Metoprolol Tartrate

Name: Metoprolol Tartrate

What is metoprolol (lopressor, metoprolol succinate er, metoprolol tartrate, toprol-xl)?

Metoprolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.

Metoprolol may also be used for other purposes not listed in this medication guide.

What is the most important information i should know about metoprolol (lopressor, metoprolol succinate er, metoprolol tartrate, toprol-xl)?

You should not use this medication if you are allergic to metoprolol, or if you have a serious heart problem such as heart block, sick sinus syndrome, or slow heart rate.

Before taking metoprolol, tell your doctor if you have congestive heart failure, low blood pressure, circulation problems, pheochromocytoma, asthma or other breathing problems, diabetes, depression, liver or kidney disease, a thyroid disorder, or severe allergies.

Metoprolol may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol can increase certain side effects of metoprolol.

Do not stop taking metoprolol without first talking to your doctor. Stopping suddenly may make your condition worse.

If you need surgery, tell the surgeon ahead of time that you are using metoprolol.

Metoprolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

  • Atrial Fibrillation (AF, AFib)
  • Beta Blockers
  • Calcium Channel Blockers (CCBs)
  • Heart Attack
  • High Blood Pressure (Hypertension) Medications
  • Hyperthyroidism
  • Mitral Valve Prolapse (MVP)
  • Palpitations
  • Raynaud's Phenomenon
  • Treatment with Beta Blockers

Introduction

β1-Selective adrenergic blocking agent (β-blocker).109 147

Metoprolol Tartrate Dosage and Administration

General

  • β1-Adrenergic blocking selectivity diminishes as dosage is increased.109 147

  • If long-term therapy is discontinued, reduce dosage gradually over a period of 1–2 weeks.109 147 (See Abrupt Withdrawal of Therapy under Cautions.)

BP Monitoring and Treatment Goals

  • Carefully monitor BP during initial titration or subsequent upward adjustment in dosage.500 501

  • When available, use evidence-based dosing information (i.e., dosages shown in randomized controlled trials to reduce complications of hypertension) to determine target dosages; target dosages usually can be achieved within 2–4 weeks but may take up to several months.501

  • Goal is to achieve and maintain optimal control of BP; individualize specific target BP based on consideration of multiple factors, including patient age and comorbidities, and currently available evidence from clinical studies.500 501

Administration

Administer orally109 147 or by IV injection.109

Oral Administration

Conventional Tablets

Administer metoprolol tartrate conventional tablets daily as a single dose or in divided doses, with or immediately following meals.109

Extended-release Tablets

Administer metoprolol succinate extended-release tablets daily as a single dose.147

Extended-release tablets are scored and can be divided.147 However, swallow tablet or half tablet whole; do not chew or crush.147

When switching from conventional tablets to extended-release tablets, administer the same daily dosage.147

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Monitor heart rate, BP, and ECG during IV therapy.158

Discontinue IV therapy when therapeutic efficacy is achieved (e.g., slowing of ventricular rate in atrial fibrillation) or if systolic BP or heart rate declines to <100 mm Hg or 50 bpm, respectively.158 Discontinue therapy in patients with severe intolerance to IV therapy.109

Rate of Administration

Administer as a rapid IV injection.109 Administer over 1–2 minutes for the management of unstable angina or non-ST-segment elevation/non-Q-wave MI†.218

Dosage

Available as metoprolol tartrate and metoprolol succinate; dosage expressed in terms of the tartrate.109 147

Pediatric Patients

Hypertension† Oral

Some experts recommend an initial dosage of 1–2 mg/kg daily given in 2 divided doses.260 Increase dosage as necessary up to a maximum dosage of 6 mg/kg (up to 200 mg) daily given in 2 divided doses.260

Adults

Hypertension Metoprolol Therapy Oral

JNC 8 expert panel recommends initial dosage of 50 mg daily and target dosage of 100–200 mg daily based on dosages used in randomized controlled studies; administer daily dosage in 1 or 2 divided doses.501

