Last reviewed by Miljan Krcobic on August 27th, 2018.
What is Metoprolol tartrate?
Metoprolol is a special kind of β1 receptor blocker type medication which marketed under Lopressor. This is mostly used for chest pain, high blood pressure, abnormally fast heart rate. Metoprolol also uses to prevent serious headaches in those with migraines.
This is normally sold in formulations which can be given intravenously or taken by mouth directly. In 1969, metoprolol was made for the first time. As per the research in 2013, metoprolol was at no 19th in the list of most prescribed medication in the United States of America.
What is metoprolol used for?
Metoprolol is a special kind of drug or known as a beta blocker which affects blood circulation through arteries, veins and hearts. This is mostly used for the treatment of high blood pressure and chest pain which is also known as angina. Metoprolol is also preventing the heart attack.
What is metoprolol molecular formula and weight and drug class?
Chemical name: (RS)-1-(Isopropylamino)-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol
Molecular formula: C15H25NO3
Weight: Average: 267.3639 Monoisotopic: 267.183443671
This compound belongs to the class of chemical entities known as tyrosols and derivatives. These are compounds containing a hydroxyethyl group attached to the C4 carbon of a phenol group. Metoprolol undergoes to a class of drug which is known as beta blockers and it better works for the treatment of chest pain, heart attack and high blood pressure.
How metoprolol works in the body?
As all of you know the heart is one of the vital organs of human body, which control all the blood push process through blood vessels to the needed parts. There are some receptors, known as beta adrenergic receptors in your heart which indicate the heart muscle to process the blood out of the heart and send around the body at the time of activated by hormones.
Beta blockers mostly attach to the beta receptors in the heart and discontinue the hormones which usually activate the receptors like as usual. As a result, the pump of the blood rate certainly goes down and this means the blood pressure will decrease when you will take this drug. This is a useful thing as it always helps to reduce the stress on the cardiovascular system and protect human from fatal stroke or heart attack.
Metoprolol brand names
Metoprolol is the active component of medication and sometimes called as the generic name. You can find several drug brand names in which you can find metoprolol as the active ingredient. So that’s the main reason behind the medication you are taking might be called differently like:
You can get the metoprolol each of these above mentioned brand names and works in a similar way to the same thing in the human body. Simply, the brand name is different as they are made by various companies.
What is FDA approved indications for metoprolol?
Metoprolol is a special type of medication which is known as beta blocker especially uses for the treatment of heart problems and help blood circulation through veins and arteries. It is specially used to treat hypertension which is also known as high blood pressure and angina or chest pain. This medication is also used for the treatment of heart attack.
Metoprolol dosage forms and strengths
Metoprolol is the best prescription medicine used to treat various conditions mostly involving blood vessels and heart such as angina, congestive heart failure and high blood pressure and it also heap people those who have the heart attack.
This medicine comes in the form of extended-release tablets or immediate-release tablets and mostly taken once or twice per day as per the doctor’s suggestion. Metoprolol tablets are well available in a variety of strengths.
You can find extended-release metoprolol tablets in numbers of strengths like:
- Generic metoprolol succinate or Toprol-XL 25 mg
- Generic metoprolol succinate or Toprol-XL 50mg
- Generic metoprolol succinate or Toprol-XL 100 mg
- Generic metoprolol succinate or Toprol-XL 200 mg
Immediate-release metoprolol come with two types like:
- Generic metoprolol tartrate or Lopressor 50 mg
- Generic metoprolol tartrate or Lopressor 100 mg
Metoprolol dosage for different indications
Adult dose for angina pectoris Prophylaxis:
The initial dose you can take 100 mg orally in one or two divided doses. You can maintain the dose 100 to 450mg per day.
The usual adult initial dose is 100 mg orally in one or two divided doses. You can maintain the dose 100 to 450mg per day.
For supraventricular Tachycardia:
Initially, you can take 100 mg orally in one or two divided doses and you have to maintain the dose 100 to 450 mg per day.
For Angina pectoris:
The initial dose is 100 mg orally as previous but maintains the dose 100 to 400 mg per day.
For Myocardial infarction:
Generally, in this type of treatment, you can find two stages of treatment like early treatment and late treatment and the dose is different also.
