Metoprolol Tartrate 37.5mg Tablets

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 decrease in blood pressure. At higher doses, it can also block beta-2 adrenergic receptors.

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 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. 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.

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 allergic reaction you experienced, including any symptoms that occurred.
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 health problems and medications with your doctor.

To ensure your safety, inform your doctor and pharmacist about:
All prescription and over-the-counter medications you are taking
Any natural products or vitamins you are using
Your complete medical history

Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe for you to do so.

Important Warnings and Cautions

It is crucial to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure your safety and prevent potential interactions with other treatments.

Caution with Daily Activities

Until you know how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, get up slowly from a sitting or lying down 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 scheduled by your doctor. Be aware that this medication may affect the results of certain lab tests, so inform all your healthcare providers and lab personnel that you are taking this medication.

Managing Low Blood Sugar

This medication may mask some 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 people 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. If you have diabetes, closely monitor your blood sugar levels.

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.

Stopping the Medication

Do not stop taking this medication abruptly, as this can lead to worsening chest pain and, in some cases, heart attack, especially if you have certain types of heart disease. To avoid side effects, your doctor will guide you on how to gradually stop taking this 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 difficult 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 risk of a 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

Before consuming alcohol, discuss the potential risks with your doctor.

Pregnancy and Breastfeeding

If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor. You will need to discuss the benefits and risks of this medication to both you and your baby.

• Fingolimod (risk of severe bradycardia)
• Any drug causing severe bradycardia or AV block in patients with pre-existing conduction abnormalities (e.g., non-dihydropyridine calcium channel blockers like verapamil, diltiazem, especially IV, in patients with severe left ventricular dysfunction or AV block)

• Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem): Increased risk of bradycardia, AV block, and hypotension.
• Other beta-blockers (e.g., carvedilol, propranolol): Additive effects, increased risk of bradycardia and hypotension.
• Clonidine: Risk of rebound hypertension upon clonidine withdrawal if beta-blocker is not tapered first.
• Digoxin: Increased risk of bradycardia.
• CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, bupropion): Can significantly increase metoprolol plasma concentrations, leading to increased beta-blockade and adverse effects.
• Insulin and oral hypoglycemics: Beta-blockers can mask symptoms of hypoglycemia (e.g., tremor, tachycardia) and prolong hypoglycemic episodes.
• MAO inhibitors: Increased risk of hypertension or bradycardia.

• NSAIDs (e.g., ibuprofen, naproxen): May reduce the antihypertensive effect of metoprolol.
• Alpha-1 blockers (e.g., prazosin, doxazosin): Increased risk of first-dose hypotension.
• Sympathomimetics (e.g., epinephrine, pseudoephedrine): May antagonize the effects of beta-blockers and cause hypertension.
• Rifampin: May decrease metoprolol levels due to CYP induction.
• Cimetidine: May increase metoprolol levels due to CYP inhibition.

• Alcohol: May increase metoprolol levels slightly.
• Antacids: May slightly decrease metoprolol absorption.

• Dizziness
• Lightheadedness
• Fatigue
• Bradycardia (slow pulse)
• Shortness of breath
• Wheezing
• Cold hands or feet
• Depression
• Insomnia
• Sexual dysfunction

Metoprolol is Pregnancy Category C. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Beta-blockers can cause fetal/neonatal bradycardia, hypoglycemia, and respiratory depression. Neonates should be monitored for these effects for 48-72 hours after birth.

Metoprolol is excreted into breast milk in small amounts. The American Academy of Pediatrics considers it 'compatible with breastfeeding'. Monitor breastfed infants for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding). L3 (Moderately Safe).

Use in pediatric hypertension is off-label for Metoprolol Tartrate and typically reserved for specialists. Dosing is weight-based and requires careful titration. Safety and efficacy are not as well established as in adults. Avoid abrupt discontinuation.

Elderly patients may be more sensitive to the effects of beta-blockers, particularly bradycardia and hypotension. Start with lower doses and titrate slowly. Monitor closely for adverse effects and drug interactions. Renal and hepatic function should be considered, though dose adjustments are primarily for severe hepatic impairment.

• Metoprolol Tartrate is an immediate-release formulation, typically dosed twice daily. Metoprolol Succinate is extended-release and dosed once daily.
• 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.
• Cardioselectivity is dose-dependent; at higher doses, metoprolol can lose its beta-1 selectivity and affect beta-2 receptors, potentially causing bronchospasm in susceptible patients (e.g., asthma, COPD).
• Educate patients on how to monitor their pulse and blood pressure at home.
• Can mask symptoms of hypoglycemia in diabetic patients and hyperthyroidism (e.g., tachycardia, tremor).
• The 37.5mg strength is unusual and likely a result of dose titration or splitting a higher dose tablet. Ensure patient understanding of how to take this specific dose.

• Other beta-blockers (e.g., Atenolol, Bisoprolol, Carvedilol, Propranolol, Nebivolol)
• ACE inhibitors (e.g., Lisinopril, Enalapril)
• Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
• Calcium Channel Blockers (e.g., Amlodipine, Nifedipine, Diltiazem, Verapamil)
• Diuretics (e.g., Hydrochlorothiazide, Chlorthalidone)
• Alpha-blockers (e.g., Prazosin, Doxazosin)

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 reach out to 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 taken, the amount, and the time it happened.