Metoprolol ER Succinate 200mg Tabs
Overview
What is this medicine?
How to Use This Medicine
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided to you and follow the instructions closely. Take your medication with or immediately after a meal to help your body absorb it properly. Swallow the tablet whole - do not chew or crush it. If needed, you can break the tablet in half, but be sure not to chew or crush it.
It's essential to continue taking your medication as directed by your doctor or healthcare provider, even if you start to feel better. This will help ensure that you receive the full benefits of the medication and minimize the risk of any potential side effects.
Storing and Disposing of Your Medication
To keep your medication effective and safe, store it at room temperature in a dry place, away from the bathroom. Protect it from heat sources, such as radiators or heaters. This will help preserve the medication's potency and prevent any degradation.
What to Do If You Miss a Dose
If you miss a dose, skip it and take your next dose at the usual time. Do not take two doses at the same time or take extra doses to make up for the missed one. Sticking to your regular schedule will help you stay on track and maintain the effectiveness of your medication.
Lifestyle & Tips
- Take the medication exactly as prescribed, usually once daily with or immediately following a meal.
- Do not crush, chew, or break the extended-release tablet; swallow it whole.
- Do not stop taking this medication suddenly, especially if you have heart disease, as it can worsen your condition. Your doctor will tell you how to slowly reduce the dose if needed.
- Monitor your blood pressure and heart rate regularly at home if advised by your doctor.
- Avoid activities that require alertness until you know how the medication affects you, as it can cause dizziness or lightheadedness.
- Limit alcohol consumption, as it can increase the effects of metoprolol.
- Maintain a healthy diet (low in sodium and saturated fats), engage in regular exercise, and manage stress as part of your overall treatment plan for hypertension or heart disease.
Available Forms & Alternatives
Available Strengths:
- Metoprolol Tartrate 50mg Tablets
- Metoprolol HCT 100/25mg Tablets
- Metoprolol HCT 50/25mg Tablets
- Metoprolol HCT 100/50mg Tablets
- Metoprolol Tartrate 100mg Tablets
- Metoprolol Tartrate 25mg Tablets
- Metoprolol Tartrate 100mg Tablets
- Metoprolol ER Succinate 100mg Tabs
- Metoprolol ER Succinate 50mg Tabs
- Metoprolol ER Succinate 200mg Tabs
- Metoprolol ER Succinate 25mg Tabs
- Metoprolol ER Succinate 25mg Tabs
- Metoprolol Tartrate 5mg/5ml Inj 5ml
- Metoprolol Tartrate 37.5mg Tablets
- Metoprolol Tartrate 75mg Tablets
- Metoprolol Tartrate 5mg/5ml Inj 5ml
Dosing & Administration
Adult Dosing
Condition-Specific Dosing:
Pediatric Dosing
Dose Adjustments
Renal Impairment:
Hepatic Impairment:
Pharmacology
Mechanism of Action
Pharmacokinetics
Absorption:
Distribution:
Elimination:
Pharmacodynamics
Safety & Warnings
BLACK BOX WARNING
Side Effects
While rare, some people may experience severe and potentially life-threatening side effects when taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of low blood sugar, including:
+ Dizziness
+ Headache
+ Feeling sleepy
+ Feeling weak
+ Shaking
+ Fast heartbeat
+ Confusion
+ Hunger
+ Sweating
Depression
Severe dizziness or fainting
New or worsening chest pain
New or worsening abnormal heartbeat
Slow heartbeat
Shortness of breath, significant weight gain, or swelling in the arms or legs
Other Possible Side Effects
Like all medications, this drug can cause side effects. Although many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:
Feeling dizzy, tired, or weak
Diarrhea
Upset stomach
Vomiting
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Very slow heart rate (less than 50 beats per minute)
- Difficulty breathing or worsening shortness of breath
- New or worsening swelling in your hands, ankles, or feet
- Unusual weight gain
- Chest pain that is new or worsening after stopping the medication
- Signs of depression (e.g., persistent sadness, loss of interest)
Before Using This Medicine
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances. Be sure to describe the allergic reaction and its symptoms.