You have to take 3 bolus injections of 5 mg in every 2-minute interval. The patients who can tolerate the full IV dose of 15 mg, 50 mg every six hours should be initiated after the full IV dose of 15 minutes and continue up to 48 hours. You have to maintain 100 mg dose orally on daily basis.
Orally you need to take 100 mg twice per day. If you are going through critical myocardial infarction or who can’t tolerate the early treatment phase or physician want to delay the therapy for any certain health issues should be started the metoprolol medication as soon as their health condition allows for the metoprolol treatment.
Adult dose for congestive Heart Failure:
At the initial stage, you have to take 25 mg once regularly for two weeks those who have NYHA class II heart failure and 2.5 mg once those who have serious heart failure. The maintenance dose should be double in every two weeks up to the highest dose level which is 200 mg.
If the patient face worsening of heart failure then you may treat with increased doses of diuretics or some cases you need the lower dose or discontinue treatment until the worsening heart failure well stabilized. Initially, the patient may face difficulties with titration but should not preclude but if the patient experience any kind of symptomatic bradycardia then you have to reduce the dose.
Pediatric dose of metoprolol for Hypertension:
For this, you have two sections one is for immediate release and other is extended release. Let’s discuss in brief.
For 1 to 17 years old, the initial dose should be 1 to 2 mg/kg per day and you can take it with two divided doses. One more thing the dose should always be adjusted according to the response of the patient. The maximum dose is 6mg/kg per day.
For 6 to 16 years of age, the initial dose is 1mg/kg per day and you have to take it once orally never take more than 50mg once per day. The minimum average dose is always one-half of the 25 mg tablet. The maintenance dose should always be adjusted according to the patient’s blood pressure result.
Metoprolol highest dose
200 mg per day is the highest dose of metoprolol but you need to consult your doctor for the best dose for you. Never take any extra dose or if you miss your dose then don’t take it double to adjust it because by doing this you may mark severe side effects or overdose problems.
Metoprolol overdose may lead various side effects on your body like severe sinus bradycardia, heart failure, atrioventricular block, cardiac arrest, vomiting, cyanosis, occasionally and other symptoms like
- Sleepy or very drowsy
- Consciousness changes
- No pulse or blood pressure
- Stopping of heart
- Bluish color lips, palms, nail beds, skin and fingernails
- Consciousness loss
So in such cases, you need to consult your doctor immediately.
Metoprolol side effects
If you are taking metoprolol then you may face several side effects so if you mark any side effects then you may require proper medical attention. Let’s first discuss some major side effects. In this category, you have to consult your doctor immediately.
- Feel discomfort or chest pain
- Breath shortness
- Weakness or tiredness
Less common type:
- Unusual weight loss or gain
- Breathing problems
- Chest tightness
- Fatigue extreme level, double vision, difficulty with speaking
- Vision loss
- Swelling arms, hands, legs or feet
- Tension, pain, noisy breathing, slow speech
- Memory loss for short term
- Dilated neck veins
- Light-colored stools
- Dark color urine
- Continues vomiting or severe nausea
- Loss of appetite
- Feel difficulty in moving
- Skin itching, clay-colored stools, chills, rash, sore throat
- Side or lower back pain
- Unpleasant breath odor
- Blood vomiting
- Weakness, unusual bruising or bleeding
- Muscle stiffness or pain
If overdose occurs then you may mark some of the following side effects in such case you have to consult your doctor immediately.
- Sleepy or very drowsy
- Consciousness changes
- No pulse or blood pressure
- Stopping of heart
- Bluish color lips, palms, nail beds, skin and fingernails
- Consciousness loss
Minor side effects:
Some side effects are not so harmful with metoprolol intake so you don’t need to consult your doctor if you mark these side effects on your body. These side effects will go away after the medicine is well adjusted with your body after some days. But it’s always better to discuss regarding your problems with your doctor. So here is the list of those minor side effects.
