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Why it's used

Metoprolol is used to treat certain heart conditions including high blood pressure, heart attack, and abnormal heart rhythm (tachyarrhythmia). This medicine is also used for the long-term treatment of chest pain (angina pectoris). It is a prescription medicine. This medicine works by relaxing blood vessels and reducing the heart rate to promote blood flow which further helps in lowering blood pressure. Metoprolol is also used to prevent migraine.
Metoprolol may also be taken in combination with other medicines to treat certain conditions as recommended by the doctor. Metoprolol is used together with other antihypertensive agents to treat high blood pressure. This medicine works by relaxing blood vessels and reducing the heart rate to promote blood flow which further helps in lowering blood pressure.
Beta-Adrenergic Blocker
Metoprolol belongs to a class of medicines called Beta-Adrenergic Blocker. Beta adrenergic blockers are a class of medicines which are used to treat high blood pressure, chest pain, migraines and to manage abnormal heart rhythms. Beta blockers are also used after the first heart attack to prevent the heart from the second heart attack.

How to use

Follow directions on the product label, information guide, and provided by your doctor before using Metoprolol. Use this medicine as per your doctor's instructions.
You should track your blood pressure levels regularly. Discuss your results with the doctor, especially if your blood pressure measurements are too high or too low. Your treatment may need changes.
Metoprolol is used without food. The Metoprolol should be consumed on an empty stomach.
The typical adult dose of Metoprolol is 100-200 mg daily as a single dose in the morning, or in divided doses (morning and evening). The maximum dose for adults of Metoprolol is 450 mg/day per day. There are no known habit-forming tendencies with this medicine.
Metoprolol is to be used for longer periods of time. The Metoprolol should be taken for long-term to treat chest pain associated with decreased blood flow to heart (angina pectoris).
Tell your doctor if your condition persists or worsens or if you develop new symptoms. Talk to your doctor if swelling of the face, swelling of the throat, swelling of the lips, swelling of the tongue, itching, difficulty in breathing, feel weak, feel dizzy, slow heart rate, and slow blood pressure. If you have issues with the health of your liver, a low dose of Metoprolol is recommended in patients with abnormal functioning of the liver. Consult with your doctor before stopping the use of Metoprolol.
To see the impact of Metoprolol on the body, your doctor may recommend a lower initial dose. Please follow your doctor's instructions carefully.
When stopping this medicine, it is possible that you may experience withdrawal symptoms such as high blood pressure, and abnormal heart rhythm. You may need to gradually decrease the dose of this medicine before stopping.
The safety and effectiveness of using this medicine in children has not been established. There is no efficacy study of Metoprolol established for use in children.
To decrease the possibility of side-effects, you might be recommended to use the extended-release form of this medicine by your doctor. The extended-release medicine helps in maintaining a steady level of the medicine in your body for a longer period of time. Do not crush or chew the medicine, unless indicated on the package or by your doctor.
The injection form of the medicine may be used on the vein. Three Metoprolol injections of dose 5 mg should be given at intervals of 2 minutes into the vein.
Limit drinking alcohol with Metoprolol.
Medicines may be given for uses other than those listed in the medicine guide. Do not use Metoprolol for symptoms for which it was not prescribed. Do not give Metoprolol to others who may have similar symptoms as you. Self-medication can cause harm.
Store Metoprolol at 15-30°C (59-86°F), away from moisture, and away from light. Keep this medicine away from children and pets.

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How to take Metoprolol

Your dose and how often you take Metoprolol will depend on the following factors:
  • patient's health
  • the health of the patient's kidneys
  • response to the medicine

Metoprolol Dosage

Dosage for high blood pressure

Adult
  • Recommended: initial dose increased after 1 week up to 100-450 mg/day based on the patient's response
  • Initial: 100 mg/day in single or divided doses
  • Maximum: 450 mg/day

Dosage for chest pain (angina pectoris)

Adult
  • Recommended: initial dose increased after 1 week up to 100-400 mg/day based on the patient's response
  • Initial: 100 mg/day in two divided doses
  • Maximum: 400 mg/day

Dosage for early treatment of heart attack

Adult
  • Recommended: after well tolerate initial injection dose (15 mg), 50 mg tablet every 6 hours for 48 hours started after 15 minutes of the last injection dose. After that maintenance dose 100 mg twice daily should be given to the patients. If the initial injection dose is not well tolerated, 25 or 50 mg tablet every 6 hours started after 15 minutes of the last injection dose.
  • Initial: three injections of 5 mg dose given at time interval of 2 minutes