Certain heart conditions, such as:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor blood circulation to the arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
Respiratory issues, including:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
Please note that this is not an exhaustive list of potential interactions. To ensure your safety, it is crucial to discuss all of your:
Medications (prescription, over-the-counter, and natural products)
Vitamins
Health problems
with your doctor and pharmacist. They will help you determine whether it is safe to take this medication in conjunction with your other treatments and health conditions. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.
Caution with Daily Activities
Until you understand how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying position, and be cautious when climbing stairs.
Monitoring Your Condition
Follow your doctor's instructions for checking your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests done as directed by your doctor.
Interference with Lab Tests
This medication may affect certain laboratory tests. Inform all your healthcare providers and laboratory personnel that you are taking this medication.
Risk of Low Blood Sugar
This medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged low blood sugar. This is particularly concerning for individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have questions or concerns, discuss them with your doctor.
Management of High Blood Sugar
If you have diabetes, it is crucial to closely monitor your blood sugar levels while taking this medication.
Interactions with Other Medications
If you have high blood pressure and are taking this medication, consult your doctor before using over-the-counter products that may increase blood pressure, such as cough and cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, and certain natural products or aids.
Discontinuing the Medication
Do not stop taking this medication abruptly, as this may lead to worsened chest pain or even a heart attack, particularly if you have certain types of heart disease. To avoid side effects, your doctor will instruct you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, contact your doctor immediately.
Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as a rapid heartbeat. If you have an overactive thyroid and stop taking this medication suddenly, your condition may worsen and become life-threatening. Discuss this with your doctor.
Allergic Reactions
If you have a history of severe allergic reactions, inform your doctor. You may be at a higher risk of an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult your doctor, as epinephrine may be less effective while taking this medication.
Alcohol Consumption
Discuss your alcohol consumption with your doctor before drinking while taking this medication.
Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor to discuss the benefits and risks of this medication to you and your baby.
Overdose Information
Overdose Symptoms:
- Severe bradycardia (very slow heart rate)
- Hypotension (very low blood pressure)
- Cardiogenic shock
- Bronchospasm (difficulty breathing)
- Heart failure
- Hypoglycemia
- Cardiac arrest
What to Do:
Seek immediate medical attention or call 911. For poison control, call 1-800-222-1222. Treatment may involve atropine for bradycardia, glucagon, vasopressors, and intravenous fluids.
Drug Interactions
Major Interactions
- Verapamil (increased risk of bradycardia, AV block, hypotension)
- Diltiazem (increased risk of bradycardia, AV block, hypotension)
- Clonidine (risk of rebound hypertension upon clonidine withdrawal if beta-blocker is not tapered first)
- Fingolimod (increased risk of bradycardia)
Moderate Interactions
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, propafenone, ritonavir, bupropion, terbinafine, cimetidine) - may increase metoprolol plasma concentrations and enhance effects.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs) - may blunt the antihypertensive effect of metoprolol.
- Digitalis glycosides (e.g., digoxin) - increased risk of bradycardia and AV block.
- Other antihypertensives (e.g., ACE inhibitors, ARBs, diuretics) - additive hypotensive effects.
- Insulin and oral hypoglycemics - beta-blockers may mask symptoms of hypoglycemia (e.g., tachycardia) and prolong hypoglycemic episodes.
- Sympathomimetics (e.g., epinephrine, norepinephrine) - may cause paradoxical hypertension and bradycardia.
Minor Interactions
- Alcohol (may increase metoprolol levels slightly)
- Rifampin (may decrease metoprolol levels)
Monitoring
Baseline Monitoring
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Rationale: To establish baseline and assess for bradycardia.
Timing: Prior to initiation
Rationale: To assess for pre-existing conduction abnormalities (e.g., AV block).
Timing: Prior to initiation (especially in heart failure patients)
Rationale: To assess kidney function, though dose adjustment is generally not needed for renal impairment.