- Tiredness, sleeping trouble, stuffy nose
- Trouble in concentrating
- Runny nose, nightmares
- Loss in sexual ability, loss of pleasure or interest
- Passing gas
- Pain in breastbone or below chest
- Full feeling, irritability, indigestion feeling
- Discouragement, dry mouth, belching
- Excess gas in intestines or stomach
- Sensation of spinning
- Sexual intercourse interest decrease
- Feeling of constant movement of surrounding or self
- Feeling empty or sad
- Severe sunburn
- Thinning of hair or hair loss
- Dry eyes
- Continuing unexplained noise in the ear
- Nervousness or fear
- Pain on erection of penis
- Hearing loss
- Bone pain
These are various kinds of side effects may occur on your body so it’s always better to consult your doctor and take the suggestion for the best treatment.
How to take metoprolol?
It’s recommended that take metoprolol every day at the same time. You can take metoprolol with food or after your meal. Remember one thing you have to take the medicine as directed by your doctor never take more or less. There may be changes required in your dose but it totally depends on how your body reacts and a doctor can change the dose as per your health condition.
You may feel some side effects so never neglect just consult your doctor and take suggestion regarding the dose and other diet plans. This medication never cures your high blood pressure but it can control it up to some extent.
It’s better to swallow the whole tablet with a glass of water never crush, break or chew it. This medication dose always varies and it’s totally depending on your health issue and your body resistance so always takes the dose as recommended by your doctor.
Metoprolol for arrhythmias
Metoprolol or beta blockers are always prescribed by the doctor in case of arrhythmias, not all time like after cardiac arrest the routine administration is always harmful and not recommended at all. But in the case of normal arrhythmias, you can take metoprolol and can get the better result. Always consult your doctor and take the suggestion for the best medication for your health.
Metoprolol for hypertension and angina pectoris
Metoprolol medication is always good and effective for both hypertension and angina pectoris. In the case of Hypertension, the usual adult dose for initial stage is 100 mg orally in one or two divided doses. You should maintain 100 to 450 mg every day. In the case of angina pectoris, the initial adult dose is 100mg orally same as Hypertension but you should maintain the dose 100 to 400 mg per day.
Metoprolol for myocardial infarction
Metoprolol works better for the myocardial infarction. At the early stage of treatment, you can take 5mg IV every two minutes 3 doses as tolerated. Full 50mg orally every 6 hours starting 15 minutes after the last IV dose and just continue for forty-eight hours is the patients tolerant of full IV dose.
In the case of intolerance of full IV dose,5 or 25mg orally and it’s depending upon the intolerance beginning 15 minutes after the last IV dose or when the clinical condition allows. For late treatment, you can maintain a dose which is 100mg orally twice per day. As per the study beta blockers for myocardial infarction should treat 1 to 3 year.
Metoprolol for heart failure
Metoprolol specially uses for heart problems like chest pain, high blood pressure. This medication always reduces the heart rate and slower down your high blood pressure so most of the doctor prescribe this medicine for heart diseases.
If you have serious heart block problems then you should take the low dose as per the doctor suggestion. 25mg metoprolol tablets once a day dose is the common adult dose for heart failure. The highest tolerated dose is up to 200mg orally once in a day.
Metoprolol for hyperthyroidism
At the time of chronic administration, the clearance of metoprolol or beta blockers are metabolized by the liver, as a result, it may be increased in the hyperthyroidism patient’s body because of the active blood enzyme. So it’s always better to consult your doctor for the perfect therapy and accurate dose. It normally differs according to the blood concentrations.
Metoprolol and Bronchospastic disease
Those who have bronchospastic disease can’t receive beta blockers because of its relative beta1 cardio selectivity but Metoprolol Succinate extended tables can be used for the patients with bronchospastic problem those who can’t tolerate any antihypertensive treatment. You can use low possible dose because beta 1-selectivity is not fully absolute.
Metoprolol for Pheochromocytoma
If metoprolol tablets are used for Pheochromocytoma then you should use it with the combination of an alpha-blocker, and only after the initiation of alpha blocker. If you take it without alpha blocker then the blood pressure will increase due to the reduction of beta-mediated vasodilatation in skeletal muscle.
Metoprolol for anxiety
In metoprolol, you can get the beta1 receptors so this medication is also recommended by doctors for social anxiety or other relevant anxiety disorder.
How long does it take for metoprolol to work?
