Metoprolol: Uses, Dosage and Side Effects

 

Metoprolol: Uses, Dosage and Side Effects

What is metoprolol?

Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure).

Metoprolol is also used to lower your risk of death or needing to be hospitalized for heart failure.

Metoprolol injection is used during the early phase of a heart attack to lower the risk of death.

Warnings

You should not use metoprolol if you have a serious heart problem (heart block, sick sinus syndrome, slow heart rate), severe circulation problems, severe heart failure, or a history of slow heart beats that caused fainting.

Before taking this medicine

You should not use this medicine if you are allergic to metoprolol, or other beta-blockers (atenololcarvedilollabetalol, nadolol, nebivolol, propranolol, sotalol, and others), or if you have:

  • a serious heart problem such as heart block, sick sinus syndrome, or slow heart rate;

  • severe circulation problems;

  • severe heart failure (that required you to be in the hospital); or

  • a history of slow heart beats that have caused you to faint.

To make sure this medicine is safe for you, tell your doctor if you have:

  • asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;

  • diabetes (taking metoprolol may make it harder for you to tell when you have low blood sugar);

  • liver disease;

  • congestive heart failure;

  • problems with circulation (such as Raynaud's syndrome);

  • a thyroid disorder; or

  • pheochromocytoma (tumor of the adrenal gland).

Do not give this medicine to a child without medical advice.

Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether metoprolol will harm an unborn baby. However, having high blood pressure during pregnancy may cause complications such as diabetes or eclampsia (dangerously high blood pressure that can lead to medical problems in both mother and baby). The benefit of treating hypertension may outweigh any risks to the baby.

Ask a doctor before using this medicine if you are breast-feeding. Metoprolol can pass into breast milk and may cause dry skin, dry mouth, diarrhea, constipation, or slow heartbeats in your baby.

How should I take metoprolol?

Take metoprolol exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Metoprolol should be taken with a meal or just after a meal.

Take the medicine at the same time each day.

Swallow the capsule whole and do not crush, chew, break, or open it.

A Toprol XL tablet can be divided in half if your doctor has told you to do so. Swallow the half-tablet whole, without chewing or crushing.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

You will need frequent medical tests, and your blood pressure will need to be checked often.

If you need surgery, tell the surgeon ahead of time that you are using this medicine.

You should not stop using this medicine suddenly. Stopping suddenly may make your condition worse.

If you have high blood pressure, keep using metoprolol even if you feel well. High blood pressure often has no symptoms. You may need to use this medicine for the rest of your life.

Store at room temperature away from moisture and heat.

Metoprolol injection is given as an infusion into a vein. A healthcare provider will give you this injection in a medical setting where your heart and blood pressure can be monitored. The injections are given for only a short time before switching you to the oral form of this medicine.

Dosing information

Usual Adult Dose for Hypertension:

Metoprolol Tartrate Immediate Release Tablets:
Initial dose: 100 mg orally per day in single or divided doses

Maintenance dose: 100 to 450 mg orally per day.

Metoprolol Succinate Extended Release Tablets:
Initial dose: 25 to 100 mg orally once a day

Maintenance dose: 100 to 400 mg orally once a day.

Usual Adult Dose for Angina Pectoris:

Initial dose:
-Metoprolol tartrate immediate release tablets: 50 mg orally twice a day
-Metoprolol succinate extended release tablets: 100 mg orally once a day

Maintenance dose: 100 to 400 mg per day.

Usual Adult Dose for Myocardial Infarction:

Metoprolol Tartrate :
Early Treatment:
Initial dose: 5 mg IV every 2 minutes as tolerated for 3 doses
-Patients tolerant of full IV dose (15 mg): 50 mg orally every 6 hours starting 15 minutes after the last IV dose and continued for 48 hours
-Patients intolerant of full IV dose (15 mg): 25 or 50 mg orally every 6 hours depending on the degree of intolerance starting 15 minutes after the last IV dose or as soon as their clinical condition allows

Late Treatment:
Maintenance dose: 100 mg orally twice a day.

Usual Adult Dose for Congestive Heart Failure:

Metoprolol Succinate Extended Release Tablets:
25 mg orally once a day (12.5 mg orally once a day in patients with more severe heart failure); double dose every 2 weeks to highest tolerated dose or up to 200 mg orally once a day.

Usual Pediatric Dose for Hypertension:

Metoprolol Succinate Extended Release Tablets:
6 Years or Older:
Initial dose: 1 mg/kg orally once a day (not to exceed 50 mg orally once a day)

Maximum dose: 2 mg/kg (or 200 mg) orally once a day.