Conventional metoprolol tartrate tablets: Manufacturer states usual initial dosage is 100 mg daily in single or divided doses, either alone or in combination with a diuretic.600

Extended-release metoprolol succinate tablets: Manufacturer states usual initial dosage is 25–100 mg once daily.602

Increase dosage at weekly (or longer) intervals until optimum effect is achieved.600 602

If satisfactory BP response is not maintained throughout the day, larger doses, more frequent administration, or use of extended-release tablets may be required.a

If intolerable adverse effects occur, consider dosage reduction; if adverse effects worsen or fail to resolve, may need to discontinue and switch to another antihypertensive drug class.501

Metoprolol/Hydrochlorothiazide Fixed-combination Therapy Oral

Manufacturer states fixed-combination preparation should not be used for initial antihypertensive therapy; administer each drug separately, then use the fixed combination if the optimum maintenance dosage corresponds to the ratio of drugs in the combination preparation.a

Angina Long-term Management Oral

Initially, 100 mg given once daily (extended-release tablets) or in 2 divided doses daily (conventional tablets).109 147 Increase dosage at weekly intervals until optimum response is obtained or pronounced slowing of heart rate occurs.109 147

Usual maintenance dosage is 100–400 mg daily.109

Unstable Angina or Non-ST-Segment Elevation MI† IV, then Oral

Patients at high risk for ischemic events should receive IV loading dose followed by conversion to an oral regimen; oral therapy is recommended for lower risk patients.218 219

5 mg IV every 5 minutes up to a total of 15 mg.218 If IV dose is tolerated, 25–50 mg orally, initiated 15 minutes after the last IV dose and repeated every 6 hours for 48 hours, followed by 100 mg twice daily.218 Target resting heart rate is 50–60 bpm in the absence of dose-limiting adverse effects.218

MI

As soon as clinical condition allows, administer oral therapy (conventional tablets) to patients who have contraindications to or do not tolerate IV therapy during the early phase of definite or suspected acute MI or to patients in whom therapy is delayed.a

Early Treatment. IV, then Oral

2.5–5 mg IV every 2–5 minutes up to a total of 15 mg over 10–15 minutes.a If total IV dose is tolerated, 50 mg orally, initiated 15 minutes after the last IV dose and repeated every 6 hours for 48 hours, followed by 100 mg twice daily.109 If total IV dose is not tolerated, 25 or 50 mg (depending on the degree of intolerance) orally every 6 hours beginning 15 minutes after the last IV dose or as soon as clinical condition allows.109

Late Treatment Oral

100 mg twice daily for at least 3 months.109

Supraventricular Arrhythmias Atrial Fibrillation†. IV, then Oral

2.5–5 mg IV over 2 minutes; may repeat up to 3 doses.301 Then, 25–100 mg orally twice daily (as metoprolol tartrate) or 50–400 mg once daily (as metoprolol succinate) for long-term control.301

SVT (e.g., Atrial Flutter†, PSVT†, Junctional Tachycardia†, Atrial Tachycardia†) IV, then Oral

Experts recommend initial IV dose of 2.5–5 mg over 2 minutes; may repeat after 10 minutes, up to a total of 3 doses.300

Usual oral maintenance dosage for ongoing treatment is 200 mg twice daily (as metoprolol tartrate) or 400 mg once daily (as metoprolol succinate).300

Heart Failure Oral

Initially, 25 mg (extended-release tablets) once daily in adults with NYHA class II heart failure.147 In patients with more severe heart failure, use an initial dosage of 12.5 mg (extended-release tablets) once daily.147 Double the dosage every 2 weeks to a dosage of 200 mg or until highest tolerated dosage is reached.147

Some experts recommend initiation of therapy with 12.5–25 mg (extended-release tablets) once daily.524 If tolerated, gradually titrate dosage upward (maximum dosage 200 mg once daily).524

If deterioration occurs during titration, increase dosage of concurrent diuretic147 and decrease dosage of metoprolol or temporarily discontinue metoprolol.147 524 Do not continue dosage titration until symptoms of worsening heart failure have stabilized.147 524 Initial difficulty in dosage titration should not preclude subsequent attempts to successfully titrate the dosage.147