Metoprolol normally works immediately but the full effects of this medicine take about two weeks to get free from dizziness and other side effects. So never stop take medicine suddenly if you feel any type of side effects without the suggestion of your diction.
Can you take metoprolol in the case of Major Surgery?
In the case of major surgery high dose is not allowed at all. Beta-blocking therapy should not be withdrawn earlier to major surgery, but the harm ability of the heart may augment the risk of surgical process or normal anesthesia.
Can metoprolol cause a heart attack?
No, metoprolol never causes the heart attack because this medication uses for high blood pressure and prevent high blood pressure which normally the main cause of heart attack in most of the cases. As metoprolol uses for the treatment of chest pain and heart attacks there is no suck risk of heart attack by taking this medication.
Can metoprolol cause low blood pressure?
Metoprolol help to lower your blood pressure so if you take the too high dose then the blood pressure of your body may drop dangerously and you may feel light headedness, fainting and dizziness.
Do metoprolol make you feel tired?
Most of the people those who takes beta blockers have no side effects but Yes, in some cases you may feel tired if you are taking beta blockers as it slows down your heart.
Can diabetics take metoprolol?
Yes, diabetics can take metoprolol but it’s not recommended at all for high doses of beta-1 and you must take beta blockers cautiously as per the prescription of the doctor. Never take any decision without consulting your doctor otherwise you may face serious health issues.
Can I take metoprolol if I have asthma?
No, you can’t take metoprolol if you have serious asthma problem. If it is quite necessary to take metoprolol then beta-1 selectively is always considered as safer but always should be used with more caution. Just take the advice of your doctor and take the dose accordingly.
Can I abrupt metoprolol therapy suddenly? Can metoprolol cause withdrawal effects?
No, you can’t abrupt metoprolol therapy suddenly or can’t discontinue the metoprolol therapy suddenly if you have artery disease. It’s always recommended that consult your doctor before taking any decision.
Metoprolol medication you can’t stop suddenly but the doctor may reduce the dose as per the requirement. Yes, metoprolol can cause withdrawal effects so in case you feel any side effects like this then consult your doctor soon because you may need any change in your dose.
Precautions and warnings during metoprolol use
There are many warnings and precautions for the metoprolol use like
- If you have allergy to metoprolol then you can’t use this medication.
- Serious heart diseases like slow heart rate, sick sinus syndrome, heart block
- If you have asthma, Sleep apnea, breathing disorder and COPD then consult your doctor before using this medication.
- If you have low blood sugar then it may risky to use metoprolol
- Liver disease person also can’t take high dose of metoprolol
- Thyroid disorder
- Raynaud’s syndrome
- Tumor or adrenal gland problem patient
How long does metoprolol work?
Normally the half-life of metoprolol is around 3 to 7 hours but for the total elimination of metoprolol from the human system is around 5.5 times of the half-life that means around 38.5 hours.
How long does metoprolol stay in your system, urine, blood, saliva?
If you are taking metoprolol then it will stay at least 5 days in your system, urine, blood and saliva.
Metoprolol during pregnancy, Is it safe?
You can use this drug during pregnancy if you need it clearly. Unless outweighs, use of this medicine during pregnancy is not recommended at all. If you are using this during pregnancy then it should be lowest possible dose and also avoid 2 to 3 days to the expected delivery date. So, overall, it’s not safe but if it’s really needed then you can take low doses.
Metoprolol during breastfeeding
It’s quite low levels of metoprolol found in breastmilk and infant ingested very small amount which has no such adverse effects in breastfed infants. So it’s totally safe and there are no special precautions needed during breastfeeding.
Can patients with renal disease take metoprolol safely?
Yes, renal disease patients can take metoprolol. The renal disease occurs because of high blood pressure. It’s quite important to keep your blood pressure in the normal range to avoid renal disease.
High blood pressure also damages the blood vessels and leading to hardening of the arteries. So it’s always needed to keep your blood pressure normal. Metoprolol normally works to lower down the blood pressure so it’s totally safe to use metoprolol those who have renal disease.
Can patients with liver disease take metoprolol safely?
Due to decreased drug clearance take metoprolol for patients with liver disease may be quite risky. Metoprolol therapy for liver disease patients should be always administered cautiously. Dose adjustment may be needed in such case so better to consult your doctor for the best suggestion.
