What is metoprolol used for? What are the side effects of metoprolol? This article provides a detailed overview of the indications, mechanism of action, administration, and adverse effects of the medication metoprolol.

Indications of Metoprolol

Metoprolol is a FDA-approved medication used to treat a variety of cardiovascular conditions, including angina, heart failure, myocardial infarction, atrial fibrillation/flutter, and hypertension. It also has off-label uses for the management of supraventricular tachycardia and thyroid storm. Both oral and intravenous formulations of metoprolol are available, with immediate-release and extended-release preparations offered orally.

The selection of beta-blockers for the above conditions remains a topic of controversy, and there is conflicting evidence regarding the optimal choice of a particular beta-blocker for each specific disease. Several landmark studies have, however, demonstrated the clinical benefits of metoprolol in specific settings. For example, the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) trial showed a reduction in sudden cardiac death and myocardial infarction with metoprolol compared to diuretics. A large randomized trial in the 1990s also found that chronic use of metoprolol after myocardial infarction can reduce mortality and risk of re-infarction.

Additionally, beta-blockers such as metoprolol have demonstrated prognostic benefit and reduced mortality in the treatment of chronic heart failure. The Carvedilol or Metoprolol European Trial (COMET) directly compared metoprolol and carvedilol, showing a statistically significant lower risk of all-cause death with carvedilol. However, more recent trials have had conflicting evidence on whether selective beta-1 blockers like metoprolol provide any additional benefit over other beta-blockers like carvedilol.

Mechanism of Action of Metoprolol

Metoprolol is a cardioselective beta-1-adrenergic receptor antagonist, meaning it competitively blocks beta-1 receptors with minimal effects on beta-2 receptors at oral doses less than 100 mg in adults. This mechanism of action leads to a decrease in cardiac output through negative inotropic (reduced contractility) and chronotropic (reduced heart rate) effects.

Metoprolol is a lipophilic drug that is almost completely absorbed from the gastrointestinal tract when taken orally. However, there is significant hepatic first-pass elimination, resulting in only around 50% of the oral dose reaching the systemic circulation. Metoprolol is approximately 11% bound to serum albumin, and its half-life is typically 3-4 hours in most patients for the non-extended-release formulation. Metoprolol is primarily excreted through the kidneys.

Compared to the immediate-release metoprolol tartrate, the extended-release metoprolol succinate formulation produces more consistent drug concentrations with less peak-to-trough variation. However, studies have shown that both formulations have similar clinical effects, both acutely and chronically.

Administration of Metoprolol

Metoprolol can be administered orally or intravenously. The immediate-release oral formulation should be taken with or immediately following food intake. The short-acting metoprolol tartrate is typically dosed twice daily, while the once-daily dosing may be effective for hypertension, though lower doses may not provide 24-hour blood pressure control.

For the extended-release metoprolol succinate, the recommended starting dose is 25-100 mg once daily, with the dose titrated based on the patient’s response and tolerability. The maximum recommended daily dose is 400 mg for the extended-release formulation.

Adverse Effects of Metoprolol

What are the side effects of metoprolol? Metoprolol can cause a range of adverse effects, including:

• Bradycardia (slow heart rate)
• Hypotension (low blood pressure)
• Fatigue
• Dizziness
• Nausea
• Constipation
• Bronchospasm (in patients with reactive airway disease)
• Exacerbation of heart failure symptoms

Patients with certain conditions, such as sinus bradycardia, heart block, or cardiogenic shock, may be at increased risk of adverse effects and should be closely monitored when starting metoprolol therapy.

Contraindications and Precautions with Metoprolol

Metoprolol is contraindicated in patients with:

• Cardiogenic shock
• Sinus bradycardia
• Second- or third-degree atrioventricular block (without a pacemaker)
• Overt cardiac failure

Caution should be exercised when using metoprolol in patients with:

• Pulmonary disease (e.g., COPD, asthma)
• Diabetes mellitus (risk of masking hypoglycemia symptoms)
• Peripheral vascular disease
• Thyrotoxicosis (risk of worsening symptoms)

Interprofessional Team Strategies for Metoprolol Management

To optimize the safe and effective use of metoprolol, an interprofessional team approach is recommended. This involves coordination and communication between healthcare providers, including physicians, pharmacists, and nurses. Key strategies include:

• Careful patient selection and monitoring for appropriate indications
• Titration of metoprolol dosage to achieve optimal clinical effects while minimizing adverse events
• Monitoring of vital signs, ECG, and laboratory parameters (e.g., electrolytes, liver function tests)
• Patient education on the proper administration of metoprolol, expected effects, and potential side effects
• Coordination of care, especially for patients with comorbidities or at high risk of adverse events

By implementing these interprofessional strategies, the healthcare team can enhance patient outcomes and safety in the management of conditions where metoprolol is clinically indicated.

