Metoprolol

What is metoprolol?

Metoprolol is a prescription-only beta-blocker, a type of medicine that affects the heart and circulation. It works by blocking beta-adrenergic receptors, which reduces the effects of stress hormones like adrenaline on the heart. This slows the heart rate, lowers blood pressure, and helps the heart pump more efficiently[1].  

What is metoprolol used for?

Metoprolol is prescribed for a range of cardiovascular and neurological conditions. These include[1]: 

• High blood pressure (hypertension) 

• Angina pectoris (chest pain due to reduced blood flow to the heart) 

• Irregular heart rhythms (arrhythmias) 

• Heart failure (used as part of combination therapy) 

• Prevention of migraines 

• After a heart attack, to reduce the risk of further cardiac events 

• Hyperthyroidism (to reduce symptoms such as rapid heart rate caused by excess thyroid hormone) 

How does metoprolol work?

Metoprolol works by blocking beta-1 receptors in the heart. This leads to[1]: 

• A slower heart rate 

• Reduced force of heart contractions 

• Lower blood pressure 

• Decreased oxygen demand by the heart 

These effects help relieve chest pain, regulate heart rhythms, and reduce the workload on the heart. 

Who can take metoprolol?

Most adults can take metoprolol, but you should speak to your doctor or pharmacist if you[1]: 

• Have severe asthma or COPD 

• Have a very slow heart rate or certain heart conduction problems 

• Have low blood pressure or a slow heart rate 

• Are in cardiogenic shock 

• Have metabolic acidosis 

• Have a liver condition 

• Have an overactive thyroid 

• Have untreated heart failure 

• Have severe circulation problems (such as Raynaud’s syndrome) 

• Are allergic to beta-blockers or metoprolol specifically 

Please tell your doctor or pharmacist about any conditions you may have or medication you take before you start treatment, and always follow the instructions in the Patient Information Leaflet[2].  

How do you take metoprolol?

Metoprolol should be taken according to the following guidance[1]: 

• Take with or just after food to reduce side effects 

• Swallow the tablets whole with water 

• Try to take it at the same time each day 

• Do not crush or chew extended-release tablets 

• Some tablets have a score line so you can split them in half and make them easier to swallow 

What is the typical dosage of metoprolol?

Dosage depends on the condition being treated. Common examples include[1]: 

• Hypertension: 50 to 100mg twice daily 

• Angina or chest pain: 50mg to 100mg, two to three times a day 

• Arrhythmias: 50mg two to three times a day 

• Migraine prevention: 50mg to 100mg, twice a day 

• Hyperthyroidism: 50mg, four times a day, as prescribed 

• Heart failure: Usually starts at a low dose (e.g. 12.5mg) and is gradually increased 

Always follow the dosage prescribed by your doctor or pharmacist. 

Can you stop taking metoprolol?

Do not stop taking metoprolol suddenly unless told to do so by your doctor. Stopping abruptly can cause problems such as increased heart rate, raised blood pressure, chest pain or risk of heart attack. Your doctor or pharmacist will guide you on how to safely reduce your dose if needed[1]. 

What do you do if you take too much metoprolol?

Taking too much metoprolol can be dangerous. Symptoms of overdose include very slow heart rate, low blood pressure, difficulty breathing and fainting or seizures. Call 999 or go to A&E immediately if you suspect an overdose[1]. 

What do you do if you forget to take metoprolol?

If you forget a dose[1]: 

• Take it as soon as you remember 

• If it’s nearly time for your next dose, skip the missed one 

• Do not take two doses at once to make up for a missed dose 

What medicines can’t you take with metoprolol?

Metoprolol can interact with a number of other medicines. These include[1]: 

• Other blood pressure medicines (e.g. verapamil, diltiazem) 

• Antiarrhythmics (e.g. amiodarone) 

• Antidepressants (e.g. fluoxetine) 

• NSAIDs (e.g. ibuprofen) 

• Insulin or diabetes tablets (can mask signs of low blood sugar) 

• Asthma medications (e.g. salbutamol may be less effective) 

Always inform your doctor or pharmacist about all medications and supplements you take before you start a new medicine, and follow the instructions in the Patient Information Leaflet[2]. 

What are the side effects of metoprolol?

Common side effects include[1]: 

• Tiredness, dizziness, or weakness 

• Cold hands or feet 

• Headaches 

• Stomach pain 

• Nausea 

Serious side effects for which you should seek urgent medical help include[1]: 

• Shortness of breath 

• Swelling of the ankles or feet 

• Unexplained bruising or bleeding 

• Fainting 

• Severe dizziness 

• Symptoms of liver problems (e.g., yellowing of the skin or eyes, dark urine) 

You should contact your GP if you experience any of these symptoms. In rare cases, the medicine may cause a serious allergic reaction (anaphylaxis). You should call 999 or visit A&E immediately if you believe this is happening[1]. 

Symptoms of anaphylaxis include[1]:  

• Difficulty breathing  

• Tightness in throat and chest  

• Swelling of the tongue or throat  

• Feeling faint or dizzy  

• Blue/grey skin or lips  

• Loss of consciousness 

If you experience any side effects, including those not listed, you are encouraged to report them via the Yellow Card Scheme or contact your doctor, pharmacist, or nurse. This information is intended as a summary for general awareness and does not replace professional medical advice. 

The information provided in the side effects section is not a comprehensive list of all possible side effects associated with this medication. For a complete list of side effects, please refer to the Patient Information Leaflet (PIL) provided with your medication or consult your healthcare professional[2]. 

Frequently asked questions about metoprolol

Can I drink alcohol with metoprolol? 
Yes, but alcohol can enhance side effects such as dizziness or drowsiness, so moderation is advised[1]. 

Does metoprolol cause weight gain? 
Some people may gain weight, often due to fluid retention or reduced activity from tiredness[1]. 

Can I take metoprolol long-term? 
Yes. It is often prescribed for long-term use and is generally safe when monitored regularly[1]. 

Is it safe to take during pregnancy? 
It may be prescribed if necessary, but it should only be taken under medical advice, especially in late pregnancy[1]. 

Can I drive while taking metoprolol? 
Yes, unless you feel dizzy or excessively tired. If so, avoid driving until you feel better[1]. 

Does it affect sexual function? 
In some people, yes. It can reduce libido or cause erectile dysfunction[1]. 

Can I have surgery while taking metoprolol? 
It’s a good idea to inform your surgeon if you’re taking metoprolol, as it can lower blood pressure in combination with anaesthetics[1]. 

For the official NHS guide for metoprolol, visit their website.