Dosage for late treatment of heart attack

Adult
  • Initial: 100 mg twice daily for 3 months

Dosage for prevention of migraine

Adult
  • Recommended: 100-200 mg/day in the morning and evening in divided doses

Dosage for abnormal heart rhythm (cardiac arrhythmia)

Adult
  • Recommended: 100-150 mg/day in the morning and evening in divided doses

Forms

Extended Release Capsule
Strength: 25 mg, 50 mg, 100 mg, and 200 mg
Injection
Strength: 1 mg/1 ml and 5 mg/5 ml
Tablet
Strength: 25 mg, 50 mg, and 100 mg
Extended Release Tablet
Strength: 25 mg, 50 mg, 100 mg, and 200 mg
Coated Tablet
Strength: 25 mg, 50 mg, 100 mg, and 200 mg
Film Coated Tablet
Strength: 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg
Film Coated, Extended Release Tablet
Strength: 23.75 mg, 25 mg, 47.5 mg, 50 mg, 90 mg, 100 mg, 190 mg and 200 mg

Missed Dose

If you have missed a dose, take the dose as soon as you remember. Otherwise, skip the missed dose if it's time for the next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Metoprolol?
In case of overdose, treatment with close monitoring under intensive care unit (ICU) should be provided. Use of activated charcoal, a substance that absorbs poisons from the stomach is recommended. Stomach emptying should be done by cleaning out the contents of the stomach (gastric lavage). Also, provide treatment with a laxative to prevent absorption of the remaining drug in the stomach and intestine. Use blood products to treat low blood pressure and shock. 1-2 mg injection of atropine should be injected into the veins to treat slow heartbeat. A bolus injection of 10 mg glucagon may be given into the veins if required. This may be repeated or followed by 1-10 mg/hour infusion of glucagon into veins based on the patient's response. If no response occurs with glucagon or if glucagon is not available, a beta-adrenoceptor stimulant such as isoprenaline, dobutamine, noradrenaline may be given. A dobutamine dose of 2.5-10 micrograms/kg/minute (1.14-4.55 micrograms/lb/minute) can also be injected into the vein.
Symptoms of an overdose of Metoprolol
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Metoprolol, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Metoprolol

Before you use Metoprolol, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information. Discuss with your doctor if you are allergic to other beta-blockers.
Before you use Metoprolol, tell your doctor of your medical history including tightening of the airway muscles (bronchospasm), breathing problems, asthma, second and third-degree heart block, heart failure, shock, poor blood circulation, very slow heart rate, heart rhythm problem (called as, sick sinus syndrome), a tumour near the kidney (phaeochromocytoma), low blood pressure, diabetes, slow heartbeat, increased acidity of the blood (metabolic acidosis), severe liver problems, overactive thyroid, skin rashes (psoriasis), chest pain, dry eyes, allergy to Metoprolol, or injection of calcium channel blockers directly into veins. Before having any surgery, discuss with your doctor and dentist about medicines you use including prescription medicines, non-prescription medicines, and herbal supplements.
The use of Metoprolol may change heart rate. A decrease in the heart rate is seen in the patients using this medicine.
The use of this medicine may change high-density lipoproteins. A decrease in the high-density lipoprotein level occurs in the patients using this medicine.
The use of Metoprolol may change triglyceride level in the blood. An increase in the triglyceride level occurs in the patients using this medicine.
Metoprolol should be used only when required in patients who are pregnant or planning to become pregnant. Metoprolol crosses the placenta. Beta-blockers decreases placental perfusion, which may result in premature childbirth and can be fatal to the baby. In neonates, Metoprolol may cause decreased heartbeat, low blood sugar level, and respiratory distress. Monitor the baby carefully during the first days after birth. Consult with your doctor on the use of Metoprolol during breastfeeding. Metoprolol may pass into breast milk in a low quantity. Caution is recommended in mothers who are breastfeeding while using Metoprolol. Consult with your doctor on the use of Metoprolol, if you are trying to conceive.
Metoprolol can make you feel sleepy. Be careful, especially while driving, while using heavy machinery, or when doing any activity that needs you to be completely alert. The consumption of alcohol with Metoprolol can worsen the sleepiness.
This medicine may increase your sensitivity to sunlight and make you prone to sunburn. If this happens, limit your time outdoors to prevent sunburn. Use a sunscreen and cover your skin when you are outdoors. If you get sunburns on your body, consult with your doctor.
Older patients may have a higher incidence of side-effects when using Metoprolol. Elderly patients may see an increased risk of low blood pressure, and excessive slow heart rate (bradycardia).

