Metoprolol

What is metoprolol?

Metoprolol belongs to a class of drugs called beta-blockers. Beta-blockers work by slowing the heart rate and relaxing the blood vessels. This reduces blood pressure and permits increased blood flow around the body.¹

This drug is only available with a prescription.

What is metoprolol used to treat?

Metoprolol has been approved by the US Food and Drug Administration (FDA) to treat:

• High blood pressure (hypertension)

• Severe chest pain (angina)

• Heart failure

• Heart attack (myocardial infarction)

Metoprolol is used to reduce high blood pressure and lower the risk of repeated heart attacks. It is also used after a heart attack and for the treatment of heart failure to reduce the risks of hospitalization and death.

Studies have shown that metoprolol can be used to prevent migraine headaches. Other beta-blockers (like timolol and propranolol) have FDA approval for use in migraine prevention, but metoprolol has not yet been approved for this indication. Despite this, it may be prescribed off label.²

Dosage forms and strengths

Metoprolol is available in immediate-release (IM) and extended-release (ER) forms.

Immediate-release metoprolol (metoprolol tartrate) is also sold under the brand name Lopressor. Metoprolol ER (metoprolol succinate) is also sold under the brand names Toprol XL and Kapspargo Sprinkle.

Metoprolol is available in the following dosage forms:³ ⁴ ⁵

Generic metoprolol (tartrate)

• Oral tablet: 25mg, 37.5mg, 50mg, 70mg, and 100mg

• Injectable solution: 1mg/mL

Lopressor

• Oral tablet: 50mg and 100mg

Generic metoprolol (succinate) ER

• Oral tablet: 25mg, 50mg, 100mg, and 200mg

• Oral capsule: 25mg, 50mg, 100mg, and 200mg

Toprol XL

• Oral tablet: 25mg, 50mg, 100mg, and 200mg

Kapspargo Sprinkle

• Oral capsule: 25mg, 50mg, 100mg, and 200mg

How do you take metoprolol?

Your doctor will prescribe and adjust your dosage according to your medical condition and response to treatment.

You can take metoprolol with a meal or immediately after a meal. Take the tablet by mouth. Swallow it whole; don’t break, crush, or chew it.

If you find the extended-release capsule difficult to swallow, you can open it, sprinkle the contents over a teaspoon of soft food (like yogurt or custard), and swallow the mixture. You must consume it within an hour.

Seeing results

Metoprolol starts working within two hours of taking your first tablet, but you may need to wait a week before it takes full effect.⁶

You might not feel different when you take metoprolol, but that does not mean it’s ineffective. You should continue taking your medicine as prescribed and have your blood pressure checked regularly.

Who should not take metoprolol?

Metoprolol might not be suitable if you have had an allergic reaction to it or other beta-blockers, like sotalol, nebivolol, propranolol, labetalol, and others.

You may not be able to take this medication if you have the following:

• Liver disease

• Diabetes

• Lung disease, like asthma or chronic obstructive pulmonary disease (COPD)

• Overactive thyroid (hyperthyroidism)

• A slow heart rate or history of fainting because of a slow heartbeat

• Low blood pressure (hypotension)

• Previous heart failure that required hospitalization

• Severe blood circulation problems (for example, Raynaud’s syndrome)

• Certain heart conditions, such as sinus bradycardia, heart block, or sinus node dysfunction (formerly known as sick sinus syndrome)

Potential side effects of metoprolol

Like all medicines, metoprolol can cause side effects.

Some of the more common side effects include the following:¹

• Feeling dizzy or lightheaded, vertigo

• Feeling tired

• Heartburn

• Nausea

• Vomiting

• Stomach pain

• Constipation or diarrhea

• Gas or bloating

• Dry mouth

• Runny nose

• Cold hands or feet

• Rash or feeling itchy

• Sleep disturbances

• Depression

This list is not exhaustive, and other less common side effects have been reported.