Conclusion

In conclusion, metoprolol is a versatile and widely used beta-blocker with a range of approved indications, including angina, heart failure, myocardial infarction, atrial fibrillation/flutter, and hypertension. It exerts its effects through selective beta-1 adrenergic receptor blockade, leading to reduced cardiac output and heart rate. While there is ongoing debate about the optimal choice of beta-blocker in various clinical scenarios, metoprolol has demonstrated significant clinical benefits in numerous studies.

Healthcare providers should be aware of the appropriate use, administration, adverse effects, and precautions associated with metoprolol to ensure its safe and effective use in the management of cardiovascular conditions. An interprofessional team approach, involving coordination and communication between physicians, pharmacists, and nurses, is crucial for optimizing patient outcomes with metoprolol therapy.

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.

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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.

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.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. CONSULTATION OF A SPECIALIST IS REQUIRED. 0005

Podoinitsyna Alena Andreevna,

Diploma of Pharmaceutical Education: 105924 3510722 reg. number 31917

All authors

Contents of the article

• Metoprolol: mechanism of action
• Metoprolol: from what
• Metoprolol: prescription
• Metoprolol: dosage
• Metoprolol: analogues
• Metoprolol or Egilok: which is better
• Anaprilin or Metoprolol: what 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.

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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.

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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.

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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.

Ask an expert about the topic of the article

Still have questions? Ask them in the comments below and our experts will answer you. There you can also share your experience with other readers of Megasovets.

Managing editor

Zotina Natalya Igorevna,

Expert pharmacist

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Metoprolol: side effects, dosage, application and more

content

Highlights for metoprolol

• Metoprolol tablets for oral use available as a generic and as a branded drug. Trade names: Lopressor and Toprol XL.
• Metoprolol is available in the form of immediate and extended release tablets and extended release capsules. It also comes as an injection, which is only given by a healthcare provider.
• Metoprolol is a beta-blocker medicine. It is used to treat high blood pressure, heart failure, and angina (chest pain).

What is metoprolol?

Metoprolol is a prescription drug. It is available in the form of sustained-release and sustained-release oral tablets, as well as sustained-release oral capsules. It also comes as an injection, which is only given by a healthcare provider.

Metoprolol oral tablets are available as protected drugs Lopressor and Toprol XL. They are also available as generic drugs. Generics usually cost less than versions. In some cases, they may not be available in all strengths and forms as protected drugs.

The two commercial forms of metoprolol (as well as various generic forms) are different versions of the drug. Both are metoprolol but contain different forms of salt. Lopressor is metoprolol tartrate and Toprol-XL is metoprolol succinate. various forms of salt include drugs used to treat various conditions.

Metoprolol succinate is a sustained release version of metoprolol so it stays in the blood longer. Metoprolol tartrate is an instant release version of metoprolol.

Why it is used

Both metoprolol tartrate (Lopressor) and metoprolol succinate (Toprol-XL) are used for:

• reduce high blood pressure
• reduce chest pain (angina) 90 014

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

Metoprolol can be used in combination therapy. This means you may need to take it with hydrochlorothiazide or chlorthalidone.

How it works

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

Blood pressure often rises due to constriction of the blood vessels. This stresses the heart and increases the body’s need for oxygen.

Beta-blockers prevent norepinephrine (adrenaline) from acting on beta receptors in the blood vessels and heart. As a result, the vessels relax. By relaxing the blood vessels, beta-blockers help lower the heart rate and reduce the heart’s need for oxygen. This, in turn, helps lower blood pressure and reduce chest pain.

Side effects of metoprolol

Metoprolol oral tablets may cause certain side effects.

