II. Indications
III. Mechanism
- Selective Beta Blocker
IV. Pharmacokinetics
- Intravenous dosing
- Onset of action in 5 minutes after intravenous dose
- Sustained response for 6-8 hours
V. Precautions
- Transitioning from immediate to extended release formulation is NOT a mg for mg substitution
- Exercise caution with gradual titration of dose
VI. Dosing
- Oral: Metoprolol Succinate (Toprol XL, extended release)
- Preferred oral formulation for Hypertension
- Avoid for acute management of Heart Rate (Atrial Fibrillation Rate Control)
- Onset of activity is too slow and difficult to titrate acutely
- Typical Hypertension Dose: 50-100 mg orally daily (Maximum 400 mg/day)
- Congestive Heart Failure: Start at 12.5 to 25 mg orally twice daily
- Oral: Metoprolol Tartrate (Lopressor, immediate release)
- Preferred for rapid activity onset (e.g. Atrial Fibrillation with Rapid Ventricular Response) and for dose titration (e.g. elderly, CHF)
- Typical Hypertension Dose: 50 mg orally twice daily (Maximum 450 mg/day)
- SVT Rate Control or Myocardial Infarction: 25 to 50 mg every 6 hours
- Congestive Heart Failure: Start at 6.25 mg orally twice daily
- Elderly: Start at 12.5 to 25 mg orally twice daily
- Intravenous Metoprolol (Lopressor)
- Load: 2.5 to 5 mg IV over 2 to 5 minutes
- Repeated up to 3 doses (15 mg maximum)
VII. Adverse Effects
- See Beta Blocker
VIII. Safety
- Pregnancy Category C
- Unknown safety in Lactation
IX. Drug Interactions
- Increased Metoprolol levels with strong CYP2D6 Inhibitors (e.g. Bupropion, Cimetidine)
X. Resources
- Metoprolol Succinate Extended Release Tablet or Toprol XL (DailyMed)
- Metoprolol Tartrate Immediate Release or Lopressor Tablet (DailyMed)
- Metoprolol Tartrate Injection Solution (DailyMed)
XI. References
- (2019) Presc Lett, Resource #350503, Comparison of Oral Beta Blockers
- Hamilton (2020) Tarascon Pharmacopoeia, Jones and Bartlett, Boston
- Morris (2022) Metoprolol, StatPearls, Treasure Island, FL
Images: Related links to external sites (from Bing)
Related Studies
| metoprolol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| METOPROLOL SUCC ER 100 MG TAB | Generic | $0.13 each |
| METOPROLOL SUCC ER 200 MG TAB | Generic | $0.20 each |
| METOPROLOL SUCC ER 25 MG TAB | Generic | $0.08 each |
| METOPROLOL SUCC ER 50 MG TAB | Generic | $0.08 each |
| METOPROLOL TARTRATE 100 MG TAB | Generic | $0.03 each |
| METOPROLOL TARTRATE 25 MG TAB | Generic | $0.02 each |
| METOPROLOL TARTRATE 50 MG TAB | Generic | $0.02 each |
| METOPROLOL TARTRATE 75 MG TAB | Generic | $0.16 each |
| METOPROLOL-HYDROCHLOROTHIAZIDE 100-25 MG TAB | Generic | $1.56 each |
| METOPROLOL-HYDROCHLOROTHIAZIDE 50-25 MG TAB | Generic | $1.11 each |
| toprol xl (on 9/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| TOPROL XL 100 MG TABLET | Generic | $0.13 each |
| TOPROL XL 25 MG TABLET | Generic | $0.08 each |
| TOPROL XL 50 MG TABLET | Generic | $0.08 each |
Ontology: Metoprolol (C0025859)
| Definition (MSH) | A selective adrenergic beta-1 blocking agent that is commonly used to treat ANGINA PECTORIS; HYPERTENSION; and CARDIAC ARRHYTHMIAS. |
| Definition (NCI) | A cardioselective competitive beta-1 adrenergic receptor antagonist with antihypertensive properties and devoid of intrinsic sympathomimetic activity. Metoprolol antagonizes beta 1-adrenergic receptors in the myocardium, thereby reducing the rate and force of myocardial contraction leading to a reduction in cardiac output. This agent may also reduce the secretion of renin with subsequent reduction in levels of angiotensin II thereby preventing vasoconstriction and aldosterone secretion. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008790 |
