Metoprolol Tartrate 25mg Tablets
It is used to treat high blood pressure.It is used to treat some types of chest pain (angina).It is used after a heart attack to help prevent future heart attacks and lengthen life. It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antihypertensive, Antianginal, Antiarrhythmic
Pharmacologic Class
Beta-1 Selective Adrenergic Blocker
Pregnancy Category
Category C
FDA Approved
Jun 1978
DEA Schedule
Not Controlled
Overview
What is this medicine?
Metoprolol is a type of medicine called a beta-blocker. It works by slowing down your heart rate and relaxing blood vessels, which helps to lower your blood pressure and reduce the strain on your heart. It's used to treat high blood pressure, chest pain (angina), and to help prevent future heart problems after a heart attack.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take your medication with or immediately after a meal. Continue taking this medication as directed by your doctor or healthcare provider, even if you start feeling well.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry location, avoiding the bathroom. Protect the medication from heat sources.
Missing a Dose
If you miss a dose, skip it and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take your medication with or immediately after a meal. Continue taking this medication as directed by your doctor or healthcare provider, even if you start feeling well.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry location, avoiding the bathroom. Protect the medication from heat sources.
Missing a Dose
If you miss a dose, skip it and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take metoprolol exactly as prescribed, usually with or immediately following a meal.
- Do not stop taking this medication suddenly, as it can worsen your condition. Your doctor will tell you how to gradually reduce the dose if needed.
- Monitor your blood pressure and heart rate regularly as 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 risk of side effects.
- Maintain a healthy diet (low in sodium and saturated fats), engage in regular exercise, and quit smoking to support heart health.
- Inform your doctor or dentist that you are taking metoprolol before any surgery or dental procedures.
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
Standard Dose:
Hypertension: 50 mg twice daily; Angina: 50 mg twice daily
Dose Range:
25 - 450 mg
Condition-Specific Dosing:
hypertension:
Initial: 50 mg twice daily; Maintenance: 100-450 mg/day in divided doses
anginaPectoris:
Initial: 50 mg twice daily; Maintenance: 100-400 mg/day in divided doses
myocardialInfarction:
Early treatment: 5 mg IV every 2 minutes for 3 doses, then 50 mg orally every 6 hours for 48 hours; Late treatment: 100 mg twice daily
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Hypertension (off-label): Initial 0.5-1 mg/kg/day divided twice daily; Max 2 mg/kg/day or 200 mg/day
Adolescent:
Hypertension (off-label): Initial 0.5-1 mg/kg/day divided twice daily; Max 2 mg/kg/day or 200 mg/day
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Dialysis:
Not significantly removed by hemodialysis; no supplemental dose needed
Hepatic Impairment:
Mild:
No adjustment needed
Moderate:
Consider dose reduction, monitor closely
Severe:
Significant dose reduction (e.g., 25-50% of usual dose) required due to reduced metabolism
Pharmacology
Mechanism of Action
Metoprolol is a cardioselective beta-1 adrenergic receptor blocker. It competitively blocks beta-1 adrenergic receptors, primarily located in the heart, reducing heart rate, myocardial contractility, and cardiac output. This leads to a reduction in blood pressure. It also reduces renin release from the kidneys.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 50% (highly variable due to first-pass metabolism)
Tmax:
1.5-2 hours
FoodEffect:
Food increases bioavailability by 20-40%
Distribution:
Vd:
Approximately 5.6 L/kg
ProteinBinding:
10-12%
CnssPenetration:
Limited
Elimination:
HalfLife:
3-7 hours
Clearance:
Approximately 1 L/min
ExcretionRoute:
Renal (primarily as metabolites)
Unchanged:
Approximately 5% (up to 10% in poor metabolizers)
Pharmacodynamics
OnsetOfAction:
Approximately 1 hour (oral)
PeakEffect:
2-4 hours
DurationOfAction:
6-12 hours
Safety & Warnings
BLACK BOX WARNING
Ischemic Heart Disease: Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered metoprolol, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol administration should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of unstable angina pectoris should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol therapy abruptly even in patients treated only for hypertension.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate 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. While 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.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate 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. While 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 (e.g., less than 50 beats per minute)
- Difficulty breathing or worsening shortness of breath
- Swelling in your hands, ankles, or feet
- Unusual weight gain
- Chest pain or discomfort that worsens
- Signs of depression (e.g., persistent sadness, loss of interest)
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Certain heart conditions, including:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor blood circulation to your arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
* Respiratory issues, such as:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing health conditions and other drugs. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Certain heart conditions, including:
+ Abnormal heart rhythms (heart block or sick-sinus syndrome)
+ Heart failure (a weakened heart)
+ Low blood pressure
+ Poor blood circulation to your arms or legs
+ Shock caused by heart problems
+ A slow heartbeat
* Respiratory issues, such as:
+ Asthma
+ Chronic obstructive pulmonary disease (COPD) or other breathing problems
This list is not exhaustive, and it is crucial to discuss all your medications (prescription, over-the-counter, natural products, and vitamins) and health problems with your doctor and pharmacist. They will help determine if it is safe to take this medication with your existing health conditions and other drugs. Never start, stop, or adjust the dosage of any medication without consulting your doctor first.