More common side effects

Common side effects that may occur with metoprolol include: 55 breathing problems such as shortness of breath, coughing and wheezing

If these effects are mild, they may disappear within a few days or a couple of weeks. If they are more severe or do not go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor if you have serious side effects. Call 911 if your symptoms seem life-threatening or if you think you need emergency medical attention. Serious side effects and their symptoms may include the following:

• Low blood pressure (hypotension). Symptoms may include:
  • severe dizziness
  • dizziness
  • unconsciousness
• Cold hands and feet. Symptoms may include
  • hands and feet may be cold and sore
• Very slow heart rate (severe bradycardia)
• Extreme fatigue. Symptoms may include:
  • feel more tired than usual
  • tiredness that gets worse every day
• severe depression Symptoms may include:
  • persistent sadness or anxiety
  • feeling hopeless or worthless that you once enjoyed
  • have too much or too little
  • concentration problems

Metoprolol may interact with other medicines.

Metoprolol oral tablet may interact with other medicines. Vitamins or herbs you may be taking. An interaction is when a substance changes the way a drug works. It can be harmful or prevent the medicine from working well.

To avoid interactions, your doctor must carefully administer all of your medicines. Tell your doctor about any medications, vitamins, or herbs you are taking. To find out how this medicine may interact with other medicines you are taking, talk to your doctor or pharmacist.

Examples of drugs that can interact with metoprolol are listed below.

Mental health medicines

Taking metoprolol with reserpine and monoamine oxidase inhibitors (MAOIs) may increase or increase the effects of metoprolol. They can also increase unconsciousness or slow down the heart rate. MAOIs may continue to interact with metoprolol for up to 14 days after ingestion. Examples of MAOIs include:

• 5555Boxazid
• Fenelzine
• Selegilin
• Tranilsipromin

CEUTION of the heart rhythm

Medication of heart rhythm with metoprolol can slow down the heart rhythm too much. Examples of such drugs include:

• digoxin
• quinidine
• propafenone

Calcium channel blockers

Like metoprolol, these drugs are used to treat high blood pressure and some other heart problems. In combination with metoprolol, calcium channel blockers can further slow the heart rate. Doctors sometimes use this combination under strict supervision.

Examples of calcium channel blockers include:

• amlodipine
• diltiazem
• felodipine
• isradipine
• nicardipine
• neither Fedipine
• Nimodipine
• Nisoldipine
• Verapamil

The drugs are handled in the same way as metoprolol.

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

• fluoxetine
• fluvoxamine
• paroxetine
• sertraline
• bupropion
• clomipramine
• desipramma 9 0014
• chlorpromazine
• fluphenazine
• haloperidol
• thioridazine

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

• antiretroviral ritonavir
• antihistamines, including diphenhydramine
• antimalarials such as hydroxychoroquine and quinidine
• antifungals such as terbinafine
• hydralazine blood pressure medicine

All of these drugs can increase the levels of metoprolol in the body.

Alpha blockers

Alpha blockers also lower blood pressure. They can lower blood pressure too much when combined with metoprolol. Examples of such preparations include:

• reserpine
• alpha-methyldopa
• clonidine
• prazosin

Clonidine should be administered with caution in combination with metoprolol. Abrupt discontinuation of the drug while taking metoprolol can cause a large jump in blood pressure.

Ergot alkaloids

Ergot alkaloids such as dihydroergotamine are narrow blood vessels that need to be treated. headaches. If taken at the same time as metoprolol, they can cause dangerous vasoconstriction.

dipyridamole

Dipyridamole is used to check the functioning of the heart. Since metoprolol affects the heart rate, stop taking it before giving him dipyridamole to ensure an accurate test result.

How to take metoprolol

Not all possible dosages and schedules are included here. Your dose, form and frequency of medication will depend on:

• your age
• the condition being treated
• how serious your condition is
• other health conditions you have
• how you respond to the first dose

High blood pressure dosage

Generic: metoprolol

• spilled tartrate).
• Strength: 25 mg, 37.5 mg, 50 mg, 75 mg and 100 mg
• Composition: long-acting oral tablet (metoprolol succinate).
• Strength: 25 mg, 50 mg, 100 mg and 200 mg

Trade name: Lopressor

• Presentation: immediate release oral tablet (metoprolol tartrate).
• Strength: 50 mg and 100 mg

Brand: Toprol XL

• Presentation: long-acting oral tablet (metoprolol succinate).
• Strength: 25mg, 50mg, 100mg and 200mg

Adult Dose (18-64 years)

Instant Release Tablets

• Typical starting dose: 100 mg per day as a single or divided dose. If necessary, it can be gradually increased.
• Typical maintenance dose: 100-450 mg per day.
• Maximum dose: 450 mg per day.

