Metoprolol is a beta-1 selective beta-blocker that reduces the workload on the heart by slowing the heart rate and decreasing the force of contraction. This class effect helps lower blood pressure and oxygen demand, making metoprolol a mainstay in cardiovascular care.
Key indications include hypertension (high blood pressure), chronic stable angina (chest pain), rate control in supraventricular arrhythmias such as atrial fibrillation, and secondary prevention after myocardial infarction (heart attack). The extended-release formulation, metoprolol succinate, also has an FDA indication for heart failure with reduced ejection fraction (HFrEF), improving symptoms and outcomes when titrated to guideline-directed doses alongside ACE inhibitors/ARNI, SGLT2 inhibitors, and mineralocorticoid receptor antagonists.
Metoprolol comes in two common oral forms: immediate-release metoprolol tartrate (often taken twice daily) and extended-release metoprolol succinate (once daily). Brand names you may recognize include Lopressor (tartrate) and Toprol-XL (succinate). Both forms are considered “cardioselective,” but this selectivity is dose-dependent and can diminish at higher doses.
Beyond blood pressure control, patients often receive metoprolol for symptomatic relief of palpitations, performance anxiety with tachycardia, and migraine prophylaxis (off-label, individualized). Always confirm that metoprolol is appropriate for your specific condition, especially if you have asthma/COPD, diabetes, circulation problems, or a slow heart rhythm.
This section provides general information and does not replace your clinician’s instructions. Dose selection depends on the formulation (tartrate vs succinate), condition treated, other medications, and how you tolerate therapy. Never change your dose or stop metoprolol abruptly without medical guidance.
Formulations and typical strengths: Immediate-release metoprolol tartrate tablets are commonly available in 25 mg, 50 mg, and 100 mg; extended-release metoprolol succinate tablets typically come in 25 mg, 50 mg, 100 mg, and 200 mg. The products are not automatically interchangeable milligram-for-milligram; switching should be supervised to ensure therapeutic equivalence.
Hypertension: Metoprolol succinate (extended-release) is often started at 25–100 mg once daily and titrated every 1–2 weeks to a usual range of 50–200 mg daily based on response and tolerability. Metoprolol tartrate (immediate-release) may start at 50 mg twice daily, adjusted to effect. Beta-blockers are frequently combined with other antihypertensives (e.g., thiazides, ACE inhibitors, ARBs, calcium channel blockers) when needed.
Angina: Metoprolol tartrate commonly begins at 50 mg twice daily, titrated to symptom control and heart rate goals. Extended-release metoprolol succinate may be prescribed once daily, titrating to 100–200 mg as tolerated.
Heart failure (HFrEF): Use only the extended-release succinate formulation. A typical initiation is 12.5–25 mg once daily, with gradual uptitration every 2 weeks to a target of 200 mg daily as tolerated. Initiation and uptitration are done carefully, monitoring blood pressure, heart rate, and fluid status.
Post–myocardial infarction: Metoprolol is started in-hospital (often IV initially) and transitioned to oral therapy, with typical maintenance doses of 100–200 mg per day divided (tartrate) or once daily (succinate), individualized to the patient’s heart rate, blood pressure, and recovery course.
Rate control in atrial fibrillation: Doses vary widely; clinicians target symptom relief and resting heart rate goals (often 60–80 bpm at rest). Immediate-release tartrate allows flexible splitting; once control is achieved, some patients transition to extended-release for convenience.
Administration tips: Take metoprolol tartrate with or immediately after meals to enhance absorption and reduce stomach upset. Metoprolol succinate can be taken with or without food, but consistency helps. Swallow extended-release tablets whole; do not crush or chew. Some extended-release tablets are scored and may be split if your pharmacist confirms the product is designed for splitting; never crush the granules.
Abrupt discontinuation warning: Stopping suddenly can trigger rebound tachycardia, elevated blood pressure, worsening angina, or even heart attack in high-risk patients. If discontinuation is necessary, your prescriber will direct a gradual taper over 1–2 weeks or longer.