Timing: Prior to initiation
Rationale: To assess hepatic function, as metoprolol is primarily metabolized by the liver.
Timing: Prior to initiation (especially in patients with suspected hepatic impairment)
Routine Monitoring
Frequency: Regularly, e.g., weekly during titration, then monthly or quarterly once stable.
Target: <130/80 mmHg (general target for hypertension, may vary based on comorbidities)
Action Threshold: Systolic >140 mmHg or Diastolic >90 mmHg (consider dose adjustment); Systolic <90 mmHg or symptomatic hypotension (consider dose reduction/discontinuation).
Frequency: Regularly, e.g., weekly during titration, then monthly or quarterly once stable.
Target: 50-70 bpm (resting HR, may vary based on indication)
Action Threshold: <50 bpm or symptomatic bradycardia (consider dose reduction/discontinuation).
Frequency: Regularly, especially in heart failure patients.
Target: Improvement or stability of symptoms.
Action Threshold: Worsening heart failure symptoms (consider temporary dose reduction or discontinuation, re-evaluate treatment plan).
Frequency: Regularly, as per diabetes management guidelines.
Target: Individualized
Action Threshold: Frequent or severe hypoglycemic episodes (educate patient on masked symptoms, adjust diabetes regimen if needed).
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fatigue
- Shortness of breath
- Swelling in ankles/feet (edema)
- Bradycardia (slow heart rate)
- Cold hands/feet
- Depression
- Insomnia
Special Patient Groups
Pregnancy
Category C. Use during pregnancy only if the potential benefit justifies the potential risk to the fetus. Metoprolol crosses the placenta. Neonates exposed to beta-blockers in utero may be at risk for bradycardia, hypoglycemia, and respiratory depression.
Trimester-Specific Risks:
Lactation
L3 (Moderately Safe). Metoprolol is excreted into breast milk in small amounts. Monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, drowsiness, hypoglycemia). Generally considered compatible with breastfeeding, especially with ER formulation due to lower peak levels.
Pediatric Use
Safety and effectiveness of metoprolol succinate extended-release in pediatric patients have not been established. Use of immediate-release metoprolol for hypertension in children 6 years and older is established, but ER formulation is generally not recommended.
Geriatric Use
No overall differences in safety or effectiveness have been observed between elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Start with lower doses and titrate slowly, monitoring for adverse effects like bradycardia and hypotension.
Clinical Information
Clinical Pearls
- Metoprolol ER Succinate should be taken once daily, preferably with or immediately following a meal to enhance absorption and reduce variability.
- Do not crush or chew the extended-release tablets; they must be swallowed whole.
- Abrupt discontinuation can lead to rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with ischemic heart disease. Taper dose gradually over 1-2 weeks.
- While cardioselective at lower doses, metoprolol can lose its beta-1 selectivity at higher doses (e.g., 200mg), potentially affecting beta-2 receptors and causing bronchospasm in susceptible patients (e.g., asthma, COPD).
- Monitor heart rate closely, especially in patients with pre-existing bradycardia or AV block. Avoid in patients with sick sinus syndrome or second/third-degree AV block without a pacemaker.
- Can mask symptoms of hypoglycemia in diabetic patients (e.g., tachycardia, tremors), but sweating may still occur. Use with caution in diabetics.
- Often a preferred beta-blocker for heart failure due to its proven mortality benefit in chronic stable heart failure (NYHA Class II-IV).
Alternative Therapies
- Other Beta-blockers (e.g., Carvedilol, Bisoprolol, Atenolol, Labetalol)
- ACE Inhibitors (e.g., Lisinopril, Ramipril)
- Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
- Calcium Channel Blockers (e.g., Amlodipine, Nifedipine, Diltiazem, Verapamil)
- Diuretics (e.g., Hydrochlorothiazide, Furosemide)
- Alpha-1 Blockers (e.g., Prazosin, Terazosin)
- Direct Vasodilators (e.g., Hydralazine, Minoxidil)