Metoprolol is a prescription, orally (taken by mouth) beta-blocker used to treat various cardiovascular (heart) conditions. Beta-blockers reduce the heart rate, lower the heart’s demand for oxygen and reduce the frequency of angina attacks.

In particular, it is used alone or with other medicines to improve blood flow and reduce hypertension (high blood pressure). It also treats chronic (long-term) angina (chest pain) and heart stress following a heart attack.

Metoprolol is often a drug of first choice for people with heart problems. However, initiation and cessation of metoprolol use should be done carefully and as prescribed.

This article will explain the steps and precautions needed to safely discard metoprolol and other pertinent information about using this commonly prescribed drug safely.


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How does metoprolol work?

Beta-blockers, such as metoprolol, are also referred to as beta-adrenergic blocking agents.

Specifically, metoprolol works by blocking the release of the stress hormones adrenaline and norepinephrine by acting on beta receptors in blood vessels and the heart.

This inhibitory effect causes blood vessels to relax. Relaxation of blood vessels slows the heart rate and reduces the heart’s need for oxygen. This, in turn, helps lower blood pressure and relieve chest pain.

Metoprolol is available in generic and brand-name forms, including Lopressor (metoprolol tartrate), an immediate-release tablet (IR; a formulation designed to be swallowed whole where the drug disintegrates instantly), and Toprol-XL (metoprolol succinate), an extended-release capsule (ER; a formulation meant to dissolve more slowly in the body, thus meant to last longer and require fewer dosages).

Metoprolol is also combined with a diuretic (water pill) hydrochlorothiazide. The combination is available under Lopressor HCT for the treatment of high blood pressure.

Metoprolol is also used to improve survival after a heart attack and in combination with other medications to treat heart failure. Metoprolol relaxes blood vessels by acting on specific receptors to improve blood flow and decrease blood pressure.

How to stop taking metoprolol

All brands and the generic version of metoprolol come with a black box warning on how to stop taking metoprolol. So, you will have to follow the precise instructions given by your doctor.

More significantly, abrupt discontinuation of metoprolol may lead to withdrawal syndrome (with the possibility of accompanying tachycardia [increased heart rate] and high blood pressure), worsening chest pain, irregular heartbeat and increased risk of heart attack.

As you complete your prescription, the FDA warns you to slowly taper (reduce) your dose over a week or two before stopping altogether. Your doctor will reduce the amount gradually under close supervision to avoid serious adverse effects.

Also, your doctor will determine the dose of metoprolol by considering your age, body weight, and health condition.

You need to make sure you don’t stop metoprolol on your own even if your symptoms are improving or you feel well. It can be highly life-threatening.

Who should use metoprolol?

Beta blockers such as metoprolol are widely prescribed for people with heart disease in combination with other medications to treat people with the following conditions:

  • Treatment of angina: By reducing the heart rate, beta-blockers are used as first-line treatment in people with angina, either alone or in combination with a calcium channel blocker.
  • Treatment of heart failure: Beta-blockers improve life expectancy in people with heart failure caused by decreased contraction of the left ventricle (the main pumping chamber of the heart). The beta blocker works with angiotensin converting enzyme (ACE) inhibitors, for example, Altace (ramipril) and, in many cases, an aldosterone inhibitor.
  • Treatment of some heart rhythm disorders: Beta-blockers control irregular heart rhythms in people with atrial fibrillation (AF). These drug symptoms caused by AF, particularly palpitations and fatigue, are often improved by slowing the heart rate.
  • Protection against recurring heart attacks: In people who have had a heart attack, beta blockers help reduce the risk of heart attacks in the future.
  • Blood pressure control: Beta-blockers are commonly used to help lower blood pressure in combination with other medicines, such as an ACE inhibitor or calcium channel blocker.

For context, high blood pressure is caused by increased pressure in blood vessels than usual.

High blood pressure causes the heart to pump blood harder. An average blood pressure level is below 120/80 millimeters of mercury (mmHg). If high blood pressure is not controlled and treated, it can be life-threatening.

By comparison, angina pectoris causes pain, pressure, squeezing, or discomfort in the center of the chest or neck, jaw, shoulder, back, or arm. It is caused when the heart muscle does not get enough oxygen-rich blood that it needs.

Angina is not a disease but a symptom of an underlying heart problem such as ischemic heart disease. One of the main causes of angina is blockage or narrowing of one or more arteries of the heart, also called ischemia (poor oxygen supply due to decreased blood flow).