Precautions & Cautions
Important Warnings and 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
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying down position, and exercise caution when climbing stairs.
Monitoring Your Condition
Follow your doctor's instructions for monitoring your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests checked as directed by your doctor.
Interference with Lab Tests
This medication may affect the results of 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 risk is higher in 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.
Diabetes Management
If you have high blood sugar (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 worsening chest pain or even a heart attack, particularly in individuals with 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 risk with your doctor.
Allergic Reactions
If you have a history of severe allergic reactions, inform your doctor, as you may be at 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 this medication may reduce the effectiveness of epinephrine.
Alcohol Consumption
Discuss the risks of alcohol consumption with your doctor 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.
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
Avoid driving and performing tasks that require alertness until you understand how this medication affects you. To minimize the risk of dizziness or fainting, rise slowly from a sitting or lying down position, and exercise caution when climbing stairs.
Monitoring Your Condition
Follow your doctor's instructions for monitoring your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests checked as directed by your doctor.
Interference with Lab Tests
This medication may affect the results of 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 risk is higher in 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.
Diabetes Management
If you have high blood sugar (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 worsening chest pain or even a heart attack, particularly in individuals with 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 risk with your doctor.
Allergic Reactions
If you have a history of severe allergic reactions, inform your doctor, as you may be at 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 this medication may reduce the effectiveness of epinephrine.
Alcohol Consumption
Discuss the risks of alcohol consumption with your doctor 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
- Loss of consciousness
- Seizures
What to Do:
Seek immediate medical attention or call 911. For poison control, call 1-800-222-1222. Treatment is supportive and may include atropine for bradycardia, glucagon, vasopressors, and IV fluids.
Drug Interactions
Major Interactions
- CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, propafenone, ritonavir, bupropion, terbinafine, chlorpromazine, cimetidine, hydralazine): May significantly increase metoprolol plasma concentrations, leading to increased beta-blockade and risk of bradycardia/hypotension.
- Calcium channel blockers (non-dihydropyridine, e.g., verapamil, diltiazem): Increased risk of bradycardia, AV block, and hypotension. Avoid concomitant IV administration.
- Clonidine: Risk of rebound hypertension upon clonidine withdrawal if metoprolol is not tapered first.
- Digoxin: Increased risk of bradycardia and AV block.
Moderate Interactions
- NSAIDs (e.g., ibuprofen, naproxen): May reduce the antihypertensive effect of metoprolol.
- Sympathomimetics (e.g., epinephrine, norepinephrine): May cause paradoxical hypertension followed by bradycardia.
- Insulin and oral hypoglycemics: May mask symptoms of hypoglycemia (e.g., tachycardia) and prolong hypoglycemic episodes.
- Other antihypertensives: Additive hypotensive effects.
- Amiodarone: Increased risk of bradycardia and AV block.
- Rifampin: May decrease metoprolol plasma concentrations.
Minor Interactions
- Alcohol: May increase metoprolol plasma levels slightly.
