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Metoprolol, Oral Tablet

Highlights for metoprolol

  1. Metoprolol oral tablet is available as both a generic and brand-name drugs. Brand names: Lopressor and Toprol XL.
  2. The tablets come in immediate-release and extended-release forms.
  3. Metoprolol is a beta-blocker. It’s used to treat conditions such as high blood pressure, heart failure, or angina (chest pain).
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Important warnings

Important warnings

FDA Warning: Don’t stop taking metoprolol suddenly
  • Metoprolol has a black box warning. This is the most serious warning from the U.S. Food and Drug Administration (FDA). Though the medication can still be sold and used, a black box warning alerts doctors and patients to potentially dangerous problems.
  • 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 dose should be gradually decreased under a doctor's supervision.

About

What is metoprolol?

Metoprolol is a prescription drug that’s available as the brand-name drugs Lopressor and Toprol XL. It’s also available as a generic drug. Generic drugs usually cost less. In some cases, they may not be available in every strength or form as the brand-name version. Metoprolol oral tablet comes in immediate-release and extended-release forms.

Why it's used

Metoprolol is used to:

  • lower high blood pressure
  • reduce chest pain
  • after a heart attack, the medication reduces the amount of work your heart muscle has to do to push blood through your body.

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

Metoprolol belongs to a class of drugs called beta blockers. A class of drugs refers to medications that work similarly in your body. They have a similar chemical structure and are often used to treat similar conditions.

Beta blockers prevent norepinephrine (adrenalin) from acting on beta receptors in blood vessels and in the heart. This causes blood vessels to relax. By relaxing the vessels, beta blockers help to lower blood pressure and reduce chest pain. Blood pressure is often raised because vessels are tightened. That puts a strain on the heart and increases the body's oxygen demand. Beta blockers help to lower the heart rate and the heart's demand for oxygen.

Beta blockers don’t permanently change blood pressure and chest pain. Instead, they help to manage the symptoms.

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Side effects

Metoprolol side effects

Metoprolol oral tablet can cause certain side effects.

Most common side effects

The following common side effects may occur, but don’t usually require emergency care. Talk with your doctor or healthcare provider if these side effects continue or if they bother you:

Tiredness: Metoprolol slows your heart rate by blocking the effect of adrenaline. As a result, blood doesn’t travel to your brain as fast. This can make you feel fatigued. This side effect usually goes away after the first several days of taking metoprolol, once your body gets used to the effect.

Mild dizziness: Metoprolol lowers your blood pressure and can lead to mild dizziness, especially when making sudden movements. This side effect often goes away once your body becomes acclimated to the dosage; however, in some cases metoprolol can lower your blood pressure too much. A big or fast drop in blood pressure may cause severe dizziness, which can be a dangerous side effect. While on this drug, you should report dizziness to your doctor immediately.

Diarrhea or constipation: Metoprolol can block nerve signals from your brain to your gut. This can speed up or slow down digestion in your intestines. Faster digestion causes diarrhea; slower digestion causes constipation.

Breathing problems: Metoprolol can block signals from your brain to the muscles in your lung passages (bronchioles) that allow them to relax. This tightens your airways, causing symptoms such as shortness of breath, cough, and wheezing.

Slower than normal heart rate (bradycardia): Metoprolol can slow the nerve impulses that travel from your brain to your heart. This can slow your heart rate to an abnormally low level.

Reduced interest in sex: In men, metoprolol can interfere with the part of the brain that signals an erection. Metoprolol can also cause lower sexual desire and difficulty in achieving orgasm, both in men and women.

Rash: An allergic reaction to metoprolol can cause various types of skin rashes and hives, along with generalized itching. If you experience a rash, you should stop taking the medication and seek immediate medical help.

Serious side effects

The following are severe side effects that require emergency care. Contact your doctor or healthcare provider right away if you experience any of these side effects:

Low blood pressure (hypotension): Metoprolol causes your blood pressure to drop. If your dose is too high, or if your heart receptors are overly sensitive to this medicine, your blood pressure can drop to dangerously low levels. Symptoms include severe dizziness, lightheadedness, or fainting. You should seek immediate medical attention if you experience any of these symptoms.

Cold hands and feet: Metoprolol is a beta blocker. Beta blockers tend to slow down your heart rate and lower your blood pressure. When this happens, less blood gets pumped to your hands and feet. With less blood to warm them, they get cold and sometimes painful.

Very slow heart rate (severe bradycardia): Metoprolol is a beta blocker. Beta blockers can slow the nerve impulses that travel to your heart. Sometimes this can slow your heartbeat to a dangerously low level. This can even lead to complete stoppage of the heart.

Extreme fatigue: Metoprolol slows your heart rate and the flow of blood to your brain, arms, and legs. This can make you feel tired. Some people have experienced tiredness that gets progressively worse each day. This can make it difficult to carry out daily activities.

Serious depression: Some people using metoprolol have experienced depression. It isn’t known whether their depression was actually caused by using this drug, as heart-disease patients have an above average rate of depression. In the last two decades, clinical studies have shown mixed results. Some studies have indicated a clear association between metoprolol use and depression, while others have shown no association. If you already experience depression, this drug may make it worse. Depression is always serious, so talk to your doctor right away if you experience it while taking metoprolol.