Most of these frequently seen side effects disappear as your body adjusts to the drug. Talk to your doctor if the symptoms persist and bother you for more than a few days.

Serious side effects

Metoprolol rarely causes severe side effects. Call your doctor immediately or seek medical assistance if you experience any of the following signs of severe adverse effects:

• Unexplained weight gain

• Swollen feet, ankles, lower legs, or hands

• Shortness of breath

• Wheezing

• Pounding, rapid, slow, or irregular heartbeat

• Low blood pressure

• Fainting

Overdose

Metoprolol overdose can slow your heart and make breathing difficult. Taking too much of this drug could cause serious adverse effects, including slow heart rate, low blood pressure, difficulty breathing, heart attack, heart failure, and death.⁵

Seek immediate medical assistance if you develop the following signs of overdose:¹

• Fainting

• Dizziness

• Trembling

• Trouble breathing

• Trouble swallowing

• Swollen feet, ankles, lower legs, or hands

The amount of metoprolol that causes an overdose varies from one person to the next.

If you suspect that you or someone else has overdosed on metoprolol, seek immediate emergency medical assistance.

Allergy information

Metoprolol can cause an allergic reaction in some people.

Symptoms include the following:⁸

• Hives (urticaria)

• Swollen face, throat, tongue, or lips

• Trouble breathing

Severe allergic reaction

Severe allergic reactions (anaphylaxis) are rare with metoprolol, but they can occur.

You may experience the following symptoms in addition to those above:⁹

• Difficulty speaking

• Wheezing

• Tightness in your throat or chest

• Itchy skin rash with peeling skin

• Nausea or vomiting

If you notice any of these signs of an allergic reaction, seek immediate medical attention or call 911.

Long-term use of metoprolol

Metoprolol treatment is usually long-term, and your doctor might recommend that you take it for the rest of your life.

The drug is safe for long-term use and works best when used in this way.⁶

Pregnancy category

Metoprolol has been designated by the FDA as a pregnancy category C drug. This means:⁷

• Animal reproductive studies have demonstrated the risk of fetal harm, but they involved higher doses than would be given to humans. No satisfactory human studies have been conducted on pregnant women.

• The risks of taking this drug during pregnancy cannot be ruled out.

• The benefits of taking this drug during pregnancy may outweigh the risks.¹⁰

Metoprololand pregnancy

If you are taking metoprolol for a heart problem, your doctor might recommend an alternative or advise you to stay on this medication during pregnancy while monitoring your dose and making necessary alterations.

Metoprolol and breastfeeding

Metoprolol can pass into breast milk in very low concentrations. Monitoring infants for constipation, diarrhea, slow heart rate, or dry mouth, eyes, or skin is recommended.⁵

Ask your doctor whether they advise taking the medication while breastfeeding in your specific situation.

Missed doses

Take a missed dose as soon as you remember. If it is close to the time of your next dose, skip the one you missed and take your next dose as scheduled.

Do not double up on this medication to make up for a missed dose.

Contact your doctor or pharmacist if you have missed several doses.

Drug interactions

Metoprolol interacts with some drugs to change how your medicines work or cause harmful side effects. These drugs include the following:¹ ¹¹

• Mental health drugs, including the following:

• Monoamine oxidase (MAO) inhibitors, such as phenelzine (Nardil), selegiline (Eldepryl or Zelapar), isocarboxazid (Marplan), and tranylcypromine (Parnate)

• Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Brisdelle, Paxil, and Pexeva)

• Bupropion (Wellbutrin, Zyban, Aplenzin, and others)

• Antipsychotics, such as haloperidol and chlorpromazine

• Heart rhythm drugs, such as digoxin (Digitek, Cardoxin, Lanoxin, and Lanoxicaps), quinidine, and propafenone (Rythmol)

• Calcium channel blockers, like diltiazem (Cardizem, Diltzac, Tiazac, and others) and verapamil (Calan, Covera HS, Verelan, and others)

