion until a therapeutic effect is achieved. In the absence of a selective β1-agonist, dopamine or atropine sulfate can be administered to block the vagus nerve. Atropine (0.25–0.5 mg in adults, 10–20 mcg/kg body weight in children) should be given in gastric lavage due to the risk of vagal stimulation. May require intubation and use of a ventilator; adequate restoration of circulating blood volume; glucose infusion; ECG monitoring; repeated administration of atropine 1-2 mg (mainly with vagal symptoms). If a therapeutic effect is not achieved, other sympathomimetics such as dobutamine or norepinephrine can be used.

Glucagon 50-150 µg/kg IV should also be given, as well as amrinone. With significant bradycardia, refractory to drug therapy, it is necessary to use an artificial pacemaker. To stop bronchospasm, an intravenous β2-agonist should be administered. It should be borne in mind that the doses of antidotes required to eliminate the symptoms of an overdose of β-blockers are much higher than therapeutic, since β-receptors are associated with β-blockers.

Toxicity. In an adult, a dose of 7.5 g caused a lethal intoxication. The intake of 100 mg by a 5-year-old child was not accompanied by symptoms of intoxication after gastric lavage. A moderate intoxication was caused by a dose of 450 mg in a 12-year-old child and a dose of 2.5 g, and 7.5 g – a very serious intoxication.

Careful monitoring of the patient (circulation and respiratory parameters, kidney function, glucose levels, serum electrolytes) is necessary.

In case of myocardial depression: infusion of dobutamine or dobutamine and calcium glubionate 9 mg/ml, 10-20 ml.

Side effects:

On the part of the blood and lymphatic system: thrombocytopenia, agranulocytosis, leukopenia.

Metabolic and nutritional disorders: weight gain.

From the side of the psyche: sleep disturbance, drowsiness, insomnia, nightmares, depression, attention disorder, memory disorders, amnesia, confusion, hallucinations, nervousness, anxiety.

From the nervous system: dizziness, headache, paresthesia, taste disorders.

On the part of the organ of vision: blurred vision, dry eyes or inflammation of the conjunctiva.

On the part of the organs of hearing and balance: sensation of noise / ringing in the ears, hearing impairment.

Cardiac disorders: postural disturbances (very rarely with dizziness), cold extremities, bradycardia, 1st, 2nd, or 3rd degree block, pericardial pain, chest pain, transient worsening of symptoms of heart failure, tachycardia, arrhythmias, cardiac abnormalities conduction, arterial hypotension, cardiogenic shock in patients with acute myocardial infarction, tachycardia.

On the part of the vessels: orthostatic arterial hypotension (which in very rare cases is accompanied by syncope), Raynaud’s syndrome, gangrene in patients with existing severe peripheral circulatory disorders.

From the respiratory system, chest and mediastinum: shortness of breath on exertion, bronchospasm, rhinitis.

From the gastrointestinal tract: nausea, vomiting, abdominal pain, diarrhea, constipation, dry mouth, heartburn, bloating.

From the digestive system: hepatitis.

From the skin and subcutaneous tissue: hypersensitivity reactions, including rash (in the form of psoriatic and degenerative skin lesions), urticaria, itching, erythema; photosensitivity, psoriasis, increased severity of psoriasis, increased sweating, hair loss; fat metabolism disorders.

From the musculoskeletal system and connective tissue: muscle spasms, arthralgia, increased symptoms of intermittent claudication, muscle weakness.

From the reproductive system and mammary glands: impotence / sexual dysfunction, Peyronie’s disease.

General disorders and reactions at the injection site: increased fatigue, peripheral edema.

Lab Findings: abnormal liver function tests, antinuclear antibodies (not associated with systemic lupus erythematosus), decreased high-density lipoprotein (HDL) cholesterol, and elevated triglycerides with normal total cholesterol.

Metoprolol may mask the symptoms of thyrotoxicosis, a manifestation of latent diabetes mellitus.

Drug Interactions:

Patients should be closely monitored if they are taking ganglioblockers, other β-blockers (eg eye drops) or monoamine oxidase inhibitors (i-MAOIs) concomitantly with Metoprolol.

Co-administration with propafenone should be avoided. Propafenone inhibits the metabolism of metoprolol through cytochrome P450 2D6. The result of this combination is unpredictable, since propafenone also has β-blocking properties.

Sudden withdrawal of clonidine during treatment with β-blockers may increase blood pressure. If concomitant clonidine therapy is to be discontinued, the β-blocker should be discontinued a few days before clonidine is discontinued.

Negative inotropic and chronotropic effects may occur in patients who are taking verapamil-type calcium antagonists or diltiazem and/or drugs for the treatment of arrhythmias concomitantly with Metoprolol. Patients taking β-blockers should not be given intravenous verapamil (due to the risk of cardiac arrest). β-blockers may enhance the negative inotropic and chronotropic effects of drugs for the treatment of arrhythmias (quinidine analogues or amiodarone). Interaction with amiodarone (pronounced sinus bradycardia) may occur for a long time after discontinuation of the drug.

In patients treated with β-blockers, inhalational anesthetics increase the cardiodepressive effect. Inducers or inhibitors of metabolism can affect the concentration of metoprolol in blood plasma. Plasma concentrations of metoprolol decrease with rifampicin or may increase with cimetidine, phenytoin, alcohol, hydralazine, and serotonin reuptake inhibitors (paroxetine, fluoxetine, and sertraline).

With simultaneous treatment with indomethacin or other drugs that inhibit prostaglandin synthetase, the antihypertensive effect of β-blockers may decrease.

Cardioselective β-blockers have a significantly less effect on blood pressure when epinephrine is administered to patients than non-selective β-blockers.

Diltiazem and β-receptor blockers have an additive inhibitory effect on AV conduction and sinus node function. In this case, severe bradycardia can be observed.

β-receptor blockers may provoke paradoxical hypertensive reactions in patients using high doses of phenylpropanolamine.

Co-administration of β-blockers with insulin or oral hypoglycemic agents may enhance or prolong their action. In this case, the symptoms of hypoglycemia (especially tachycardia and tremor) may be masked or disappear. In such cases, it is necessary to conduct regular monitoring of blood glucose levels.

Concomitant use with barbiturates should be avoided because barbiturates (tested for pentobarbital) stimulate the metabolism of metoprolol by enzyme induction. Plasma concentrations of metoprolol may be affected by drugs that inhibit CYP 2D6, such as quinidine, terbinafine, paroxetine, fluoxetine, sertraline, celecoxib, propafenone, and diphenhydramine. At the beginning of treatment with these drugs, it may be necessary to reduce the dose of metoprolol.

Simultaneous use of digitalis glycosides and β-receptor blockers may increase AV conduction time and cause bradycardia. Diphenhydramine reduces (by 2.5 times) the clearance of metoprolol to α-hydroxymetoprolol via the CYP 2D6 system in individuals with rapid hydroxylation. The effects of metroprolol are enhanced. It is possible that diphenhydramine may inhibit the metabolism of other CYP 2D6 substrates.

Rifampicin may stimulate the metabolism of metoprolol resulting in decreased plasma levels.

Caution should be exercised when combined with nitrates due to the risk of hypotension and/or bradycardia.

Expiration date:

5 years.