What precautions should be taken during Pregnancy and Nursing, and administering Metoprolol to Children or the Older Adults?

Pregnant Women

Only When Necessary
Warning: Monitor the baby carefully during the first days after birth.

Breastfeeding

Precaution
Warning: As Metoprolol may pass into breast milk in a low quantity so take necessary precautions while using Metoprolol in breastfeeding mother.

Younger Adults Population

Contraindication
Warning: The safety and effectiveness of Metoprolol have not been established in children.

Older Adults Population

Precaution
Warning: The Metoprolol should be used with caution in the elderly patients as they may be more sensitive to it.

Metoprolol Side-effects

The following side-effects may commonly occur when using Metoprolol. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
The following side-effects may commonly occur in older patients on the use of Metoprolol. Discuss with your doctor if any of these side-effects last for a long time or are severe:
Rarely, the use of Metoprolol may cause the following side-effects:
  • abnormal sensations in the body
  • abnormal skin sensations
  • an increase in blood triglycerides
  • breathing difficulties
  • chest pain
  • conduction disturbances
  • cramping pain in the leg (claudication)
  • decreased performance
  • difficulty in sleeping
  • disorientation for time and place
  • drowsiness
  • dry eyes
  • dry mouth
  • emotional lability
  • feeling unreal (depersonalisation)
  • first degree heart block (atrioventricular block)
  • gas formation (flatulence)
  • heartburn
  • hives
  • impotence
  • inability to think clearly (slightly clouded sensorium)
  • increased sweating
  • inflammation of the eye
  • insomnia
  • irritated eyes
  • joint inflammation (arthritis)
  • joint pain (arthralgia)
  • memory disturbances
  • muscle cramps
  • muscle weakness
  • nervousness
  • nightmares
  • personality changes
  • purple or red discolored spots on the skin not associated with low levels of thrombocytes
  • red, raised patches coated with the silvery white accumulation of dead skin cells (psoriatic or dystrophic skin lesions)
  • reduced alertness
  • reduced libido
  • reversible hair loss
  • reversible hearing loss
  • ringing in the ears (tinnitus)
  • runny nose
  • short-term memory loss (amnesia)
  • spinning sensation (vertigo)
  • stuffy nose (rhinitis)
  • swelling of the legs
  • taste disturbances
  • water retention
  • weight gain
The following severe side-effects may also occur when using Metoprolol:
  • Symptoms: tightening of airway muscles (bronchospasm) shortness of breath (dyspnea)
    Consult with your doctor, if serious side effects occur while using Metoprolol.
  • liver disorder
    Symptoms: an inflammation of the liver (hepatitis), yellowish pigmentation of the skin (jaundice), non-specific liver dysfunction, increased level of liver enzymes (alkaline phosphatase, transaminase lactic dehydrogenase)
    If any of these symptoms become serious, contact your doctor.
  • Symptoms: reduction in blood platelets low level of white blood cells
    If serious side effects appear, contact your doctor immediately.
  • reproductive disorders
    Symptoms: abnormal curvature of the penis (Peyronie's disease)
    If any of these symptoms become serious, contact your doctor.
  • skin disorders
    Symptoms: rash, increased skin sensitivity to the sun (photosensitivity) worsening of psoriasis
    If serious side effects appears, contact your doctor immediately.
  • heart and blood vessels disorders
    Symptoms: shortness of breath, slow heartbeat (bradycardia), decreased blood flow through the arteries (arterial insufficiency), heart failure, low blood pressure, death of body tissue due to either a lack of blood flow or a serious bacterial infection (gangrene), worsening of heart failure second or third-degree heart block
    If any of these symptoms become serious, contact your doctor.
  • stomach and intestinal disorders
    Symptoms: diarrhea, constipation vomiting
    If serious side effects appear, ask your doctor.
  • central nervous system disorder
    Consult with your doctor, if serious side effects occurs while using Metoprolol.
  • Symptoms: a decrease in high-density lipoprotein, increased very low-density lipoprotein strengthening of insulin induced low blood glucose level
  • eye disorder
    Symptoms: blurred vision pink eye (conjunctivitis)
    Consult with your doctor, if serious side effects occurs while using Metoprolol.
Your doctor has prescribed Metoprolol because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious side-effects. This page does not list all possible side-effects of Metoprolol.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Side-effects and Allergic Reactions of Metoprolol by Severity and Frequency