Long-acting tablets

• Typical starting dose: 25-100 mg once a day. If necessary, it can be gradually increased.
• Maximum dose: 400 mg per day.

Pediatric dose (ages 6-17 years)

Long-acting tablets

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

Instant Release Tablets

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

Pediatric dose (age 0-5 years)

Dosage for persons younger than 6 years has not been established.

Higher dose (age 65 and older)

Your body may process this medicine more slowly. Your doctor may start with a reduced dose so that too much of this medicine does not build up in your body. Too many drugs in your body can be dangerous.

Dosage for angina (chest pain)

Generic: Metoprolol

• Composition: instant release oral tablet (metoprolol tartrate).
• Strength: 25 mg, 37.5 mg, 50 mg, 75 mg and 100 mg
• Composition: long-acting oral tablet (metoprolol succinate).
• Strength: 25mg, 50mg, 100mg and 200mg

Trademark: Lopressor

• Presentation: immediate release oral tablet (metoprolol tartrate).
• Strength: 50 mg and 100 mg

Brand: Toprol XL

• Presentation: long-acting oral tablet (metoprolol succinate).
• Strength: 25 mg, 50 mg, 100 mg and 200 mg

Adult Dose (18-64 years)

Instant Release Tablets

• Typical starting dose: 50 mg twice daily. If necessary, it can be gradually increased.
• Typical maintenance dose: 100-400 mg per day.
• Maximum dose: 400 mg per day.

Long-acting tablets

• Typical starting dose: 100 mg once a day. If necessary, it can be gradually increased.
• Maximum dose: 400 mg per day.

Pediatric dose (age 0-17 years)

Dosage for persons under 18 years of age has not been established.

Higher dose (age 65 and older)

Your body may process this medicine more slowly. Your doctor may start with a reduced dose so that too much of this medicine does not build up in your body. Too many drugs in your body can be dangerous.

Dosage after infarction

Generic: Metoprolol

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

Trademark: Lopressor

• Presentation: instant release oral tablet (metoprolol tartrate).
• Strength: 50mg and 100mg

Adult Dose (18-64 years)

Instant Release Tablets

Treatment with this drug is often started in the hospital by intravenous injection as soon as possible after a heart attack. Treatment with oral medications, as described below, is started if your body can tolerate intravenous administration.

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

Pediatric dose (age 0-17 years)

Dosage for persons under 18 years of age has not been established.

Higher dose (age 65 and older)

Your body may process this medicine more slowly. Your doctor may start with a reduced dose so that too much of this medicine does not build up in your body. Too many drugs in your body can be dangerous.

Dosage for heart failure

Generic: Metoprolol

• Presentation: long-acting oral tablet (metoprolol succinate).
• Strength: 25mg, 50mg, 100mg and 200mg

Brand: Toprol XL

• Presentation: long-acting oral tablet (metoprolol succinate).
• Strength: 25mg, 50mg, 100mg, and 200mg

Adult Dose (18-64 years)

Long-acting tablets

• Typical starting dose: for people with NY Class II heart failure ha she makes up 25 mg once a day for 2 weeks. For people with severe heart failure, it is 12.5 mg once a day.
• Typical maintenance dose: Your doctor may double your dose every 2 weeks to the highest dose level your body can tolerate, up to 200 mg per day.

Pediatric dose (age 0-17 years)

Dosage for persons under 18 years of age has not been established.

Higher dose (age 65 and older)

Your body may process this medicine more slowly. Your doctor may start with a reduced dose so that too much of this medicine does not build up in your body. Too many drugs in your body can be dangerous.

Special dosage advice

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 current and up-to-date information. But because drugs affect each person differently, we cannot guarantee that this list includes all possible doses. This information does not replace medical advice. Always talk to your doctor or pharmacist about the doses that are right for you.

Infamous

FDA Warning: Do not stop taking metoprolol abruptly.

