Metoprolol uses include treatment of hypertension, angina pectoris, certain arrhythmias, stable heart failure with metoprolol succinate extended-release formulation, and certain patients following myocardial infarction. It is a metoprolol beta blocker that slows down the heart rate and the force of heart contractions, decreasing the heart's workload and oxygen consumption.
The actual metoprolol use and dosing schedule can vary, depending on which formulation has been prescribed by a doctor. Metoprolol tartrate and metoprolol succinate formulations of metoprolol are different in terms of timing of administration.
What is metoprolol used for?
Most common indications to take metoprolol include:
- Hypertension
- Chronic stable angina pectoris
- Reduction of cardiac workload after myocardial infarction
- Stable heart failure with metoprolol succinate extended-release formulation
- Bradycardic therapy in selected arrhythmias
- Prevention of palpitations due to certain fast heart rhythms
- Reduction of the workload placed on the heart
Therefore, the answer to the question of what is metoprolol used for, would be mostly cardiovascular diseases where heart slowing or reduction of the cardiac workload can be beneficial.
These indications also explain what does metoprolol treat, what conditions does metoprolol treat, and what is metoprolol commonly used to treat.
Metoprolol for High Blood Pressure
metoprolol for hypertension works by slowing down the heart rate and the force of heart contractions.
Metoprolol blocks beta-1 receptors, which are predominant in the heart. Adrenaline and similar stress hormones normally bind to those receptors and stimulate heart to beat faster and stronger.
Blocking partial activation of such receptors can:
- Slow down the heart rate
- Reduce cardiac output
- Reduce the force of heart contractions
- Lower blood pressure
This is the main mechanism how does metoprolol lower blood pressure.
High blood pressure usually produces no symptoms at all. One may feel completely healthy while there is additional pressure put on the heart, brain, kidneys and blood vessels due to hypertension.
Thus, blood-pressure levels and not symptoms are the tools for evaluation of success of treatment.
This is why metoprolol for high blood pressure may be prescribed as part of an individualized treatment plan.
Why Hypertension Requires Long-Term Treatment Usually
Hypertension is usually a chronic disease.
Metoprolol may be prescribed alone to some patients, but can be also combined with other drugs, such as:
- ACE inhibitors
- Angiotensin receptor blockers
- Calcium channel blockers
- Diuretics
- Other cardiovascular drugs
Sometimes, one drug may not be sufficient to achieve the blood pressure target level recommended for the patient.
The treatment needs to be individualized because there are various influencing factors like age, resting heart rate, kidney function, other co-morbidities and cardiovascular risk of the patient.
Metoprolol for Angina Pectoris
Metoprolol can also be used for treatment of chronic stable angina pectoris.
Angina pectoris occurs when there is increased demand for oxygen in the heart muscle, but the coronary circulation is not able to provide it. Physical effort or emotional stress may increase the heart rate and the heart workload and the oxygen demand.
Using metoprolol as a beta blocker can help reduce this demand by:
- Slowing down the heart rate
- Reducing the force of heart contractions
- Lowering blood pressure in many patients
- Reducing the workload placed on the heart
It may reduce the frequency of angina attacks and improve exercise tolerance in some patients.
Metoprolol is usually prescribed for preventive therapy, but not as a rescue therapy for acute chest pain.
Acute, new or worsening chest pain require urgent medical attention.
Metoprolol for Heart Failure
Selected formulations of metoprolol are used for the treatment of heart failure.
Metoprolol succinate extended-release is prescribed for selected patients with stable symptomatic heart failure.
It might sound strange to prescribe medicine that slows down the heart rate to someone whose heart is already failing. But the excessive stimulation of body's stress hormones' system might further increase the heart's workload.
The long-term therapy with beta-blockers can reduce this stimulation.
The therapy usually begins with a relatively low dose and is increased gradually if tolerated. Doctors will monitor:
- Blood pressure
- Heart rate
- Dyspnea
- Weakness
- Edema
- Weight changes
- Other indicators that the heart failure might progress
The dose of the medication should not be increased rapidly.
This is one example of why is metoprolol prescribed for certain heart conditions.
Why Metoprolol Might Be Prescribed After Myocardial Infarction
Metoprolol might be prescribed after myocardial infarction (MI, heart attack) in selected patients.
After MI, it is useful to reduce additional stress on the heart. The therapy with metoprolol can slow down the heart rate and reduce the heart oxygen consumption.
It may be included in the broader therapy after a myocardial infarction, which may also include:
- Antiplatelet therapy
- Lipid lowering therapy
- Blood pressure treatment
- Cardiac rehabilitation
- Life-style modification
- Other medicines depending on heart functions and complications
The actual role of beta blockers after MI depends on such factors as heart functions, presence of symptoms, arrhythmias, blood pressure and other co-morbidities.
