Metoprolol

Last Updated December 20th, 2021

Therapeutic Indications

Metoprolol is a medication used to regulate hypertension and offset angina. More importantly, this drug is a beta-blocker that boosts blood flow, relaxes the blood vessels and lowers heart rate. Metoprolol is sold under the brand names of Lopressor and Toprol XL.

Heart diseases_ BPFurther, Metoprolol is also used as a combination therapy with other drugs. Above all, Metoprolol helps to:

  • Lower high blood pressure
  • Reduce Angina or chest pain
  • Prevent heart attacks
  • Offset risk of strokes
  • Protect against Kidney problems
  • Improve survival rates post heart attack
  • Treatment for Migraine headaches although it is rare

Do I Need a Prescription?

Metoprolol (Lopressor and Toprol XL) needs a prescription since it is a beta-blocker. Significantly, such class of medicines is prescription only drugs which mean they need to be prescribed by a qualified healthcare professional.

Dosage

Metoprolol is available as generic drugs with less strength compared to brand name versions. They are available as oral capsules and injections.  Metoprolol is sold as two brand names

  • Lopressor: Extended-release tablets ( Metoprolol Tartrate)
  • Toprol XL: Immediate release tablets(Metoprolol Succinate )

Both the generic and brand forms are nothing but different versions of the same medication. Lopressor and Toprol XL are both Metoprolol, the only difference is in their salt forms. Consequently, this difference in salt forms increases their usability in the treatment of diverse medical conditions.  Essentially, the extended release type allows the medicine to be in the bloodstream for more time.

The dosage of Metoprolol depends upon the condition of the patient, age, the presence of other medical conditions, severity, and side effects.

Adult Dose for Hypertension

Lopressor

  • Starting dose: 100 mg to be taken orally as a single dose. It is also prescribed as divided doses for the day
  • Maintenance dose: 100 – 450 mg one tab per day for oral consumption. Above 450 mg dose is not recommended.

Toprol XL

  • Starting dose: 25 -to 100 mg oral intake single dose per day
  • Maintenance dose: 100 – 400 mg oral intake single dose per day
  • Increase dosage after gauging response during the first week following up a review
  • Doses above 400 mg per day are yet to be researched

Child dosage (6 years and above) for hypertension

Toprol XL

  • Starting dose: 1 mg/kg oral intake once a day. Dosage must not be above 50 mg once daily
  • Highest possible dosage: 200 mg one tablet a day for oral intake

Adult Dosage for Angina

Lopressor 

  • Starting dose: 50 mg tablets oral intake twice a day
  • Maintenance dose: 100 – 400 mg per day

Toprol XL

  • Starting dose:100 mg tablets oral intake once a day
  • Maintenance dose: 100 mg to 400 mg one tab per day
  • Dosage is increased at weekly intervals till the heart rate has slowed down and the intended response is achieved.
  • Importantly, studies not undertaken for doses above 400 mg per day

Adult Dose for Myocardial Infarction

Lopressor 

  • Starting dose: Administer 5mg dosage in intervals of 2 minutes. Ascertain level of toleration for 3 doses. After the patient begins to tolerate 4 doses, next level is 50mg tab- oral intake scheduled 6 hourly for 48 hours. Those that showed intolerance for complete 4 doses, 25 – 50 mg dosage is administered orally every 6 hours.
  • Maintenance dose: 100 mg oral intake twice a day

Adult Dosage for Congestive Heart Failure

Toprol XL

  • Starting Dose: 25 mg one tab daily, oral intake

Dose Adjustments

  • Dose adjustment every 2 weeks to reach maximum tolerated dose or can go up to 200 mg oral intake once a day
  • For treatment of hypertension and angina, when switching from immediate release to extended release, use the same total daily dose.

Important pointers to remember

  • Safety and efficacy of Metoprolol Tartrate or Lopressor have not been studied in children below 18 years. The same is true for Metoprolol succinate or Toprol XL which has not been proven in patients younger than 6 years.
  • Safety is advised before prescribing this drug to senior adults over 65 years as their bodies may not be able to process this drug well enough. This may lead to lethal repercussions especially if the drug remains in the body longer than it should.
  • The tablets can be taken after meals or even along with a meal.
  • Do not crush the tablet. It can be cut along the score to consume a smaller dose
  • The tablets are to be stored away from sunlight as well as moist and damp places.
  • The drug is best stored at room temperatures

Precautions during Medication

  • Keep a check on heart rate and rhythm
  • Seek physician’s advice before discontinuing medication especially in patients with coronary artery disease.