Reduce dosage in patients with heart failure who experience symptomatic bradycardia (e.g., dizziness) or 2nd or 3rd degree heart block.147 524

Vascular Headache Migraine† Oral

Dosages of 50–300 mg daily have been used in clinical studies; usual effective dosage was 200 mg daily.231

Prescribing Limits

Pediatric Patients

Hypertension† Oral

Maximum 6 mg/kg (up to 200 mg) daily.260

Adults

Hypertension Oral

Dosages >400 mg (extended-release tablets) and 450 mg (conventional tablets) daily have not been studied.600 602

Angina Oral

Dosages >400 mg daily have not been studied.109 147

IV

Maximum 15 mg over 15 minutes in patients with unstable angina or non-ST-segment elevation MI†.218

MI IV

Maximum 15 mg over 10–15 minutes.a

Heart Failure Oral

Up to 200 mg daily.147

Special Populations

Hepatic Impairment

Elimination occurs mainly in the liver; dosage reductions may be necessary.109 a

Renal Impairment

Dosage adjustments are not required.109 147

Geriatric Patients

Cautious dosage selection recommended; initiate therapy at the lower end of the dosage range.147

Stability

Storage

Oral

Tablets

Tight, light-resistant containers at 15–30°C.109 Protect from light.109

Extended-Release Tablets

25°C (may be exposed to 15–30°C).147

Parenteral

Injection

30°C or less (preferably 15–30°C).109 Protect from light109 and freezing.a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Parenteral

Solution CompatibilityHID

Compatible

Dextrose 5% in water

Sodium chloride 0.9%

Drug Compatibility Y-Site CompatibilityHID

Compatible

Abciximab

Alteplase

Amiodarone HCl

Argatroban

Bivalirudin

Ceftaroline fosamil

Diltiazem HCl

Eptifibatide

Furosemide

Heparin sodium

Meperidine HCl

Milrinone lactate

Morphine sulfate

Procainamide HCl

Sodium nitroprusside

Incompatible

Amphotericin B cholesteryl sulfate complex

Lidocaine HCl

Nitroglycerin

Variable

Nesiritide

What is Metoprolol Tartrate (metoprolol)?

Metoprolol is a beta-blocker that affects the heart and circulation (blood flow through arteries and veins).

Metoprolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.

Metoprolol may also be used for other purposes not listed in this medication guide.

What should I discuss with my healthcare provider before taking Metoprolol Tartrate (metoprolol)?

You should not use this medication if you are allergic to metoprolol, or other beta-blockers (atenolol, carvedilol, labetalol, metoprolol, nadolol, nebivolol, propranolol, sotalol, and others), or if you have:

  • a serious heart problem such as heart block, sick sinus syndrome, or slow heart rate;

  • severe circulation problems;

  • severe heart failure (that required you to be in the hospital); or

  • history of slow heart beats that have caused you to faint.

To make sure metoprolol is safe for you, tell your doctor if you have:

  • asthma, chronic obstructive pulmonary disease (COPD), sleep apnea, or other breathing disorder;

  • diabetes (taking metoprolol may make it harder for you to tell when you have low blood sugar);

  • liver disease;

  • congestive heart failure;

  • problems with circulation (such as Raynaud's syndrome);

  • a thyroid disorder; or

  • pheochromocytoma (tumor of the adrenal gland).

It is not known whether metoprolol will harm an unborn baby. Tell your doctor right away if you become pregnant while using this medicine.

Metoprolol can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Metoprolol is not approved for use by anyone younger than 18 years old.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Metoprolol Tartrate (metoprolol) side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • very slow heartbeats;

  • a light-headed feeling, like you might pass out;

  • shortness of breath (even with mild exertion), swelling, rapid weight gain; or

  • cold feeling in your hands and feet.

Common side effects may include:

  • dizziness, tired feeling;

  • confusion, memory problems;

  • nightmares, trouble sleeping;

  • diarrhea; or

  • mild itching or rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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