Metoprolol absorption, metabolism and elimination
Metoprolol absorption is quite rapid and complete. As per the metabolism concern petoprolol metabolism is comprehensively hepatic via CYP2D6; significant first pass effect of ~50%. The half-life elimination of metoprolol for neonates is 5 to 10 hours and for adults, it is 3 to 4 hours. In the case of hepatic impairment or poor CYP2D6 metabolizer, then it is at least 7 to 9 hours.
Can I drink alcohol while taking metoprolol?
Metoprolol and alcohol together can be the cause of lowering your blood pressure, as a result, you may face various heal problems like dizziness, fainting, changes in heart rate and headache.
Normally these side effects can be seen at the very beginning of the treatment or increase of dose. So always discuss your problem with your doctors because maybe there is some adjustment of dose you need. Remember one thing never stop any medicine without the permission of the doctor.
Difference between metoprolol and propranolol
Both metoprolol and propranolol are known as cardiovascular medications which are also known as the beta blocker. Both medicines are helpful for anxiety. In the case of metoprolol you can find some side effects like Nausea, depression and shortness of breath and for propranolol, you may feel weight gain, withdrawal symptoms and insomnia.
There always a risk of interaction with alcohol in both of the cases. Both of the cases you need to follow the same food instruction either the empty stomach or after food choose anyone and continue that forever otherwise drug absorption may occur.
In the case of metoprolol, there is no certain method of use but for propranolol, there are four options like oral drops, pill and injection. Metoprolol specially taken for a Fib, Anxiety and High blood pressure and propranolol taken for migraines, panic attacks and anxiety. There is no such interaction between these two medications.
Difference between metoprolol and amlodipine
Amlodipine is a calcium channel blocker but metoprolol is a beta blocker or cardiovascular medication. Both medicines are helpful for high blood pressure. You may feel headaches, dizziness swelling by taking Amlodipine. In the case of metoprolo, you may feel Nausea, depression and shortness of breath and much more.
There may be the negative interaction between Amlodipine and alcohol and it’s same in the case of metoprolol and alcohol. For Amlodipine there are no certain food instructions but in metoprolol case, you should take medicine in a particular way for every time like with the food or on the empty stomach because if you take randomly then drug absorption may occur.
Amlodipine is mostly prescribed for high blood pressure but metoprolol is prescribed for many diseases like heart attack, high blood pressure, Palpitations, PVC’s and chest pain. There is no certain interaction between Amlodipine and metoprolol if you take it together but it’s always better to consult your doctor.
Can I take metoprolol and amlodipine together?
Amlodipine and metoprolol may have preservative effects in lowering your heart rate or blood pressure. You may feel various health issues like dizziness, fainting, headache, unusual heart rate by taking these two medicines together. These problems may occur at the very beginning of your treatment or during the increase of dose so if you feel any problems then consult your doctor because you may need any dose adjustment.
Can I take metoprolol and verapamil together?
No, you can’t take metoprolol and verapamil together without the permission of your doctor as it may cause serious side effects on your body. If you take these two medicines together then you may face various health issues like weight gain, chest pain, swelling, fainting, headache and uncertain heartbeat.
If you are taking these medicines together and feeling any above-mentioned problems then consult your doctor there may be any dose adjustment for you.
Can I take metoprolol and aspirin together?
Somehow there is a minor interaction is available as per the medical science if you take metoprolol and aspirin together. This minor interaction can’t cause harm to human. It never requires any changes in any type of therapy also but it’s always depending on your doctor if there is any adjustment to your medicines for better treatment.
Can I take metoprolol and naproxen together?
If you are regularly taking metoprolol for your high blood pressure treatment then it’s better to consult your doctor for the use of these two medicines together. These two combinations of medicines may reduce the effect of metoprolol in lowering the blood pressure.
If you are frequently taking naproxen for your chronic pain or arthritis treatment then you have to consult your doctor for the dose adjustment. Don’t stop any medicine suddenly, consult your doctor and then take medicines accordingly.
Can I take metoprolol and Viagra together?