Common Side-effects

Following are the common side-effects of this medicine:

Infrequent and Rare Side-effects

Following are the infrequent and rare side-effects of this medicine:

Severe Side-effects

Following are the severe side-effects of this medicine:

Side-effects in Older Adults

Following are the side-effects of this medicine in elderly patients:

Mild Allergic Reactions

Following are the symptoms of mild allergic reactions to this medicine:

Serious Allergic Reactions

Following are the symptoms of serious allergic reactions to this medicine:
  • difficulty in breathing
  • increased skin sensitivity to the sun (photosensitivity)
  • swelling of the lips
  • swelling of the throat
  • swelling of the tongue
If you have any of these symptoms, stop using Metoprolol and contact your doctor.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Low blood pressure

The patients with low blood pressure conditions are at an increased risk when using this medicine. If low blood pressure (less than 90 mmHg) occurs, Metoprolol should be gradually decreased or discontinued and access the status of blood flow and damage to heart muscle. The measurement of arterial pressure (using central venous, pulmonary capillary wedge) may be required. A temporary mechanical blood circulation support, positive inotropic agents, or fluids are given to the patients. If low blood pressure occurs due to sinus low heart rate or AV block, it should be treated accordingly.

Heart block

Metoprolol slows the atrioventricular conduction which results in fluid accumulation in the lungs, atrioventricular block (AV block), and shock. It may also cause first, second, or third-degree heart block. If a heart block occurs, discontinue using this medicine and atropine (0.25-0.5 mg) should be injected in the vein. If atropine treatment doesn't work, Metoprolol should be discontinued, provide isoproterenol carefully or pacemaker installation in heart should be considered.

Decreased heartbeat (bradycardia)

The patients with abnormal heart rate are at increased risk while using this medicine for treatment of heart failure. The sinus heart rate is decreased in patients suffering from heart failure. In addition, Metoprolol also causes a decrease in sinus heart rate. This risk is high in the patients with increased initial heart rate and less in patients with low initial heart rates. If a decrease in sinus heart rate (<40 beats per min) and cardiac output is seen, atropine (0.25-0.5 mg) should be injected in the vein. If atropine treatment doesn't work, Metoprolol should be discontinued, provide isoproterenol carefully or pacemaker installation in heart should be considered.

Patients with reduced blood supply to limbs

The patients with reduced blood supply to limbs such as Raynaud's disease are at increased risk while using this medicine. Such patients are at increased risk of developing low blood pressure conditions. Metoprolol should be used with caution in these patients.

Elevated thyroid hormone level (thyrotoxicosis)

The patients using Metoprolol are at increased risk of developing an increase in the thyroid hormone level. The use of beta-adrenergic blockers may mask the symptoms of an increased level of thyroid hormone, such as increased heartbeat. The patients should be carefully monitored to avoid immediate withdrawal of Metoprolol, which may cause an increase in the level of thyroid hormone.

Diabetes

Patients with diabetes are at increased risk when using this medicine. Beta-blockers including Metoprolol may affect the breakdown of glucose. In addition, Beta-blockers also hide the symptoms of low blood glucose level such as increased heart rate. Metoprolol should be used with caution in these patients. In patients with insulin-dependent and labile diabetes, the dose adjustment of blood sugar lowering medicines may be necessary.

Major surgery

Patients undergoing surgery and having a risk factor of heart and blood vessels diseases are at increased risk when using this medicine. These patients may suffer from decreased heartbeat, stroke, long-term low blood pressure and can be possibly fatal. The anesthetist should be informed about the use of Metoprolol before undergoing surgery. The treatment with high dose Metoprolol in patients undergoing non-cardiac surgery should be avoided.

Contraction of the airways (bronchospastic diseases)

Patients with bronchospastic diseases are at increased risk when using this medicine. The Metoprolol should be used with caution in these patients. A lower dose of Metoprolol or a beta-2 stimulant (for example, terbutaline) should be used in combination with Metoprolol. Discontinue this medicine if bronchospasm related to congestive heart failure occurs.