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation
Heart Rate (HR)
Rationale: To establish baseline and assess for bradycardia.
Timing: Prior to initiation
Electrocardiogram (ECG)
Rationale: To assess for pre-existing conduction abnormalities.
Timing: Prior to initiation (especially in patients with cardiac history)
Renal Function (BUN, Creatinine)
Rationale: To assess baseline kidney function, though metoprolol is primarily hepatic.
Timing: Prior to initiation
Liver Function Tests (LFTs)
Rationale: To assess baseline hepatic function, as metoprolol is metabolized by the liver.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure (BP)
Frequency: Regularly (e.g., weekly initially, then monthly or as clinically indicated)
Target: <130/80 mmHg (or individualized target)
Action Threshold: Systolic BP <90 mmHg or symptomatic hypotension; BP consistently above target
Heart Rate (HR)
Frequency: Regularly (e.g., weekly initially, then monthly or as clinically indicated)
Target: 50-60 bpm (or individualized target)
Action Threshold: <50 bpm or symptomatic bradycardia
Symptoms of Heart Failure
Frequency: At each visit
Target: N/A
Action Threshold: Worsening shortness of breath, edema, weight gain (especially in patients with heart failure)
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fatigue
- Shortness of breath
- Swelling in ankles/feet
- Bradycardia (slow pulse)
- Cold hands/feet
- Depression
- Insomnia
Special Patient Groups
Pregnancy
Metoprolol is Pregnancy Category C. Use during pregnancy should only be considered if the potential benefit justifies the potential risk to the fetus. Beta-blockers can cause fetal bradycardia, hypoglycemia, and growth restriction.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally considered low risk for major malformations.
Second Trimester:
Risk of fetal growth restriction, bradycardia, and hypoglycemia.
Third Trimester:
Increased risk of neonatal bradycardia, hypoglycemia, and respiratory depression. Monitor neonate for 24-48 hours after birth.
Lactation
Metoprolol is excreted in breast milk in small amounts. It is generally considered compatible with breastfeeding (Lactation Risk Category L2 - Safer). Monitor breastfed infant for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding).
Infant Risk:
Low risk of adverse effects, but theoretical risk of bradycardia or hypoglycemia, especially in preterm or sick infants.
Pediatric Use
Safety and efficacy not fully established for all indications. Use in hypertension is off-label and requires careful dose titration and monitoring. Not recommended for routine use in children for other indications unless specifically indicated and benefits outweigh risks.
Geriatric Use
Start with lower doses and titrate slowly due to increased sensitivity to beta-blockers and potential for reduced renal/hepatic function. Increased risk of dizziness and falls. Monitor for bradycardia and hypotension.
Clinical Information
Clinical Pearls
- Metoprolol tartrate is an immediate-release formulation and typically dosed twice daily. Metoprolol succinate is an extended-release formulation, dosed once daily.
- Do not abruptly discontinue metoprolol due to the risk of rebound hypertension, angina exacerbation, or myocardial infarction, especially in patients with ischemic heart disease.
- Take metoprolol with food or immediately after a meal to enhance absorption and reduce GI upset.
- Monitor heart rate and blood pressure regularly. Instruct patients to check their pulse and report if it's consistently below 50 bpm or if they experience symptoms of bradycardia.
- Use with caution in patients with asthma or severe COPD, as beta-1 selectivity may be lost at higher doses, potentially causing bronchospasm.
- Can mask symptoms of hypoglycemia in diabetic patients (e.g., tachycardia), but sweating may still occur.
Alternative Therapies
- Other beta-blockers (e.g., atenolol, carvedilol, bisoprolol, labetalol, propranolol)
- ACE inhibitors (e.g., lisinopril, enalapril)
- Angiotensin Receptor Blockers (ARBs) (e.g., losartan, valsartan)
- Calcium Channel Blockers (e.g., amlodipine, nifedipine, diltiazem, verapamil)
- Diuretics (e.g., hydrochlorothiazide, furosemide)
- Alpha-blockers (e.g., prazosin, doxazosin)
Cost & Coverage
Average Cost:
$10 - $30 per 30 tablets (25mg generic)
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to ensure you receive the best possible care.