Metoprolol for Arrhythmias
Yet another common metoprolol use is heart rate control in selected arrhythmias.
Beta blockers can slow down electrical conduction in parts of the heart and block the action of adrenaline.
In certain situations of rapid heart rate, it might be useful for:
- Selected patients with atrial fibrillation
- Selected patients with atrial flutter
- Selected patients with supraventricular tachycardia
- Other arrhythmia-related palpitations
But metoprolol does not treat all types of arrhythmia.
It is essential to identify the underlying arrhythmia, because certain conduction disorders and bradycardia (very slow heart rate) may actually contraindicate beta-blocker therapy.
These effects explain the role of metoprolol for heart rate control in selected arrhythmias.
How Metoprolol Works
Metoprolol is a relatively beta-1 selective beta blocker, especially in therapeutic doses.
The main effects of metoprolol on heart include:
- Slowing down the heart rate
- Reducing the force of heart contractions
- Reducing the heart's sensitivity to adrenaline
- Reducing the heart's oxygen demand
- Reducing blood pressure
- Slowing down electrical conduction through AV node in some arrhythmias
It is how metoprolol for heart rate control helps in certain cardiovascular diseases.
The beta-1 selectivity is not absolute. In high doses, the effects on beta-receptors outside the heart also begin to appear.
These cardiovascular effects are also among the main metoprolol tablet uses of this metoprolol medication.
Metoprolol Tartrate vs. Metoprolol Succinate
It is important to know the difference.
Metoprolol Tartrate
Metoprolol tartrate is an immediate-release formulation.
It is usually prescribed for:
- Hypertension
- Angina pectoris
- Treatment after certain heart attacks
As it is relatively short-acting, it might need to be taken multiple times daily.
Metoprolol Succinate
Metoprolol succinate is an extended-release formulation.
It is usually prescribed for:
- Hypertension
- Angina pectoris
- Stable symptomatic heart failure
The extended-release formulation is designed for once-daily administration.
Do not switch one formulation to another just because they both contain metoprolol. Follow the exact prescription on the medicine label.
Who Can Take Metoprolol?
Metoprolol may be prescribed to:
- Patients with hypertension
- Patients with chronic stable angina pectoris
- Selected patients with coronary artery disease
- Patients recovering from certain heart attacks
- Selected patients with stable heart failure
- Patients requiring heart rate control in certain arrhythmias
Whether metoprolol for hypertension or other heart disease is suitable, depends on the whole clinical picture.
Doctor might take into account the resting heart rate, blood pressure, ECG results, heart functions, respiratory problems, diabetes, renal and liver function, other medicines before prescribing it.
These indications help answer is metoprolol used for heart problems. It can be used for several cardiovascular conditions depending on the formulation and the patient's clinical situation.
What to Expect After Beginning Metoprolol Therapy
Starting with this treatment, one might find that the heart rate becomes slower.
Blood pressure can also become gradually lower.
Some people might experience initially:
- Fatigue
- Dizziness
- Feeling of light-headedness
- Poor exercise tolerance
- Cold hands or feet
These effects might be lessened by the adaptation of the body.
Your doctor might ask to monitor:
- Blood pressure
- Resting pulse
- Dizziness symptoms
- Symptoms of heart failure when relevant
Do not assume that metoprolol is ineffective if you do not feel changes in your blood pressure physically.
Common Side Effects
The most common side effects might be:
- Fatigue
- Dizziness
- Slow heart rate
- Low blood pressure
- Cold hands or feet
- Digestive disorders
- Shortness of breath in some patients
- Sleep disturbances in some patients
The degree of these side effects may vary.
It is expected that pulse is a little slower, but an excessively slow heart rate in connection with fainting, severe weakness, chest discomfort or breathlessness needs medical assessment.
Important Safety Information
One of the most important rules of using metoprolol is:
Never suddenly discontinue the treatment unless a healthcare professional advised to do so.
Abrupt discontinuation of metoprolol may cause a rapid increase in heart rate and blood pressure and may aggravate angina. In patients with coronary artery disease, sudden discontinuation of the drug may lead to severe cardiovascular complications.
Sometimes, if it is necessary to stop the therapy, a healthcare professional might suggest to gradually decrease the dose.
Additional care might be required for patients with:
- Excessively slow heart rates
- Certain heart conduction disorders
- Decompensated heart failure
- Significant asthma or bronchospastic disease
- Diabetes mellitus
- Poor peripheral circulation
- Impaired liver function
Metoprolol and Asthma/COPD
Metoprolol is relatively more beta-1 selective than some older non-selective beta blockers, but it is far from having no effect on lungs at all.