Patients without a history of heart diseases

Patients with ischemic heart disease are at increased risk when discontinuing the use of Metoprolol abruptly. These patients may suffer from worsening of angina, abnormal heartbeat, increased blood pressure, and, in some cases, a heart attack may occur. When the long-term used Metoprolol is discontinued, especially in the patients with ischemic heart disease, the dose of Metoprolol should be gradually decreased for 1-2 weeks until the patient is taking 25 mg of Metoprolol per dose. The lowest dose should be taken for at least 4 days before discontinuing the medicine. The careful monitoring of the patient is advised. If angina worsens or coronary insufficiency occurs, Metoprolol should be given quickly, at least temporarily, and other measures suitable for controlling unstable angina should be used. Patients should be warned for not to discontinue the therapy without the doctor’s advice. Metoprolol should not be stopped abruptly even if it is used only for high blood pressure.

Heart failure

Patients with a history of congestive heart failure controlled by diuretics and digitalis are at increased risk when using this medicine. These patients may suffer from depressed contractility of heart muscles causing or worsening heart failure. As Metoprolol and digoxin both decreases the atrioventricular conduction and thus there is a risk of atrioventricular dissociation in such patients. Also, symptoms such as dizziness, decreased heartbeat, and fainting may appear. The blood flow should be carefully monitored in such patients. Metoprolol should be discontinued if heart failure occurs or persists even after appropriate treatment. In the patients with congestive heart failure controlled by diuretics and digitalis, the Metoprolol should be used with caution.

Patients using adrenaline

The patients using adrenaline while treatment with Metoprolol are at an increased risk. These patients may develop an increase in blood pressure and a decrease in the heartbeat.

Patients with a history of psoriasis

Such patients with the history of psoriasis are at increased risk while using this medicine. Metoprolol should be used with caution in such patients.

Patients with increased contractions in coronary arteries (variant angina pectoris).

Such patients are at increased risk when using this medicine. In these patients, beta blockers may raise the duration and number of angina attacks. Proper care is required while using Metoprolol in these patients.

Patients with severe liver diseases

The patients with severe liver disease are at increased risk while using this medicine. The amount of Metoprolol in the blood is increased in such patients.

Calcium-channel blockers

Patients with intravenous use of calcium channel blockers while undergoing therapy with Metoprolol are at an increased risk. The combined use of calcium channel blockers and Metoprolol should be avoided.

