Metoprolol Tartrate 50mg 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-adrenergic blocker (beta-1 selective)
Pregnancy Category
C
FDA Approved
Jun 1978
DEA Schedule
Not Controlled
Overview
What is this medicine?
Metoprolol tartrate 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 protect the heart 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 your 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 to preserve its effectiveness.
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 your 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 to preserve its effectiveness.
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
- Do not stop taking this medication suddenly, especially if you have heart disease. Your doctor will tell you how to slowly reduce the dose.
- Take metoprolol with food or immediately after a meal to increase absorption and reduce stomach upset.
- 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 fatigue.
- Limit alcohol consumption, as it can increase the effects of metoprolol.
- Maintain a healthy diet, exercise regularly, and manage stress to support cardiovascular health.
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 initially, or 100 mg once daily. Angina: 50 mg twice daily initially. Myocardial Infarction: 50 mg every 6 hours for 48 hours, then 100 mg twice daily.
Dose Range:
50 - 450 mg
Condition-Specific Dosing:
Hypertension:
Initial 50-100 mg/day in 1-2 divided doses; maintenance 100-450 mg/day.
Angina Pectoris:
Initial 50 mg twice daily; maintenance 100-400 mg/day in 2 divided doses.
Myocardial Infarction (early intervention):
50 mg every 6 hours for 48 hours, then 100 mg twice daily.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Hypertension: 1-2 mg/kg/day divided twice daily (max 6 mg/kg/day or 200 mg/day). Use with caution, often succinate is preferred.
Adolescent:
Hypertension: 1-2 mg/kg/day divided twice daily (max 6 mg/kg/day or 200 mg/day). Use with caution, often succinate is preferred.
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 specific adjustment, monitor response.
Moderate:
Consider dose reduction, monitor closely.
Severe:
Significant dose reduction may be necessary due to reduced metabolism and increased bioavailability. Monitor closely for adverse effects.
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 decrease in blood pressure and myocardial oxygen demand. At higher doses, it can also block beta-2 adrenergic receptors.
Pharmacokinetics
Absorption:
Bioavailability:
Approximately 50% (highly variable due to significant first-pass metabolism)
Tmax:
1.5-2 hours
FoodEffect:
Food increases the bioavailability of metoprolol by 20-40%.
Distribution:
Vd:
3.2-5.6 L/kg
ProteinBinding:
10-12%
CnssPenetration:
Limited, but sufficient to cause CNS effects (e.g., fatigue, dizziness, depression).
Elimination:
HalfLife:
3-7 hours
Clearance:
Approximately 1 L/min
ExcretionRoute:
Renal (primarily as metabolites)
Unchanged:
Approximately 10% (range 3-10%)
Pharmacodynamics
OnsetOfAction:
Within 1 hour
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. 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. Many people may not experience any side effects or may only have mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:
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, contact 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. Many people may not experience any side effects or may only have mild ones. If you notice any of the following side effects or any other unusual symptoms, contact your doctor for advice:
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, contact 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)
- Shortness of breath or difficulty breathing, especially at night
- Swelling in your hands, ankles, or feet
- Unusual weight gain
- Chest pain or discomfort (if symptoms worsen after stopping the drug)
- Coldness or numbness in fingers and toes
- Depression or unusual mood changes
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 allergic reaction and its symptoms.
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 the 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 safe treatment, inform your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
All your health problems
Do not start, stop, or change the dosage of any medication without first consulting your doctor to confirm it is safe to do so in combination with this medication.
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 and its symptoms.
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 the 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 safe treatment, inform your doctor and pharmacist about:
All prescription and over-the-counter (OTC) medications you are taking
Any natural products or vitamins you are using
All your health problems
Do not start, stop, or change the dosage of any medication without first consulting your doctor to confirm it is safe to do so in combination with this medication.
