Metoprolol

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). It is also used to treat or prevent heart attack.
Metoprolol may also be used for other purposes not listed in this medication guide.

Important information

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.

 

You should not use this medication if you are allergic to metoprolol, or other beta-blockers (atenolol, carvedilol, labetalol, 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
  
• history of slow heart beats that have caused you to faint.
  

To make sure metoprolol 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).
  

FDA pregnancy category C. It is not known whether metoprolol will harm an unborn baby. Tell your doctor right away if you become pregnant while using this medication.
See also: Pregnancy and breastfeeding warnings (in more detail)
Metoprolol can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.
Metoprolol is not approved for use by anyone younger than 18 years old.

How should I take metoprolol?

Take metoprolol exactly as prescribed by your doctor. Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Take the medicine at the same time each day.
Metoprolol should be taken with a meal or just after a meal.
A Toprol XL tablet can be divided in half if your doctor has told you to do so. The half tablet should be swallowed whole, without chewing or crushing.
While using metoprolol, you may need frequent blood tests at your doctor's office. Your blood pressure will need to be checked often.
If you need surgery, tell the surgeon ahead of time that you are using metoprolol.
You should not stop using metoprolol suddenly. Stopping suddenly may make your condition worse.
If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Store metoprolol at room temperature away from moisture and heat.
See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

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

What should I avoid?

Metoprolol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can increase certain side effects of metoprolol.

Metoprolol side effects

Get emergency medical help if you have any 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;
  
• 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.
See also: Side effects (in more detail)

Metoprolol dosing information

Usual Adult Dose of Metoprolol for Angina Pectoris Prophylaxis:
Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 450 mg/day.
Extended release may be used at the same total daily dose given once a day.
Usual Adult Dose for Hypertension:
Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 450 mg/day.
Extended release may be used at the same total daily dose given once a day.
Usual Adult Dose for Supraventricular Tachycardia:
Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 450 mg/day.
Extended release may be used at the same total daily dose given once a day.
Usual Adult Dose of Metoprolol for Angina Pectoris:
Initial dose: 100 mg orally in 1 or 2 divided doses.
Maintenance dose: 100 to 400 mg/day.
Extended release may be used at the same total daily dose given once a day.
Usual Adult Dose for Myocardial Infarction:
Early treatment:
IV: 3 bolus injections of 5 mg given at 2 minute intervals.
Oral: In patients who tolerate the full IV dose (15 mg), metoprolol tablets, 50 mg every 6 hours, should be initiated 15 minutes after the last IV dose and continued for 48 hours. Maintenance dose: 100 mg orally twice a day.
Patients who appear not to tolerate the full IV dose should be started on metoprolol tablets at 25 mg or 50 mg every 6 hours 15 minutes after the last intravenous dose or as soon as their clinical condition allows.

Late treatment:
Oral: 100 mg orally twice a day.
Patients with contraindications to treatment during the early phase of suspected or definite myocardial infarction, patients who appear not to tolerate the full early treatment, and patients in whom the physician wishes to delay therapy for any other reason should be started on metoprolol tablets as soon as their clinical condition allows.
Usual Adult Dose for Congestive Heart Failure:
Initial dose: 25 mg once daily (of the XL formulation) for two weeks in patients with NYHA class II heart failure and 12.5 mg once daily (of the XL formulation) in patients with more severe heart failure.
Maintenance dose: This dosage should then be doubled every two weeks to the highest dosage level tolerated or up to 200 mg.

If transient worsening of heart failure occurs, it may be treated with increased doses of diuretics, and it may also be necessary to lower the dose or temporarily discontinue treatment. The dose should not be increased until symptoms of worsening heart failure stabilize.

Initial difficulty with titration should not preclude later attempts to institute therapy. If heart failure patients experience symptomatic bradycardia, the dose should be reduced.
Usual Pediatric Dose of Metoprolol for Hypertension:
Immediate release:
1 to 17 years:
Initial dose: 1 to 2 mg/kg/day, administered in 2 divided doses. Dosage should be adjusted based on patient response.
Maximum dose: 6 mg/kg/day (less than or equal to 200 mg/day)

Extended release:
6 to 16 years:
Initial dose: 1 mg/kg orally once daily (not to exceed 50 mg once daily). The minimum available dose is one half of the 25 mg tablet.
Maintenance dose: Dosage should be adjusted according to blood pressure response. Doses above 2 mg/kg (or in excess of 200 mg) once daily have not been studied.

What other drugs will affect metoprolol?

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with metoprolol, especially:

• prazosin;
  
• terbinafine;
  
• an antidepressant - bupropion, clomipramine, desipramine, duloxetine, fluoxetine, fluvoxamine, paroxetine, sertraline;
  
• an ergot medicine - dihydroergotamine, ergonovine, ergotamine, methylergonovine;
  
• heart or blood pressure medications - amlodipine, clonidine, digoxin, diltiazem, dipyridamole, hydralazine, methyldopa, nifedipine, quinidine, reserpine, verapamil, and others;
  
• a MAO inhibitor - isocarboxazid, linezolid, phenelzine, rasagiline, selegiline, tranylcypromine; or
  
• medicine to treat mental illness - chlorpromazine, fluphenazine haloperidol, thioridazine.
  

This list is not complete. Other drugs may interact with metoprolol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.