Interactions with Metoprolol

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Metoprolol interacts with cytochrome P450 2D6 enzyme inhibitors. When cytochrome P450 2D6 enzyme inhibitors (fluoxetine, paroxetine or bupropion, thioridazine, quinidine, propafenone, ritonavir, antihistamines, diphenhydramine, hydroxychloroquine or quinidine, terbinafine, and cimetidine) is used with Metoprolol, may increase the level of Metoprolol in the blood. It is advised to take necessary precautions while using Metoprolol and cytochrome P450 2D6 inhibitors in combination.
There may be an interaction of Metoprolol with anesthetics, which are used to induce a state of sleepiness and/or unconsciousness. Some inhalation anesthetics may increase the heart depressive effects of Metoprolol.
Metoprolol may interact with catecholamine-depleting drugs such as reserpine, which is used to treat high blood pressure. The use of Metoprolol with catecholamine-depleting drugs may cause a spinning sensation, fainting, or low blood pressure due to standing up from a sitting or lying position. Such patients should be closely monitored for low blood pressure or slow heartbeat.
Your doctor's guidelines may need to be followed while taking this medicine along with calcium antagonists, which are used to treat high blood pressure, angina, abnormal heart rhythms and migraine pain. When calcium antagonists (verapamil) is injected directly into veins in patients who are on treatment with Metoprolol may increase the risk of low blood pressure, abnormalities in heart conduction, and left ventricular insufficiency. The use of Metoprolol with calcium antagonists is not recommended in patients with abnormal functioning of the heart.
Special instructions need to be followed while taking this medicine along with centrally-acting blood lowering medicines such as clonidine, moxonidine, guanfacin, rilmenidine, methyldopa, which are used to treat high blood pressure. The combined use of clonidine and Metoprolol may increase the risk of recurrence of high blood pressure. Use of Metoprolol should be discontinued several days before withdrawal treatment of clonidine.
Your doctor's guidelines may need to be followed while taking this medicine along with digitalis, which is used to treat congestive heart failure. When Metoprolol is used in combination with digitalis, excessive slow heart rate (bradycardia) and an increase in heart conduction time (atrioventricular conduction time) may occur.
Special instructions need to be followed while taking this medicine along with ergotamine, which is used to treat migraine type headache. The use of Metoprolol with ergotamine may affect blood circulation. The combined use Metoprolol and ergotamine may require essential care.
Metoprolol interacts with antiarrhythmic drugs, which are used to treat irregular heartbeat. When Metoprolol is used with antiarrhythmic drugs (for example, quinidine, amiodarone, and propafenone), the beta blocker can intensify the decreased muscle contraction (negative inotropic) and reduced muscle conduction (negative dromotropic) effects. Patients should use caution when using Metoprolol with antiarrhythmic drugs.
There may be an interaction of Metoprolol with monoamine oxidase inhibitors, which are used to treat depression. The use of Metoprolol with monoamine oxidase inhibitors may cause a slow heart rate and enhanced low blood pressure conditions. Take necessary precautions while using monoamine oxidase inhibitors with Metoprolol. Carefully monitor the blood pressure and heart rate during initial use of Metoprolol in such patients.
Metoprolol may interact with sympathetic ganglion blockers, which are used to control blood pressure levels or other beta-blockers, which are used to treat high blood pressure. The patient should be monitored carefully while using Metoprolol with the medicines that block the transmission between nerve cells (called as; sympathetic ganglion blockers), or other beta-blockers.
Your doctor's guidelines may need to be followed while taking this medicine along with alpha blockers (prazosine, tamsulosin, terazosine, doxazosine), which are used to treat high blood pressure and prostate gland enlargement. When Metoprolol is used with alpha-blockers may increase the risk of the occurrence of low blood pressure especially when standing up from a sitting position (severe orthostatic low blood pressure).
Special instructions need to be followed while taking this medicine along with insulin or oral antidiabetics, which are used to treat high blood sugar levels. When Metoprolol is used with insulin or other oral anti-diabetics, the blood sugar-reducing effect is increased. The dosage adjustment of oral anti-diabetic agents is recommended.
Metoprolol interacts with non steroidal anti-inflammatory drugs (indomethacin), which are used to treat fever and mild to moderate pain or inflammation. The combined use of Metoprolol with indomethacin may decrease the blood pressure lowering effects of Metoprolol.
There may be an interaction of Metoprolol with sympathomimetics such as adrenaline, which are used to treat severe allergic conditions. The combined use of adrenaline with Metoprolol may lead to an increase in blood pressure and slow heart rate although these symptoms are less likely to occur with the use of β 1-selective drugs.
Metoprolol may interact with parasympathomimetics, which are used to treat glaucoma and muscle weakness. The use of Metoprolol with the medicine that stimulates the parasympathetic nervous system (parasympathomimetics) result in the prolonged condition of slow heart rate (bradycardia).
This page does not contain all the possible interactions of Metoprolol. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Interactions of Metoprolol by Severity

Severe

The following medicines are usually not to be taken together without consulting with your doctor or pharmacist.

Serious

The following medicines may interact when taken together and can cause harmful effects in the body. Please consult with your doctor or pharmacist before taking these medicines together.

Moderate

The following medicines may interact when taken together and can increase your risk of harmful effects. Please consult with your doctor or pharmacist before taking these medicines together.

When should Metoprolol be not used?

Severe allergy

This medicine is not recommended in patients who are allergic to Metoprolol or other beta-blockers. These patients may have the following symptoms if they use this medicine:
  • severe itching of the skin
  • difficulty in breathing
  • increased skin sensitivity to the sun
  • swelling of the face
  • swelling of lips
  • swelling of the throat
  • swelling of the tongue

Patients with heart block

The use of this medicine is not recommended in patients who have heart block (second or third-degree AV block).

Unstable heart disease

This medicine is not recommended in patients with unstable heart disease (fluid accumulation in the liver, heart failure, shock, or low blood pressure).

Heart rhythm disorder (sick sinus syndrome)

The use of this medicine is not recommended in patients with heart rhythm disorder (sick sinus syndrome).

Patients with a tumor in adrenal glands (called as, pheochromocytoma)

This medicine is not recommended in patients with a tumor in adrenal glands (called as, pheochromocytoma). If the use of Metoprolol is essential, it should be used in combination with an alpha-blocker and only after starting the therapy with an alpha-blocker. The use of beta blockers alone in patients with pheochromocytoma may cause an obscure increase in blood pressure due to the reduction in dilation of blood vessels. These patients may have the following symptoms if they use this medicine:
  • increase in blood pressure

Patients with asthma or bronchospasm

The use of this medicine is not recommended in patients with history of asthma or spasm of the airway muscles (bronchospasm).

Increased acidity of the blood (metabolic acidosis)

This medicine is not recommended in patients suffering from increased acidity of the blood (metabolic acidosis).

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Metoprolol is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.
This page provides information for Metoprolol .
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