Metoprolol should be used with caution in
It should not be used by:
- People who are allergic to metoprolol or to any other ingredients in the medicine
- People who are allergic to any other beta-blocker medicines such as atenolol or propranolol
- People with asthma or attacks of wheezing
- People who have had asthma or wheezing in the past
- People who have had a heart attack with shock, heart attack complicated by very slow heart rate or first degree heart block
- People with very low blood pressure and/or severe heart failure
- People with with uncontrolled heart failure (causing breathlessness and ankle swelling)
- People with second or third degree heart block which may be treated with a pacemaker
- People with the heart condition cardiogenic shock
- People with very slow or uneven heart beats
- People with low blood pressure which may cause a feeling of faintness
- People with very poor circulation
- People with a type of chest pain called Prinzmetal's angina
- People with a tumour called a phaeochromocytoma (usually near the kidney) that is untreated
- People with higher than normal levels of acid in the body (metabolic acidosis)
- People taking other medicines for blood pressure by injection, especially verapamil, diltiazem or disopyramide.
Also see list of precautions and interactions
Do not store above 25ºC. Protect from light.
What is it used for?
- Metoprolol is used to reduce the workload on the heart by making it beat more slowly.
- It is a beta-adrenergic blocking drug, sometimes known as a beta-blocker.
- It is used to make your heart beat more slowly and with less force and to reduce the contraction of blood vessels in the heart, brain and throughout the body. By reducing the heart rate and force of muscle contraction it reduces the need for oxygen by the heart muscle and helps to prevent attacks of angina (chest pain). By reducing the force of contraction of the heart muscle, metoprolol also lowers blood pressure.
- In general this drug is used to reduce high blood pressure (hypertension) and treat chest pain (angina).
- Benefits of being on this drug can include reduction in blood pressure, improvement in ability to exercise in patients with angina and a reduction in the number of angina attacks.
Listed below are the typical uses of metoprolol.
On occasion your doctor may prescribe this medicine to treat a condition not on the above list. Such conditions are listed below.
HOW TO USE/TAKE
How often do I take it?
- Take this medication by mouth usually daily in divided doses, with or without food. Swallow the tablets whole with liquid, do not crush or chew.
- Your doctor may have prescribed a special type of metoprolol tablet which releases the medicine slowly over a longer period of time than normal tablets. If you are taking these tablets than you will usually need to take them once a day. Modified release tablets should be swallowed whole and should not be crushed or chewed.
- Other formulations may need to be taken more or less frequently as indicated by your doctor or pharmacist.
- Use this medication regularly in order to get the most benefit from it.
- Remember to use it at the same time each day - unless specifically told not to by your doctor.
- Certain medical conditions may require different dosage instructions as directed by your doctor.
- Dosage is based on your age, gender, medical condition, response to therapy, and use of certain interacting medicines.
Do I need to avoid anything?
- Metoprolol may make you feel tired and dizzy or cause eye problems. If you have these symptoms do not drive or operate machinery until these effects have worn off. Consult your doctor or pharmacist for more details.
When can I stop?
- It is important to continue taking this medication even if you feel well, unless your doctor tells you to stop.
METOPROLOL SIDE EFFECTS
- Feeling tired
- Slower pulse rate
- Pounding heart beat
- Dizziness particularly when standing up
- Shortness of breath on effort
- Feeling sick
- Stomach ache
- Cold hands and feet
- Feeling depressed
- Difficulty going to sleep
- Difficulty concentrating
- Feeling sleepy
- Sensation of burning, prickling or numbness
- Heart changes shown on an ECG
- Feeling of tightness in the airways
- Being sick
- Skin rash
- Increased sweating
- Muscle cramps
- Chest pain
- Weight gain
- Dry or sore eyes or problems with vision
If any of these persist or you consider them severe then inform your doctor or pharmacist.
Tell your doctor immediately if you develop any of the following symptoms:
- Symptoms of a serious allergic reaction including rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Further information about other side effects can be found in the patient information leaflet.
A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing.
Further information about
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
The Yellow Card Scheme allows you to report suspected side effects from any type of medicine (which includes vaccines, herbals and over the counter medicines) that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory agency (MHRA). Please report any suspected side effect on the Yellow Card Scheme website.
Before taking metoprolol, tell your doctor or pharmacist if you are allergic to it; or to other beta-blockers; or if you have any other allergies.