• This medicine 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 to exposure to drugs that may be dangerous.
• Do not stop taking metoprolol suddenly. If you do, you may experience more severe chest pain, a spike in blood pressure, or even a heart attack. Stopping metoprolol is not recommended. If you need to stop taking your medication, talk to your doctor first. The dosage should be gradually reduced under medical supervision.

Allergy warning

This medicine may cause a severe allergic reaction. Symptoms may include:

• trouble breathing
• swelling of the throat or tongue

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

Do not take this medicine again if you have ever had an allergic reaction to it. Repeated use may be lethal (lead to death).

Warnings for people with certain medical conditions

For people with asthma or COPD: In general, people with asthma or chronic obstructive pulmonary disease (COPD) should not take metoprolol. It can still be prescribed by a doctor, but under close supervision. At higher doses, metoprolol can block various receptors in the airways. This narrows the passages, which worsens asthma or COPD.

For people with diabetes: Metoprolol may relieve chills and decrease heart rate. Shaking and palpitations are a sign of low blood sugar. Without these signals, it becomes harder to recognize low blood sugar levels.

For people with poor circulation: if you have poor circulation in your legs and arms, it may get worse when you take metoprolol. Since metoprolol lowers blood pressure, you may get even less blood in these parts of the body.

Warnings for other groups

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

• Animal studies have shown harmful effects on the fetus when the mother takes the medicine.
• Not enough research has been done on humans.

If you are pregnant and have high blood pressure, talk to your doctor about treatment options while you are pregnant.

For breastfeeding women: Metoprolol is excreted in breast milk and may be passed to your baby if you are breastfeeding while you are taking this medicine. Talk to your doctor before breastfeeding.

Elderly: Elderly people may initially require a lower dose of metoprolol. Then the dosage can be gradually increased.

For children: The immediate release formulation has not been established to be safe or effective in children. This long-acting medicine can be used to treat high blood pressure in children over 6 years of age.

Take as directed

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

If you stop taking the drug or do not take it at all:

• increased blood pressure
• damage to blood vessels or major organs such as the lungs, heart or liver
• increases the risk of a heart attack stop taking metoprolol due to high blood pressure, chest pain or after a heart attack, you will increase the risk of a heart attack.

  If you miss a dose or do not take your medicine as scheduled: do not take metoprolol every day, skip days, or take doses at different times of the day, there is also a risk. Your blood pressure may fluctuate too much. This may increase the risk of a heart attack.

  If you take too much: you may have dangerous levels of the drug in your body. Overdose symptoms with this medicine may include:

  • severe low blood pressure
  • changes in heart rate
  • nausea
  • vomiting

  If you think you have taken too much of this medicine, call your doctor or ask for instructions in America nian association of toxicological centers by calling 800-222-1222 or through their online tool. But if you have severe symptoms, call 911 or contact the nearest ambulance immediately.

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

  How to find out if a medicine is working:

  • If you have high blood pressure or heart failure: You may not be able to tell if the medicine is working. Your doctor may run tests to see if the medicine is helping your condition.
  • For angina: relieve chest pain.

  Important considerations for taking metoprolol

  Keep this in mind if your doctor prescribes metoprolol oral tablets.

  Basic information

  • Take metoprolol with food. This medicine may cause nausea. Taking it with food helps your stomach digest it better. Take either with meals or immediately after meals.
  • Do not crush the extended release tablet. However, you may cut the tablet in dots (slits on the tablet) if your doctor recommends a lower dose.
  • You can cut the plate with instant release.

  Warehouse

  • Store at room temperature between 68°F and 77°F (20°C to 25°C). Short-term storage of the drug can be at 59°C (15°F) and high (86°C) 30°F.
  • Keep this medicine away from light.
  • Do not store this medicine in damp or damp places such as bathrooms.

  tapping

  A prescription for this medicine cannot be filled. If you need to refill this medicine, you will need to contact your doctor to get a new prescription.

  Are there alternatives?

  There are other medicines available to treat your condition. Some may suit you better than others. Talk to your doctor about other treatment options that may help you.

  Disclaimer: Today, Medical News has made every effort to ensure that all information is, in fact, correct, complete, and up-to-date. However, this article should not be used as a substitute for the knowledge and experience of a licensed healthcare professional.