Mechanism of Action (MOA)

Metoprolol is a beta blocker.

Congestive Heart Failure manMetoprolol Succinate(Toprol XL)upsets beta 1-adrenergic receptors in the myocardium, which results in lowering the force and rate of myocardial contraction.  This agent also lowers the secretion of Renin, thereby decreasing levels of angiotensin II. This reduces aldosterone secretion, sympathetic activation, and vasoconstriction. Metoprolol succinate (Toprol-XL) effectively treats heart failure.

Metoprolol Tartrate (Lopressor) helps prevent heart attacks, It is also used as a treatment after a heart attack. Metoprolol acts to improve blood flow by relaxing blood vessels, thereby lowering blood pressure. It lowers the heart rate. This medicine also reduces angina or chest pain.

Beta blockers are effective as they obstruct the effects of adrenaline or hormone epinephrine. Therefore, this results in lower heart rate and blood pressure.  That is why beta blockers are also called beta-adrenergic blocking agents.

Contraindications

Take the advice of your healthcare professional in the presence of the following medical conditions before taking Toprol XL and Lopressor. The below-listed conditions are contraindicated with these drugs.

  • Sinus Bradycardia
  • Depression
  • Diabetes
  • Low blood sugar
  • Pheochromocytoma
  • Absolute Heart Block
  • Atrioventricular Heart Block
  • Asthma Attack
  • First Degree Atrioventricular Heart Block
  • Myasthenia Gravis
  • Sick Sinus Syndrome
  • Occasional Numbness
  • Peripheral arterial occlusive disease
  • Heart failure symptoms
  • Anaphylactic Shock due to Allergy Shots
  • Peripheral Vascular Disease
  • Low blood pressure
  • Bronchospasm
  • Psoriasis
  • Reduced Blood Circulation
  • Liver problems

Metoprolol Interactions

The list below gives an indication of the drugs that could potentially interact with Metoprolol and adversely affect its working.

Types of drugs that interact with Metoprolol include:

  • Antidepressants
  • Antimalarial drugs
  • Heartburn drugs
  • Medications for stomach problems
  • Heart drugs
  • Antihistamines
  • Few HIV treatment drugs
  • Some antifungal medications,
  • Few drugs for mental illness

Metoprolol and Alcohol

  • Avoid alcohol as it can increase drowsiness.

Side Effects

Well-known side effects of Metoprolol are:

  • Dry mouth
  • Tiredness
  • Dizziness
  • Nausea
  • Depression
  • Vomiting
  • Stomach pain
  • Heartburn
  • Bloating
  • Constipation
  • Cold hands and feet
  • Rashes

Serious side effects

  • Swelling of limbs
  • Wheezing
  • Shortness of breath
  • Fainting
  • Unusual weight gain
  • Palpitation
  • Irregular heartbeat

Take the advice of a medical specialist immediately in the presence of any serious side effects of Metoprolol.

What To Do If You Skip a Dose

In case, you miss a dose, take the next dose as per schedule. There is no need to double the dose.

Overdose

An overdose of Metoprolol can manifest as following symptoms.  Consult the medical specialist as an emergency.

  • Fainting
  • Trouble breathing or swallowing
  • Swelling of the limbs

Generic Brand Names of Metoprolol

  • Lopressor
  • Toprol XL

Different Brands and Manufacturing Companies of the drug

It is estimated that 31 companies manufacture Metoprolol

  • Metoprolol: Pfizer  Inc
  • Actiblok-IPR (100mg) :Biocon Limited
  • Betaloc: AstraZeneca Pharma India Ltd.
  • Blumeta (25mg) :Blue Cross Laboratories Ltd. (Excel)
  • Cadmet-XR (50mg) :Lividus Pharmaceuticals Pvt.Ltd
  • Lopresor :Novartis (India) Ltd.
  • Met – Xl: Ajanta Pharma Ltd.
  • Metapro-XL (50mg) :Micro Labs Ltd (Cardicare)
  • Metolar (100mg) :Cipla Limited
  • Metscore (50mg) :Zydus Cadila Healthcare Ltd.
  • Metozest-XL (25mg) :Innovative Pharmaceuticals

Substitutes for the Drug

  • Lopressor (metoprolol tartrate) and Toprol XL
  • Tenormin (atenolol)
  • Coreg (Carvedilol)
  • Inderal (propranolol)
  • Bystolic (Nebivolol)

Chemical Composition

Metoprolol Tartrate and Metoprolol Succinate are part of phenols and alcohol.  Both these drugs contain Metoprolol, although the salt forms are different – tartrate and succinate which have received the US FDA approval.

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