Respiratory conditions: Although metoprolol is relatively cardioselective, it can still provoke bronchospasm at higher doses. People with asthma or COPD should use it cautiously and under close medical supervision; report new wheezing or shortness of breath promptly.
Cardiac rhythm and conduction: Metoprolol slows the heart and may worsen bradycardia or heart block. If you have a history of low resting heart rate, sick sinus syndrome, or AV block, inform your clinician. Dizziness, fainting, or an unusually slow pulse warrants prompt evaluation.
Heart failure: Initiation is appropriate in stable HFrEF but can worsen symptoms if fluid-overloaded or during acute decompensation. Your care team may adjust diuretics or other medications during titration.
Diabetes and thyroid disease: Metoprolol can mask adrenergic warning signs of hypoglycemia (such as tremor and palpitations) and hyperthyroidism. Maintain regular glucose monitoring if you use insulin or sulfonylureas, and seek medical advice for atypical symptoms.
Peripheral circulation: Beta-blockers may aggravate symptoms in peripheral arterial disease or Raynaud phenomenon, causing cold extremities or color changes in fingers/toes. Keep warm and alert your clinician to worsening symptoms.
Allergy and anaphylaxis: Beta-blockers can blunt the response to epinephrine. If you carry an epinephrine auto-injector, discuss this interaction; you may require additional monitoring in severe allergic reactions.
Surgery and anesthesia: Tell your surgeon and anesthesiologist you take metoprolol. Do not stop it before surgery unless your doctor directs; sudden cessation increases cardiac risk.
Mental health and fatigue: Some people report fatigue, mood changes, sleep disturbance, or vivid dreams. Discuss persistent symptoms; dose adjustments or timing changes may help.
Pregnancy and breastfeeding: Beta-blockers can affect fetal growth, neonatal heart rate, and glucose regulation. Metoprolol is sometimes used in pregnancy when benefits outweigh risks. It passes into breast milk in small amounts; monitor infants for excessive sleepiness or poor feeding. Discuss risks and alternatives with your obstetrician or pediatrician.
Liver function and older adults: Metoprolol is metabolized by the liver (CYP2D6). Reduced clearance in hepatic impairment or in older adults may increase drug exposure; lower starting doses and slower titration may be appropriate.
Avoid metoprolol in the following situations unless a specialist advises otherwise and appropriate monitoring (e.g., pacemaker) is in place:
If you have a complex cardiac history or implanted devices, coordinate any changes to beta-blocker therapy with your cardiology team.
Most people tolerate metoprolol well, especially at modest doses, but side effects can occur—often early in therapy or after dose changes. Many improve as your body adapts.
Common effects:
Less common but important:
Seek urgent care if you experience chest pain that worsens, fainting, severe shortness of breath, signs of shock (pale, clammy skin), or swelling of the face and throat. For persistent but non-urgent issues such as fatigue or cold extremities, consult your clinician; sometimes a dose adjustment, timing change, or a different medication class is preferred.
Metoprolol interacts with many cardiovascular and non-cardiac medicines. Share a complete list of prescriptions, OTC products, and supplements with your healthcare professional and pharmacist.
Heart rate and rhythm medications:
Antihypertensives and vasodilators:
Metabolism (CYP2D6) inhibitors can raise metoprolol levels:
Diabetes medications: Insulin and sulfonylureas have enhanced hypoglycemic effect and masked warning symptoms with beta-blockers; increase glucose monitoring frequency during dose changes or illness.
NSAIDs (e.g., ibuprofen, naproxen) may blunt antihypertensive effect when used chronically; acetaminophen is often preferred for pain if blood pressure control is a priority.
Anesthetics and sedatives can intensify blood pressure and heart rate lowering; inform your surgical team preoperatively.
Alcohol may add to dizziness or lightheadedness; be cautious until you know your response, and avoid activities requiring alertness if affected.
Epinephrine in severe allergic reactions can have a blunted effect in the presence of beta-blockers; emergency care teams may use additional treatments (e.g., glucagon) if needed.