With higher doses, the beta-1 selectivity is becoming less complete.
It is essential for patients with asthma, COPD or other bronchospastic disease to ensure their prescriber about their respiratory history.
The appearance of new wheezing or worsening of breathing difficulties needs medical attention.
Metoprolol and Diabetes
Metoprolol can influence the way how certain symptoms of hypoglycemia manifest themselves.
The most notable example of that is rapid heartbeat. Normally, hypoglycemia causes tachycardia, but in metoprolol users this symptom may be blunted.
But other symptoms like sweating are still present.
Patients with diabetes should continue to check their blood glucose according to their treatment regimen and should not rely on physical symptoms only.
Insulin or other glucose-lowering medicines may increase the necessity to recognize hypoglycemia promptly.
What Medications Might Interact With Metoprolol?
There are numerous medications that might interfere with the effects of metoprolol.
Among them may be:
- Verapamil
- Diltiazem
- Digoxin
- Some antiarrhythmic medications
- Other blood pressure medicines
- Clonidine
- Medications that influence metabolism of CYP2D6 enzymes
- Other medicines that slow down the heart rate
Using several medicines that slow down the heart rate might sometimes lead to the excessive bradycardia or low blood pressure.
Some medications might also increase the levels of metoprolol in the body.
Make sure that your physician or pharmacist knows all the medicines that you are using, including prescription medicines, OTC medicines, supplements and herbal products.
Frequently Asked Questions
Is Metoprolol Used Only for Hypertension?
No.
Hypertension is one of the major indications, but there are other indications to the use of metoprolol.
Depending on the formulation and clinical situation, it may also be used for angina, heart failure, post-MI treatment and heart rate control in arrhythmias.
Does Metoprolol Reduce Heart Rate?
Yes.
Heart rate slowing is one of the main pharmacological effects of metoprolol.
It blocks beta-1 receptors in the heart and reduces the effects of adrenaline and similar hormones.
Does Metoprolol Treat Heart Failure?
Yes, but the formulation is important.
Metoprolol succinate extended-release is used for selected patients with stable symptomatic heart failure.
The therapy usually starts with a low dose and is gradually increased.
What is the Difference Between Metoprolol Tartrate and Metoprolol Succinate?
Metoprolol tartrate is usually an immediate-release formulation, while metoprolol succinate is extended-release.
The indications and the dosing schedule of these formulations are not identical.
The patients should take exactly the formulation that was prescribed to them and should not switch them without medical advice.
Can I Stop Taking Metoprolol Abruptly?
Not usually.
Suddenly stopping the metoprolol may cause heart rate increase, worsening angina or other cardiovascular complications, especially in people with coronary artery disease.
Any discontinuation of metoprolol should usually be supervised by a healthcare professional.
Does Metoprolol Treat Palpitations?
Yes, it can in some cases.
Due to heart slowing and reduction of adrenaline effects, metoprolol can reduce palpitations caused by certain fast heart rhythms.
But palpitations can have a lot of causes, thus it is important to identify the rhythm before prescribing metoprolol.
When to Talk to a Doctor/Pharmacist
Consult a healthcare professional, if:
- The pulse became unusually slow
- You experience fainting or repeated dizziness
- Respiratory symptoms appear or get worse
- Leg edema or heart failure symptoms increased
- Chest pain became more frequent or severe
- The blood pressure became unusually low
- You are unsure what to do if you miss the dose
- The prescription changed from tartrate to succinate and vice versa
- You developed new symptoms after starting a new medicine
If metoprolol has been prescribed to you, Grant Pharmacy can help you understand your medication label, formulation, timing of the dose, storage conditions and precautions. Our pharmacist can also review the other medicines that might slow the heart rate or interact with metoprolol.
So, what is metoprolol usually used to treat? Its major uses include hypertension and various cardiovascular diseases, where slowing of heart rate and reduction of heart's workload is useful. The formulation, dosage and duration of therapy should always correspond to the disease being treated and the patient's heart condition.
Medical References
U.S. National Library of Medicine, DailyMed – Metoprolol Tartrate Prescribing Information
https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=metoprolol%20tartrate
U.S. National Library of Medicine, DailyMed – Metoprolol Succinate Extended-Release Prescribing Information
https://dailymed.nlm.nih.gov/dailymed/search.cfm?query=metoprolol%20succinate
National Health Service (NHS) – Metoprolol and Beta Blocker Information
https://www.nhs.uk/conditions/beta-blockers/
MedlinePlus – Metoprolol Drug Information
https://medlineplus.gov/druginfo/meds/a682864.html
American Heart Association – High Blood Pressure
https://www.heart.org/en/health-topics/high-blood-pressure