Who shouldn’t take metoprolol?

Various formulations of metoprolol (such as Lopressor HCT, ToprolXL, or Lopressor) are not recommended for people with the following pre-existing conditions:

Also, be sure to discuss with your doctor before taking metoprolol if you have any of the following conditions:

Pregnant individuals or those planning to become pregnant should consult their physician before starting metoprolol, including those who are currently breastfeeding.

Side effects and safety

Metoprolol carries a black box warning as designated by the Food and Drug Administration (FDA); stopping metoprolol abruptly can lead to withdrawal effects causing severe chest pain, heart attack, or cardiac arrhythmia (irregular heart beat).

Like all medications, metoprolol has the potential for adverse effects.

Therefore, discuss with your doctor what side effects you may personally be susceptible to before starting treatment, and what can be done to increase your chances of healthily and effectively completing the full length of your prescription.

Common side effects

Some common side effects of metoprolol include:

  • Cold hands and feet
  • Constipation
  • Depression
  • Diarrhea
  • Dizziness
  • Dry mouth
  • Gas or bloating
  • Stomach ache
  • Itching
  • Nausea
  • Rhinorrhea
  • Stomach ache
  • Tiredness
  • Vomit

If any of these side effects appear and keep getting worse, contact your doctor right away.

Serious side effects

Metoprolol can cause some serious side effects. Call your doctor right away if you experience any of the following symptoms:

  • Fainting
  • Irregular heartbeat
  • Shortness of breath or difficulty breathing
  • Swelling of the hands, feet, ankles or lower legs
  • Weight gain
  • Wheezing

Abrupt discontinuation of metoprolol can lead to a withdrawal syndrome which can cause angina or myocardial infarction.

As explained earlier, tachycardia and hypertension are common in withdrawal syndrome. To prevent this, a healthcare professional will slowly reduce your dosage before stopping the drug to prevent withdrawal symptoms.

What drugs interact with metoprolol?

Metoprolol interacts with some medications when used together. Call your doctor before taking these drugs together with metoprolol:

Drugs that reduce catecholamines (hormones produced by the adrenal glands).:

These drugs can cause an additive effect with metoprolol and may cause low blood pressure (hypotension), bradycardia (slow heart rate), dizziness, sudden fainting (vasovagal syncope), or postural hypotension (sudden drop in blood pressure when standing up from a sitting).

Such examples include:

Potent CYP2D6 inhibitors:

Inhibitors of CYP2D6 (an enzyme found in the liver that plays a role in the effectiveness of some medicines, such as antidepressants or neuroleptics) can hinder the ability of metoprolol to work effectively. Monitor closely when taking these drugs together.

Such examples include:

  • Prozac (fluoxetine)
  • Paxil CR (paroxetine)
  • Rythmol SR (Propafenone)

Always tell your doctor about all your medications before starting metoprolol. Your doctor may adjust the dose of these medicines to avoid any interactions.

Summary

Metoprolol is widely prescribed to manage and treat various cardiovascular disorders.

It is available in multiple brand and generic names in different dosage forms. Metoprolol is used alone and in combination with other cardiovascular drugs.

Metoprolol is generally safe and effective, but should only be used as directed. The most critical caveat regarding using metoprolol is how to stop taking it.

All brands and the generic version of metoprolol come with a black box that warns of sudden discontinuation of the drug.

Stopping prematurely can lead to a withdrawal syndrome that can worsen chest pain and arrhythmias, high blood pressure, and increase the risk of heart attack.

It is necessary to slowly reduce the dose for some time and then stop the drug. Your doctor will reduce your dose and monitor you for side effects.

In many treatment plans, you may need to take metoprolol for a long time or even for the rest of your life.

Frequent questions

  • How can I store metoprolol?

    Store metoprolol between 68 and 77 degrees F. Also, always keep it away from excess heat and moisture (such as in a bathroom). Keep all medications out of the sight and reach of children and pets. Discard unnecessary medications.

    However, don’t flush your medicines down the toilet. The best way to discard unwanted drugs is through a drug take-back program.

  • What are some brand name drugs that contain metoprolol?

    Some common drug brands that include variations of the active ingredient metoprolol currently available in the United States include: Kapspargo Sprinkle (metoprolol succinate), Lopressor (metoprolol tartrate), Toprol XL (metoprolol succinate), and Lopressor HCT (containing metoprolol, hydrochlorothiazide).

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