Yes, you can take metoprolol with Viagra because there is no such interactions occurs till the date as per the medical science but as per the safety concern, it’s always better to consult your doctor before taking these two medicines together.
Can I take metoprolol and Advil together?
No, you can’t take metoprolol and Advil together without consulting to your doctor because if you take these two together then Advil may decrease the effect of metroprolol and you face many health difficulties so it’s mandatory to take the advice of the doctor and if he/she suggests then you can take.
Can I take metoprolol and Tylenol together?
Till the date, there is no interaction found in medical history so you can take metoprolol and Tylenol together but that doesn’t mean there is no interaction exist in all cases so it’s always recommended that take medicines after consulting your doctor.
Can I take metoprolol and lisinopril together?
You can take lisinopril and metoprolol together but sometimes it may lower your blood pressure and can be the cause of slow heart rate, as a result you may feel fainting, weakness, irregular heartbeat, loss of glucose in blood and many others.
If you feel any of these symptoms then consult your physician may be there is need a dose adjustment for you. Tell frankly about your all medicines and symptoms and one more thing never stop using any medicine without consulting your doctor.
Can I take metoprolol with water pills (diuretics) together?
It’s not recommended to take metoprolol with water pills if you have the serious heart condition like AV block or sick sinus syndrome or if you have slow heartbeats. If you are not able to urinate then don’t use this medicine. This combination of medicine normally uses for high blood pressure treatment. Never stop using medicine instantly if you feel fine so always better to consult your doctor and take the suggestion for the better dose.
Can patients with Congestive Heart Failure take metoprolol?
Congestive heart failure patients always need maximal medical treatment diuretics; digitalis and ACE inhibitor.Use of metoprolol may inhabit the activity of sympathetic and also help to reduce the risk of heart failure.
If you use metoprolol long term basis then you can find better improvement of left ventricular function and it also decreases mortality and reduce hospital readmission. So it’s mandatory to take metoprolol in low doses and require deliberate titration over weeks and months before patients can take maintenance doses.
Metoprolol + Hydrochlortiazide fixed combination
Metoprolol and Hydrochlorothiazide fixed combination of drug is never indicated for the initial stage therapy of Hypertension. If in any case the fixed combination is required as the dose for the need, then the fixed combination may be always more convenient than separate components.
Hydrochlorothiazide is contraindicated in patients with hypersensitivity or anuria but metoprolol is for cardiogenic shock, cardiac failure and sinus bradycardia.
Can I take metoprolol and digoxin together?
If you are taking digoxin and metroprolol together then it may slow down your heart rate and can cause many side effects on your body. You may feel various symptoms like vomiting, nausea, diarrhea, seizures; fatigue, abnormal heart beats, visual changes and much more so in such case contact your doctor.
For the safe use of these two medications together, it’s always better to consult your doctor there may be any changes required on the dose adjustment. Tell your doctors in details regarding all your medications.
Can I take metoprolol and hydralazine together?
Using Hydralazine and metoprolol together many slow your heart rate and lower your blood pressure. As a result, you may feel weakness, irregular heartbeats, dizziness or loss of glucose control.
So if you are taking these two medications together then it’s always better to tell your physicians regarding your unusual symptoms as there may be need of some changes in the dose of the medications. Never take or stop any medicine without consulting your doctor.
Can I take metoprolol and metformin together?
As there is no such known interaction between metoprolol and metformin till the date in medical records but however, there may be an interaction exist. So, it’s always recommended that never take any medications without consulting a physician for the safety of your life.
What should I do if I forget metoprolol dose?
It’s quite necessary to take the medication as soon as you remember it but if it is almost the time for the next dose then just skip that dose and try to continue your daily dosing as per your schedule. Remember one thing never take a double dose to adjust for the missed dose. It may put bad impact or side effects on your body. If in case you feel any type of uneasy then you can consult your doctor may be you need some dose adjustment.
All about storage and disposal of metoprolol medication
This medicine normally comes with a tightly closed container so always keep your medicine in it and make sure that the cover is tight enough so that the air could not pass through it. Always keep this medicine out of the reach of the children.
Always store this medicine at room temperature and away from excess moisture and heat. Never keep any medicine which is outdated just threw it away. Consult your physician to know the proper way of disposal of your medication.
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