Precautions & Cautions
Important Warnings and Cautions
It is crucial that you inform all of 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 engaging in activities that require you to be alert. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution 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 the results of certain laboratory tests. Be sure to inform all of 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, including people undergoing surgery, experiencing changes in appetite, or vomiting. If you have questions or concerns, discuss them with your doctor.
Managing High Blood Sugar
If you have diabetes, it is essential 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 with 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 worsened chest pain and, in some cases, heart attack. The risk is greater for individuals with certain types of heart disease. To avoid side effects, your doctor will instruct 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 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 risk for an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult with your doctor, as epinephrine may be less effective while taking this medication. Also, discuss the use of alcohol 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 for both you and your baby.
It is crucial that you inform all of 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 engaging in activities that require you to be alert. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and exercise caution 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 the results of certain laboratory tests. Be sure to inform all of 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, including people undergoing surgery, experiencing changes in appetite, or vomiting. If you have questions or concerns, discuss them with your doctor.
Managing High Blood Sugar
If you have diabetes, it is essential 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 with 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 worsened chest pain and, in some cases, heart attack. The risk is greater for individuals with certain types of heart disease. To avoid side effects, your doctor will instruct 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 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 risk for an even more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult with your doctor, as epinephrine may be less effective while taking this medication. Also, discuss the use of alcohol 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 for both 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 a poison control center (e.g., 1-800-222-1222). Treatment is supportive and symptomatic, including atropine for bradycardia, glucagon, vasopressors, and intravenous fluids.
Drug Interactions
Contraindicated Interactions
- Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) in patients with impaired ventricular function or AV nodal conduction abnormalities (risk of severe bradycardia, heart block, heart failure exacerbation)
- Severe bradycardia
- Second- or third-degree atrioventricular (AV) block
- Sick sinus syndrome (unless a permanent pacemaker is in place)
- Cardiogenic shock
- Decompensated heart failure
Major Interactions
- Strong CYP2D6 inhibitors (e.g., fluoxetine, paroxetine, quinidine, propafenone, ritonavir, bupropion, terbinafine) - can significantly increase metoprolol plasma concentrations, leading to increased beta-blockade and adverse effects.
- Clonidine (risk of rebound hypertension upon clonidine withdrawal if metoprolol is not tapered first)
- Digoxin (additive bradycardia)
- Other beta-blockers (additive effects on heart rate and conduction)
- Fingolimod (risk of severe bradycardia)
Moderate Interactions
- NSAIDs (e.g., ibuprofen, naproxen) - may reduce the antihypertensive effect of metoprolol.
- Insulin and oral hypoglycemics - beta-blockers may mask symptoms of hypoglycemia (e.g., tachycardia, palpitations) and prolong hypoglycemic episodes.
- Alpha-1 blockers (e.g., prazosin, doxazosin) - increased risk of first-dose hypotension and orthostatic hypotension.
- Reserpine, guanethidine, other catecholamine-depleting drugs (additive hypotensive and bradycardic effects).
- Sympathomimetics (e.g., epinephrine, norepinephrine) - may antagonize the effects of metoprolol or lead to hypertensive crisis with non-selective beta-blockers.
Minor Interactions
- Alcohol (may increase metoprolol levels slightly)
- Cimetidine (may increase metoprolol levels slightly)
Monitoring
Baseline Monitoring
Blood Pressure (BP)
Rationale: To establish baseline and guide initial dosing.
Timing: Prior to initiation of therapy.
Heart Rate (HR)
Rationale: To establish baseline and assess for bradycardia.
Timing: Prior to initiation of therapy.
Electrocardiogram (ECG)
Rationale: To assess for pre-existing conduction abnormalities (e.g., AV block).
Timing: Prior to initiation, especially in patients with cardiac history.
Renal Function (BUN, Creatinine)
Rationale: To assess baseline kidney function, though metoprolol is primarily hepatically metabolized, renal excretion of metabolites occurs.
Timing: Prior to initiation.
Hepatic Function (ALT, AST, Bilirubin)
Rationale: To assess baseline liver function, as metoprolol is extensively 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: Individualized, typically <130/80 mmHg for hypertension.