• Antihistamines such as diphenhydramine (Benadryl)

• Reserpine (discontinued in the US but may be found in combination products)

• Clonidine (Catapres and Capvay), an alpha agonist used to treat high blood pressure

• Anti-ulcer drugs, including cimetidine (Tagamet) and ranitidine (Zantac)

• Ritonavir (Norvir), a protease inhibitor used to treat HIV

• Antimalarial drugs, such as hydroxychloroquine (Plaquenil) and quinidine

• Antifungals, like terbinafine (Lamisil)

• Hydralazine, a vasodilator

• Migraine medicines called ergot alkaloids, such as dihydroergotamine (Migranal)

Can I drink alcohol while taking metoprolol?

Drinking alcohol while taking metoprolol can cause lightheadedness and dizziness. It is recommended not to drink alcohol at the start of treatment or shortly after your dose is increased.

If you find metoprolol makes you feel dizzy, it’s best to avoid alcohol as it could worsen this effect.⁶

Alcohol can cause metoprolol to be released in the body faster when taking the extended-release capsules, increasing your risk of adverse effects.¹¹

What to discuss with your doctor before starting metoprolol

Before you start taking metoprolol, it is essential to share the following information with your doctor:

• Drug allergies: Inform your doctor if you have any drug allergies, including any previous allergic reaction to metoprolol or other beta-blockers, such as propranolol (Inderal LA, Inderal XL, and InnoPran XL), sotalol (Betapace), atenolol (Tenormin), nebivolol (Bystolic), and others.

• Medications: Review the prescription and non-prescription medicines you take regularly. These include vitamins, herbal, and nutritional supplements.

• Medical conditions: Discuss your history of asthma (or any other lung disease), heart disease, liver disease, diabetes, or overactive thyroid (hyperthyroidism). You should make sure to mention if you currently have or have a history of heart failure, slow heart rate, blood circulation issues, or pheochromocytoma (a tumor that develops on the adrenal gland).¹

• Pregnancy/breastfeeding: Inform your doctor if you are pregnant, planning a pregnancy, or breastfeeding.

• Surgeries: Keep your doctor informed of any surgery (including dental) you are planning.

Stopping metoprolol

Suddenly stopping metoprolol can lead to withdrawal syndrome. This could cause chest pain or even a heart attack. A rapid heart rate and high blood pressure may also occur.¹²

If you want to discontinue the medication, your doctor will be able to recommend alternative therapy and help you taper off the drug safely over a few weeks.

Drug approval history

1978: The FDA first approved metoprolol for medical use to be sold as Lopressor oral tablets (immediate-release metoprolol tartrate).⁴

1992: The FDA approved metoprolol extended release (ER) to be sold as Toprol XL oral tablets (metoprolol succinate).¹¹

2018: The FDA approved metoprolol ER to be sold as Kapspargo Sprinkle capsules (metoprolol succinate).⁵

Over 27 million prescriptions are filled yearly for metoprolol.⁴

Tips for taking metoprolol

Follow these tips to help you take metoprolol safely and effectively:

• Take metoprolol as prescribed by your doctor.

• Always store metoprolol at room temperature.

• Do not share your metoprolol prescription with anyone.

• Keep the medication away from children.

• Do not stop taking metoprolol suddenly.

Metoprolol frequently asked questions

What is metoprolol mainly used for?

The FDA has approved metoprolol to treat high blood pressure, cardiac chest pain (angina), heart failure, and heart attack.

Is metoprolol a good treatment for anxiety?

Some doctors may prescribe beta-blockers like metoprolol for anxiety. However, metoprolol is not FDA-approved for this indication.

What should you avoid when taking metoprolol?

Metoprolol interacts with some heart rhythm medications, drugs for mental health, and calcium channel blockers.

Before taking metoprolol, tell your doctor about all other drugs, natural remedies, and supplements you are taking to avoid any potentially harmful interactions.