Interactions

Metoprolol may interact with other medications

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

Reserpine and monamine oxidase (MAO) inhibitors may increase or add to the effects of metoprolol. They may also increase light-headedness or slow your heart rate more. MAO inhibitors can continue to interact with metoprolol for up to 14 days after taking them. MAO inhibitors include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Emsam)
  • tranylcypromine (Parnate)

Heart rhythm drugs

These drugs can also interact with metoprolol. If you use digitalis (Lanoxin) with metoprolol, it could slow down your heart rate too much.

Calcium channel blockers

Like metoprolol, these drugs are used for hypertension and several other heart problems. Combined with metoprolol, calcium channel blockers may reduce the contraction of the heart and slow it down more. Doctors sometimes use this combination under close supervision. These drugs include:

  • amlodipine (Norvasc)
  • diltiazem (Cardizem, Dilacor, Taztia, Tiazac)
  • felodipine
  • clevidipine
  • isradipine
  • celvidipine
  • flunaraizine
  • 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 the body by the same systems as metoprolol. So, combining them could also increase the levels of metoprolol in the body. These include:

  • fluoxetine (Prozac)
  • fluvoxamine (Luvox)
  • paroxetine (Paxil)
  • sertraline (Zoloft)
  • bupropion (Wellbutrin, Zyban)
  • clomipramine (Anafranil)
  • desipramine (Norpramin)
  • chlorpromazine
  • fluphenazine
  • haloperidol
  • thioridazine

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

  • other heart rhythm drugs like quinidine and propafenone
  • the antiretroviral ritonavir (Norvir)
  • antihistamines, including diphenhydramine
  • antimalarials, such as hydroxychoroquine and quinidine
  • antifungals, 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. Types 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, like dihydroergotamine, interact with metoprolol. These drugs 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, which is sometimes used in heart testing, can conflict with metoprolol.

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Other warnings

Metoprolol warnings

Metoprolol oral tablet comes with several warnings.

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 only in small doses with careful monitoring. At higher doses, metoprolol can block different receptors on the breathing passages. This narrows the passages, worsening asthma or COPD.

For people with diabetes: Metoprolol may eliminate tremors and increase heart rate, both of which 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 dose of metoprolol at first. The dose may then increase gradually.

For children: Children aged 1–17 years may be treated with the immediate-release form of the drug.

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Dosage

How to take metoprolol

The dosage information is for metoprolol oral tablet. All possible dosages and forms may not be included here. Your dose, form, and how often you take it 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

Forms and strengths

Generic: metoprolol

  • Form: Immediate-release oral tablet
  • Strength: 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg
  • Form: Extended-release oral tablet
  • Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Brand: Lopressor

  • Form: Immediate-release oral tablet
  • Strength: 50 mg and 100 mg

Brand: Toprol XL

  • Form: Extended-release oral tablet
  • Strength: 25 mg, 50 mg, 100 mg, and 200 mg

Dosage for high blood pressure

Adult dosage (ages 18-64 years)

  • The immediate-release drug is often started at 50 mg, taken twice a day. It’s gradually adjusted if needed.
  • The extended-release drug is often started at 25 mg taken once a day or more. It’s also gradually increased if needed.

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 dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be toxic.

Dosage for angina (chest pain)

Adult dosage (ages 18-64 years)

  • The immediate-release drug is often started at 50 mg, taken twice a day. It’s gradually increased as needed.
  • The extended-release is often started at 100 mg taken once a day. It’s gradually increased if needed.

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 dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be toxic.

Dosage for heart failure or after a heart attack

Adult dosage (ages 18-64 years)

  • After heart attack or for patients with heart failure, the dose is highly individual. The oral drug is often started in the hospital.
  • The oral immediate-release tablet is often dosed at 12.5–25 mg, taken once a day to start. From there, the dose is slowly adjusted.

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 dose so that too much of this drug does not build up in your body. Too much of the drug in your body can be toxic.

Special considerations

Having liver disease may affect your dose. Speak with your healthcare provider.

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 to speak with your doctor or pharmacist about dosages that are right for you.

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Take as directed

Take as directed

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 don’t take it: If you have high blood pressure or chest pain and don’t take your metoprolol, 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

If you stop taking it suddenly: 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 don’t take it 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 miss a dose: If you miss a dose, just take the next dose as planned. Don’t double your dose.

Important considerations

Important considerations for taking metoprolol

Keep these considerations in mind if your doctor prescribes metoprolol oral tablet for you.

General

  • Take metoprolol with food. Take it either with a meal or right after. This drug may cause nausea. Taking it with food will allow your stomach to digest it better.
  • Don’t crush the 24-hour release tablet. However, you can cut the tablet along the score marks (the groove on the tablet) if your healthcare provider recommends a smaller dose.

Storage

  • Store at room temperature: 68–77°F (20–25°C).
  • Protect it from light, heat, and moisture.
  • You may also store the drug briefly at temperatures as low as 59°F and as high as 86°F.
  • Be careful of moist environments, including bathrooms. To keep drugs away from moisture, store them somewhere other than your bathroom and any other damp location.

Refills

A prescription for this medication is not refillable.

Disclaimer: Healthline 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.

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