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What to avoid

Avoid driving or hazardous activity until you know how this medicine will affect you. Your reactions could be impaired.

Drinking alcohol can increase certain side effects of this medicine.

Metoprolol side effects

Get emergency medical help if you have signs of an allergic reaction to metoprolol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • very slow heartbeats;

  • a light-headed feeling, like you might pass out;

  • shortness of breath (even with mild exertion), swelling, rapid weight gain; or

  • cold feeling in your hands and feet.

Common metoprolol side effects may include:

  • dizziness, tired feeling;

  • depression, confusion, memory problems;

  • nightmares, trouble sleeping;

  • diarrhea; or

  • mild itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect metoprolol?

Tell your doctor about all your current medicines. Many drugs can interact with metoprolol, especially:

  • any other heart or blood pressure medications;

  • epinephrine (Epi-Pen);

  • an antidepressant;

  • an ergot medicine--dihydroergotamine, ergonovine, ergotamine, methylergonovine; or

  • an MAO inhibitor--isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine.

This list is not complete and many other drugs may interact with metoprolol. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

Popular FAQ

Which is safer: metoprolol succinate or tartrate?

Metoprolol succinate and metoprolol tartrate contain the same active drug, metoprolol. The only difference is the salt form. Similar side effects may occur. These include:

  • Dizziness
  • Tiredness
  • Decreased heart rate
  • Decreased blood pressure
  • Depression
  • Diarrhea
  • Rash
  • Feeling short of breath
  • Worsening heart failure or chest pain
  • Risk of heart attack or worsening chest pain if metoprolol is stopped abruptly

Does metoprolol cause weight gain?

Metoprolol is not likely to cause weight gain. However, weight gain can be a warning sign that heart failure is getting worse. If you are taking metoprolol for heart failure, tell your doctor right away if you gain weight suddenly. This weight gain is due to extra fluid in the body that may cause swelling in the feet, ankles, legs and belly. The fluid builds up because the heart isn’t working as well as it should.

Does metoprolol lower blood pressure?

Yes, metoprolol causes the blood vessels to relax, which helps to lower blood pressure. If you are prescribed metoprolol for high blood pressure, your doctor may ask you to check your blood pressure regularly at home with an automatic, cuff-style device that goes around your upper arm. Keeping track of your blood pressure at home is one way to help your doctor know if the prescribed dosage of metoprolol is working for you.

Should I take metoprolol in the morning or at night?

When you take metoprolol depends on which salt form is prescribed.

  • Metoprolol tartrate is usually taken twice daily, so it may be taken in the morning then at night.
  • Metoprolol succinate is taken once daily, so it may be taken either morning or night.
  • Both forms are usually taken with or immediately after a meal.

Follow your health care provider’s directions for when to take metoprolol.

Is Metoprolol a blood thinner?

No, metoprolol is not a blood thinner. It works to relax blood vessels and slow heart rate.

Your doctor may prescribe metoprolol tartrate to:

  • Lower blood pressure
  • Treat angina pectoris (a condition where the blood supply to the heart is decreased)
  • Lower the risk of death due to a heart attack

Metoprolol succinate may be prescribed to:

  • Lower blood pressure
  • Treat angina pectoris
  • Treat heart failure

How long does it take for metoprolol to work?

How long it takes metoprolol to work depends on what form is given and what condition is being treated. Effects on heart rate can be seen within one hour after taking metoprolol tartrate tablets and within 20 minutes after the intravenous form is given. The onset of action of metoprolol succinate is similar to metoprolol tartrate.

Metoprolol tartrate is immediate release (fast-acting), while metoprolol succinate is extended release (released over time). You usually take metoprolol tartrate twice daily and take metoprolol succinate once daily. Metoprolol tartrate also comes as an injection that’s given in the hospital and used in the early stages of a heart attack.

The dosage of metoprolol may need to be adjusted depending on what condition is being treated.

  • For high blood pressure or angina, the dosage may be increased at weekly intervals to reach the maximum effect.
  • For heart failure, the dosage of metoprolol succinate may be doubled every 2 weeks to reach the maximum effect.
  • For heart attacks that are caught early, the intravenous form of metoprolol tartrate is usually given. If treatment is started later, metoprolol tartrate tablets are usually given twice daily.

Generic name: metoprolol [ me-TOE-pro-lol ]
Brand names: Kapspargo Sprinkle, Lopressor, Toprol-XL
Drug class: Cardioselective beta blockers

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