Herbal supplements: St. John’s wort may reduce drug levels of some medicines (variable effects), and certain stimulatory supplements (yohimbine, bitter orange) can oppose blood pressure control. Discuss supplements before use.
If you miss a dose of metoprolol, take it as soon as you remember unless it is close to your next scheduled dose. If it is nearly time for the next dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose, as this can cause excessive bradycardia or hypotension.
For once-daily extended-release tablets, take the missed dose the same day when remembered; if you do not remember until the next day, skip and continue. If you miss multiple doses, contact your prescriber, especially if you are using metoprolol for angina or heart failure.
Symptoms of metoprolol overdose include profound dizziness, fainting, very slow heart rate, low blood pressure, confusion, difficulty breathing, bluish lips or fingers, seizures, and unusually low blood sugar (sweating, shakiness, confusion). Severe toxicity can lead to cardiogenic shock.
If overdose is suspected, call emergency services immediately. In the U.S., you can also contact Poison Control at 1-800-222-1222 for real-time guidance. Do not attempt to self-treat. Hospital management may include airway support, IV fluids, atropine for bradycardia, glucagon, vasopressors, and in some cases high-dose insulin euglycemia therapy with glucose monitoring. Early medical attention is critical for the best outcome.
Store metoprolol tablets at controlled room temperature (generally 20°C–25°C / 68°F–77°F) in a dry place, away from heat, moisture, and direct light. Keep the medication in its original, tightly closed container and out of reach of children and pets.
Do not store in the bathroom. When traveling, carry tablets in your hand luggage with original labeling. Do not use metoprolol past the expiration date; ask your pharmacist about proper disposal or medicine take-back options in your area.
In the United States, metoprolol is a prescription-only medication. Federal and state regulations require a licensed clinician to evaluate whether it is appropriate for you and to authorize a prescription before the pharmacy can dispense it. This framework safeguards safety by screening for contraindications, interactions, and correct dosing.
HealthSouth MountainView offers a legal and structured way to access metoprolol without a formal prescription on hand. Through a compliant telehealth pathway, you can complete a secure medical questionnaire and, when appropriate, consult with a licensed clinician who can issue an electronic prescription. If approved, partner pharmacies dispense metoprolol and ship it directly, ensuring medication access remains fully within U.S. law.
Key advantages include convenience, continuity of care, and integrated pharmacist support. Importantly, approval is not guaranteed; clinicians will not prescribe metoprolol if it is unsafe or unsuitable for your condition. If you already have an existing prescription, HealthSouth MountainView can help transfer it to a partner pharmacy for streamlined refills and delivery.
Bottom line: While you cannot buy metoprolol over the counter in the U.S., HealthSouth MountainView enables you to buy metoprolol without prescription in advance by connecting you with licensed providers who can evaluate, prescribe when appropriate, and arrange timely home delivery through compliant channels.
Metoprolol is a beta-1 selective beta-blocker that slows the heart rate and reduces the heart’s workload. By blocking stress hormones (adrenaline/noradrenaline) mainly in the heart, it lowers blood pressure, eases angina, and helps control certain arrhythmias. It also improves survival in heart failure when used appropriately.
Metoprolol is prescribed for high blood pressure, chronic stable angina, heart failure with reduced ejection fraction, and to control heart rate in arrhythmias like atrial fibrillation. It’s also used after heart attacks to reduce the risk of future events. Some use it off-label for migraine prevention, performance anxiety, and certain types of tremor.
Metoprolol tartrate is the immediate-release form typically taken two times daily, while metoprolol succinate is an extended-release form usually taken once daily. Succinate (ER) is the formulation studied and approved for heart failure. They are not interchangeable milligram-for-milligram, and switching forms should be guided by your clinician.
Heart rate and blood pressure effects begin within about 1 hour for tartrate and a few hours for succinate. Immediate-release effects last roughly 6–12 hours, whereas extended-release provides a smoother 24-hour effect. Full benefits for blood pressure and angina may take 1–2 weeks; heart failure benefits accrue over months.