This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist in case you have:
- An allergy to metoprolol or to any other ingredients in the medicine, or to any other beta-blocker medicines such as atenolol or propranolol
- Asthma or attacks of wheezing, if you have had asthma or wheezing in the past
- Had a heart attack with shock, heart attack complicated by very slow heart rate, first degree heart block, very low blood pressure and/or severe heart failure
- Uncontrolled heart failure (causing breathlessness and ankle swelling)
- Second or third degree heart block which may be treated with a pacemaker
- The heart condition cardiogenic shock
- Very slow or uneven heart beats
- Low blood pressure which may cause a feeling of faintness
- Very poor circulation
- A type of chest pain called Prinzmetal's angina
- A tumour called a phaeochromocytoma (usually near the kidney) that is untreated
- Higher than normal levels of acid in your body (metabolic acidosis)
- Fallen pregnant or are breastfeeding
- Taken other medicines for blood pressure by injection, especially verapamil, diltiazem or disopyramide
Before using this medication tell your doctor or pharmacist your medical history, especially any of the following:
- Liver problems,
- Allergies to insect stings, foods or other substances
- Poor circulation of blood
- Controlled heart failure
- First-degree heart block
- Low blood sugar levels (diabetes)
- An overactive thyroid gland (thyrotoxicosis)
- The skin condition psoriasis or a history of psoriasis
- The muscle condition myasthenia gravis
- Portal hypertension (high blood pressure usually related to liver disease)
- If you are about to have an operation requiring an anaesthetic.
Before having surgery, tell your doctor or dentist that you are taking this medication.
Does alcohol intake affect this drug?
- It is best to avoid alcohol while taking this medicine.
The elderly: metoprolol should be used with caution in the elderly as it may produce a large reduction in blood pressure or pulse rate which may prevent an adequate supply of blood reaching the vital organs.
Pregnancy and breastfeeding - please ensure you read the detailed information below
Metoprolol is not safe to take if you are, or are planning to become, pregnant.
It is sensible to limit use of medication during pregnancy whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Metoprolol is not safe to take if you are breastfeeding.
It is sensible to limit use of medication during breastfeeding whenever possible. However, your doctor may decide that the benefits outweigh the risks in individual circumstances and after a careful assessment of your specific health situation.
If you have any doubts or concerns you are advised to discuss the medicine with your doctor or pharmacist.
Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.
This drug should not be used with the following medications because very serious, possibly fatal interactions may occur:
- Calcium channel blockers such as verapamil and diltiazem given by injection
If you are currently using any such medicine, tell your doctor or pharmacist before starting metoprolol
Before using this medication, tell your doctor or pharmacist of all prescription and non-prescription/herbal products you may use, especially of:
- Other beta-blockers including eye drops
- ACE inhibitors
- Adrenergic neurone blockers such as guanethidine
- Antiretroviral medicines used to treat AIDs
- Adrenaline (also known as epinephrine)
- Alpha-blockers such as prazosin
- Angiotensin-II receptor antagonists
- Calcium channel blockers (such as diltiazem and nifedipine)
- Ergotamine medicines for migraine
- Lidocaine (lignocaine)
- Medicines for abnormal heart rhythm (anti-arrhythmics) such as amiodarone and propafenone
- Medicines for depression
- Medicines for diabetes including insulin
- Medicines for anxiety
- Medicines to prevent malaria
- Medicines for fungal infections
- Medicines for mental illness (such as phenothiazines)
- Monoamine-oxidase inhibitors (MAOIs)
- Non-steroidal anti-inflammatory drugs (NSAIDs) including indomethacin
- Noradrenaline (norepinephrine)
- Sleeping tablets
- Sodium nitroprusside
- Water tablets
This information does not contain all possible interactions. Therefore, before using metoprolol, tell your doctor or pharmacist of all the products you use.
Taking too much metoprolol may cause the following: very low blood pressure, slow heart beat, heart block, heart failure (when the heart is unable to pump blood as efficiently round the body as it should), the heart condition cardiogenic shock, cardiac arrest (sudden interruption of the normal blood flow around the body because of failure of the heart), difficulty breathing (bronchospasm), reduced consciousness, coma, fitting, feeling sick and being sick, low blood sugar levels, high blood potassium levels, blue discolouration of the skin (cyanosis).
People who have taken too much metoprolol should talk to a doctor or go to a hospital straight away. Take the medicine pack with you so that the tablets can be identified.
If you think you, or someone you care for, might have accidentally taken more than the recommended dose of metoprolol or intentional overdose is suspected, contact your local hospital, GP or if in England call 111. In Scotland call NHS 24. In Wales, call NHS Direct Wales. In the case of medical emergencies, always dial 999.
If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.