| SnomedCT | 372826007, 7092007 |
| LNC | LP16204-7, MTHU016612 |
| English | Metoprolol, 2-Propanol, 1-(4-(2-methoxyethyl)phenoxy)-3-((1-methylethyl)amino)-, (+-)-, metoprolol (medication), Metoprolol [Chemical/Ingredient], METOPROLOL, metoprolol, Metoprolol (product), Metoprolol (substance) |
| Swedish | Metoprolol |
| Czech | metoprolol |
| Finnish | Metoprololi |
| Russian | N 93-26, METOPROLOL, МЕТОПРОЛОЛ, Н 93-26 |
| Japanese | 酒石酸メトプロロール, セレクナート, メデピン, メルコモン, ロプレソール, セロケン, ロプレソールSR, シオプトロール, セグミューラー, ココナリン, シプセロン, モジュメニー, セロケンL, メトプリック, メトラスター, カルスホン, メトプロロール |
| Polish | Metoprolol |
| Spanish | metoprolol (producto), metoprolol (sustancia), metoprolol, Metoprolol |
| French | Métoprolol |
| German | Metoprolol |
| Italian | Metoprololo |
| Portuguese | Metoprolol |
Ontology: Metoprolol Tartrate (C0700548)
| Definition (NCI) | The tartrate salt form of metoprolol, a cardioselective competitive beta-1 adrenergic receptor antagonist with antihypertensive properties and devoid of intrinsic sympathomimetic activity. Metoprolol tartrate antagonizes beta 1-adrenergic receptors in the myocardium, thereby reducing the rate and force of myocardial contraction, and consequently a diminished cardiac output. This agent may also reduce the secretion of renin with subsequent reduction in levels of angiotensin II thus decreasing sympathetic activation, including vasoconstriction, aldosterone secretion. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008790 |
| SnomedCT | 318463000, 72770009 |
| English | Tartrate, Metoprolol, metoprolol tartrate, metoprolol tartrate (medication), METOPROLOL TARTRATE, Metoprolol Tartrate [Chemical/Ingredient], Metoprolol tartrate, Metoprolol tartrate (substance), Metoprolol tartrate [dup] (substance), Metoprolol Tartrate |
| French | Tartrate de métoprolol, Métoprolol tartrate |
| Spanish | tartrato de metoprolol (sustancia), tartrato de metoprolol |
Ontology: Lopressor (C0700776)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | D008790 |
| English | Lopresor, Novartis Brand of Metprolol Tartrate, lopresor, lopressor, Lopressor |
Ontology: Toprol-XL (C0723783)
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C402833 |
| English | Toprol-XL, toprol-xl, toprol xl, Toprol XL |
Ontology: metoprolol succinate (C0724633)
| Definition (NCI) | The succinate salt form of metoprolol, a cardioselective competitive beta-1 adrenergic receptor antagonist with antihypertensive properties and devoid of intrinsic sympathomimetic activity. Metoprolol succinate antagonizes beta 1-adrenergic receptors in the myocardium, thereby reducing the rate and force of myocardial contraction, and consequently a diminished cardiac output. This agent may also reduce the secretion of renin with subsequent reduction in levels of angiotensin II thus decreasing sympathetic activation, including vasoconstriction, aldosterone secretion. |
| Concepts | Pharmacologic Substance (T121) , Organic Chemical (T109) |
| MSH | C402833 |
| SnomedCT | 412432007 |
| English | metoprolol succinate (medication), metoprolol succinate, METOPROLOL SUCCINATE, metoprolol succinate [Chemical/Ingredient], succinate metoprolol, metoprolol CR-XL, Metoprolol succinate (substance), Metoprolol succinate, Metoprolol Succinate |
| Spanish | succinato de metoprolol (sustancia), succinato de metoprolol |