Common side effects include fatigue, dizziness, low heart rate, cold hands or feet, and mild gastrointestinal upset. Some people experience sleep disturbances or vivid dreams, especially at higher doses. Side effects often improve as your body adjusts, but persistent or severe symptoms warrant medical review.
Seek urgent care for fainting, very slow heart rate, severe shortness of breath or wheezing, swelling of legs or sudden weight gain (possible heart failure worsening), or allergic reactions (rash, swelling, difficulty breathing). Diabetics should watch for masked low blood sugar symptoms. Any chest pain, new confusion, or blue discoloration of fingers needs prompt evaluation.
No. Abrupt discontinuation can trigger rebound effects such as increased heart rate, blood pressure spikes, angina, and even heart attack in people with coronary disease. If you need to stop, your clinician will taper the dose gradually over 1–2 weeks while monitoring symptoms.
Take metoprolol at the same time each day. Extended-release tablets should be swallowed whole (do not crush or chew); some brands allow splitting if scored—confirm with your pharmacist. Taking it with or after food can improve absorption and reduce stomach upset. Consistency matters more than the exact hour.
If you miss a dose, take it when you remember unless it’s close to the time for your next dose. Skip the missed dose rather than doubling up. For extended-release forms, keep to the daily schedule. If you miss more than one dose, contact your clinician for advice.
Metoprolol lowers heart rate and may reduce peak exercise capacity, which can feel like reduced stamina, especially at the start. Many people adjust over time. Athletes using heart-rate targets should rely more on perceived exertion or power metrics. Discuss training goals with your clinician if performance is a priority.
Because metoprolol is beta-1 selective, it is generally safer than nonselective beta-blockers in people with reactive airway disease. However, at higher doses it can still worsen bronchospasm. Use with caution, carry your rescue inhaler, and inform your prescriber about any wheezing or breathing changes.
Yes. Metoprolol can mask some symptoms of low blood sugar (like tremor and palpitations) while sweating may persist. It may also slightly raise blood glucose in some patients. Monitor sugars closely, especially when starting or changing dose, and coordinate adjustments with your diabetes care provider.
Metoprolol is metabolized by CYP2D6; inhibitors like fluoxetine, paroxetine, bupropion, quinidine, or ritonavir can raise metoprolol levels and increase side effects. Combining with other drugs that slow heart rate or lower blood pressure (verapamil, diltiazem, digoxin, clonidine) can cause bradycardia or hypotension. Always check interactions before starting new medicines or supplements.
Doses vary by condition and formulation. Hypertension: metoprolol succinate 25–100 mg once daily or metoprolol tartrate 50–100 mg/day in divided doses, titrated to response. Angina and rate control often require higher doses; heart failure typically starts low (e.g., succinate 12.5–25 mg daily) and uptitrates slowly. Follow your prescriber’s plan.
Some people notice mild weight gain, decreased energy, or sexual dysfunction (reduced libido or erectile difficulties). These effects are often dose-related and may improve over time or with a dose/formulation change. If bothersome, discuss alternatives or adjustments with your clinician.
Alcohol can enhance blood pressure–lowering and sedative effects, increasing the risk of dizziness or fainting, especially when standing up. It may also interfere with blood pressure control. If you drink, do so in moderation and be cautious with position changes; avoid drinking close to dosing until you know your response.
Beta-blockers may be used in pregnancy when benefits outweigh risks; metoprolol has some use but can be associated with fetal growth restriction and neonatal bradycardia. During breastfeeding, small amounts pass into milk; infants should be monitored for sleepiness or poor feeding. Decisions should be individualized with your obstetrician.
Tell your surgical team you’re on metoprolol. Most patients continue beta-blockers through surgery to avoid rebound cardiovascular events, but dosing may be adjusted. Anesthetics and pain medicines can compound bradycardia or low blood pressure, so intraoperative monitoring is important.