Action Threshold: Systolic BP <90 mmHg or symptomatic hypotension; inadequate BP control.
Heart Rate (HR)
Frequency: Regularly, e.g., weekly initially, then monthly or as clinically indicated.
Target: Typically 50-60 bpm at rest.
Action Threshold: HR <50 bpm or symptomatic bradycardia.
Symptoms of Heart Failure
Frequency: At each visit.
Target: N/A
Action Threshold: Worsening dyspnea, edema, weight gain, fatigue.
Blood Glucose (for diabetic patients)
Frequency: Regularly, as per diabetes management guidelines.
Target: Individualized.
Action Threshold: Unexplained hypoglycemia or difficulty recognizing hypoglycemic symptoms.
Symptom Monitoring
- Dizziness
- Lightheadedness
- Fatigue
- Shortness of breath
- Swelling in ankles/feet
- Bradycardia (slow heart rate)
- Cold hands/feet
- Depression
- Insomnia
- Masked symptoms of hypoglycemia (in diabetics)
Special Patient Groups
Pregnancy
Category C. Metoprolol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Beta-blockers can cause fetal bradycardia, hypoglycemia, and growth restriction. Neonates exposed to beta-blockers in utero may be at risk for hypoglycemia and bradycardia.
Trimester-Specific Risks:
First Trimester:
Limited data, but generally avoided unless clearly needed.
Second Trimester:
Potential for fetal growth restriction and bradycardia.
Third Trimester:
Increased risk of neonatal bradycardia, hypoglycemia, and respiratory depression. Monitor neonate for several days after birth.
Lactation
Metoprolol is excreted into breast milk in small amounts. Generally considered compatible with breastfeeding, but monitor the infant for signs of beta-blockade (e.g., bradycardia, lethargy, poor feeding). The American Academy of Pediatrics considers metoprolol to be compatible with breastfeeding.
Infant Risk:
Low risk, but monitor for bradycardia, hypotension, and hypoglycemia.
Pediatric Use
Safety and efficacy for hypertension in pediatric patients are not as well-established as in adults. Dosing is weight-based, and careful titration is required. Metoprolol succinate (extended-release) is often preferred for pediatric use due to once-daily dosing. Not recommended for children under 6 years of age for hypertension.
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 due to potential for increased sensitivity to hypotensive and bradycardic effects, and potential for reduced hepatic clearance.
Clinical Information
Clinical Pearls
- Metoprolol tartrate is an immediate-release formulation, typically dosed twice daily. Metoprolol succinate is an extended-release formulation, dosed once daily.
- Always take metoprolol tartrate with food or immediately after a meal to ensure consistent absorption and reduce GI upset.
- Do not abruptly discontinue metoprolol, especially in patients with ischemic heart disease, due to the risk of rebound angina, myocardial infarction, or sudden death.
- Monitor heart rate and blood pressure regularly. Target heart rate is typically 50-60 bpm at rest.
- Use with caution in patients with asthma or COPD, as beta-1 selectivity is dose-dependent and higher doses can cause bronchospasm.
- Can mask symptoms of hypoglycemia in diabetic patients, particularly tachycardia and tremors.
Alternative Therapies
- Other Beta-blockers (e.g., Atenolol, Bisoprolol, Carvedilol, Nebivolol)
- ACE Inhibitors (e.g., Lisinopril, Enalapril)
- Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan, Losartan)
- Calcium Channel Blockers (e.g., Amlodipine, Nifedipine, Diltiazem, Verapamil)
- Thiazide Diuretics (e.g., Hydrochlorothiazide, Chlorthalidone)
- Alpha-1 Blockers (e.g., Prazosin, Doxazosin)
- Direct Vasodilators (e.g., Hydralazine, Minoxidil)
Cost & Coverage
Average Cost:
$10 - $30 per 30 tablets (generic 50mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 (Preferred 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 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, including the amount taken and the time it happened, to ensure you receive the best possible care.