Both are beta-1 selective beta-blockers used for hypertension and angina. Metoprolol is more lipophilic, crosses the blood–brain barrier more, and is metabolized by the liver (CYP2D6), while atenolol is renally cleared and less likely to cause CNS side effects. Outcome data and guideline use often favor metoprolol in heart failure and post-MI settings.
Bisoprolol is highly beta-1 selective and long-acting, often once-daily at lower milligram doses. Both effectively reduce blood pressure and heart rate; in heart failure, bisoprolol and metoprolol succinate both improve survival when titrated properly. Choice often hinges on tolerability, dosing preference, coexisting conditions, and clinician experience.
Carvedilol blocks beta-1, beta-2, and alpha-1 receptors, providing additional vasodilation and metabolic effects. In heart failure, both carvedilol and metoprolol succinate improve outcomes; carvedilol may lower blood pressure more and can be preferred in patients with resistant hypertension, while metoprolol may be gentler in patients prone to dizziness.
Propranolol is nonselective and more lipophilic, useful for tremor, migraine prevention, and performance anxiety. Metoprolol’s beta-1 selectivity makes it preferred for patients with asthma/COPD risk or those focused on cardiac indications. For arrhythmia or coronary disease, metoprolol is often favored; for non-cardiac uses, propranolol may be better.
Both lower blood pressure; nebivolol also enhances nitric oxide–mediated vasodilation and may have fewer sexual side effects and better tolerability in some patients. Metoprolol has broader evidence in post-MI and heart failure (succinate). Selection depends on comorbidities, side effects, cost, and clinician familiarity.
Labetalol blocks alpha-1 in addition to beta receptors, making it effective for rapid BP control and often used in pregnancy and hypertensive emergencies. Metoprolol is commonly used for chronic hypertension, angina, heart failure, and rate control. For pregnancy-related hypertension, labetalol is typically preferred.
Nadolol is nonselective, long-acting, and renally cleared, allowing stable once-daily dosing with minimal CNS penetration. It’s used for portal hypertension prophylaxis and some arrhythmias. Metoprolol offers beta-1 selectivity and flexible dosing, with more evidence in heart failure and post-MI care.
No. Sotalol is both a nonselective beta-blocker and a class III antiarrhythmic that prolongs the QT interval, used primarily for atrial and ventricular arrhythmias with required ECG monitoring. Metoprolol is a beta-1 selective blocker for rate control and BP/angina/heart failure. They serve different roles and have different risks.
Esmolol is an ultra–short-acting IV beta-1 selective blocker used in acute settings (e.g., perioperative tachycardia) due to its rapid on/off profile. Metoprolol is used for chronic or subacute management in oral and IV forms. Choice depends on urgency and setting: esmolol for titratable acute control, metoprolol for ongoing therapy.
Timolol is nonselective and frequently used as ophthalmic drops for glaucoma; systemic forms can affect heart rate and bronchospasm. Metoprolol is systemic, beta-1 selective, and tailored to cardiovascular conditions. Patients using timolol eye drops should still consider beta-blocker interactions and side effects.
Betaxolol is beta-1 selective and long-acting, used orally for hypertension and ophthalmically for glaucoma. It may have a smoother BP effect and fewer pulmonary effects than nonselective agents. Metoprolol has more extensive outcome data in heart failure and post-MI scenarios; selection is individualized.
Acebutolol has intrinsic sympathomimetic activity (ISA), meaning it partially stimulates beta receptors while blocking them, which can cause less resting bradycardia but may be less effective post-MI. Metoprolol lacks ISA and is often preferred for CAD and heart failure. ISA agents are generally avoided in angina and post-MI patients.
Both can slow ventricular rate in atrial fibrillation. Metoprolol is more commonly used in hospital and outpatient protocols due to flexible IV and oral dosing and hepatic metabolism, making it easier to titrate in patients with kidney disease. Atenolol’s renal clearance requires dose adjustments in CKD.
Propranolol and metoprolol are more lipophilic and can cross into the brain, potentially causing vivid dreams, insomnia, or depression in susceptible patients. Atenolol is less lipophilic and may have fewer CNS effects. Individual responses vary; dose and timing adjustments can help.
