Formulary
Metoprolol tartrate: Indications, Dosing, Side Effects and Interactions
Metoprolol tartrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 5 min read
Metoprolol tartrate: Indications, Dosing, Side Effects and Interactions
Metoprolol tartrate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Hypertension**
- **Adult** (By Mouth Using Immediate-Release Medicines): Initially 100 mg daily, increased if necessary to 200 mg daily in 1-2 divided doses, high doses are rarely required; maximum 400 mg per day.
- **Adult** (By Mouth Using Modified-Release Medicines): 200 mg once daily.
**Angina**
- **Adult** (By Mouth Using Immediate-Release Medicines): 50-100 mg 2-3 times a day.
- **Adult** (By Mouth Using Modified-Release Medicines): 200-400 mg daily.
**Arrhythmias**
- **Adult** (By Mouth Using Immediate-Release Medicines): Usual dose 50 mg 2-3 times a day, then increased if necessary up to 300 mg daily in divided doses.
- **Adult** (By Intravenous Injection): Up to 5 mg, dose to be given at a rate of 1-2 mg/minute, then up to 5 mg after 5 minutes if required, total dose of 10-15 mg.
**Migraine prophylaxis**
- **Adult** (By Mouth Using Immediate-Release Medicines): 100-200 mg daily in divided doses.
- **Adult** (By Mouth Using Modified-Release Medicines): 200 mg daily.
**Hyperthyroidism (adjunct)**
- **Adult** (By Mouth Using Immediate-Release Medicines): 50 mg 4 times a day.
**In surgery**
- **Adult** (By Slow Intravenous Injection): Initially 2-4 mg, given at induction or to control arrhythmias developing during anaesthesia, then 2 mg, repeated if necessary; maximum 10 mg per course.
**Hypertension for metoprolol tartrate**
- **Child 1 month-11 years** (By mouth using immediate-release medicines): Initially 1 mg/kg twice daily, increased if necessary up to 8 mg/kg daily in 2-4 divided doses (max. per dose 400 mg).
- **Child 12-17 years** (By mouth using immediate-release medicines): Initially 50-100 mg daily, increased if necessary to 200 mg daily in 1-2 divided doses, high doses are rarely necessary; maximum 400 mg per day.
- **Child 12-17 years** (By mouth using modified-release medicines): 200 mg once daily.
**Arrhythmias for metoprolol tartrate**
- **Child 12-17 years** (By mouth using immediate-release medicines): Usual dose 50 mg 2-3 times a day, then increased if necessary up to 300 mg daily in divided doses.
Cautions
For all beta-adrenoceptor blockers (systemic) Diabetes; first-degree AV block; history of obstructive airways disease (introduce cautiously); myasthenia gravis; portal hypertension (risk of deterioration in liver function); psoriasis; symptoms of hypoglycaemia may be masked; symptoms of thyrotoxicosis may be masked Cautions, further information Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: in combination with verapamil or diltiazem (risk of heart block) with bradycardia (heart rate less than 50 beats per minute), or second- or third-degree AV block (contra-indicated; risk of complete heart block, asystole) in diabetes mellitus patients with frequent hypoglycaemic episodes (risk of suppressing hypoglycaemic symptoms) if prescribed a non-selective beta-blocker (including topical beta-blockers) in a history of asthma requiring treatment (contra-indicated in asthma; risk of increased bronchospasm)
Contraindications
For all beta-adrenoceptor blockers (systemic) Asthma; cardiogenic shock; hypotension; marked bradycardia; metabolic acidosis; phaeochromocytoma (apart from specific use with alpha-blockers); Prinzmetal's angina; second-degree AV block; severe peripheral arterial disease; sick sinus syndrome; third-degree AV block; uncontrolled heart failure Contra-indications, further information Bronchospasm Beta-blockers, including those considered to be cardioselective, should usually be avoided in patients with a history of asthma, bronchospasm or a history of obstructive airways disease. However, when there is no alternative, a cardioselective beta-blocker can be given to these patients with caution and under specialist supervision. In such cases the risk of inducing bronchospasm should be appreciated and appropriate precautions taken.
Side effects
For all beta-adrenoceptor blockers (systemic) Common or very common Abdominal discomfort; bradycardia; confusion; depression; diarrhoea; dizziness; dry eye (reversible on discontinuation); dyspnoea; erectile dysfunction; fatigue; headache; heart failure; nausea; paraesthesia; peripheral coldness; rash (reversible on discontinuation); Raynaud's phenomenon; sleep disorders; syncope; visual impairment; vomiting Uncommon Alopecia; atrioventricular block; bronchospasm Rare or very rare Hallucination; psoriasis exacerbated Side-effects, further information With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. Overdose Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate. For details on the management of poisoning, see Beta-blockers, under Emergency treatment of poisoning . Side-effects For metoprolol tartrate General side-effects: Common or very common Constipation; palpitations; postural disorders Uncommon Chest pain; drowsiness; dystrophic skin lesion; hyperhidrosis; muscle cramps; oedema; weight increased Rare or very rare Arrhythmia; conjunctivitis; dry mouth; eye irritation; gangrene; hepatitis; rhinitis; sexual dysfunction; thrombocytopenia Specific side-effects: Uncommon With intravenous use Cardiogenic shock; concentration impaired; dermatitis psoriasiform Rare or very rare With intravenous use Anxiety; arthralgia; atrioventricular block exacerbated; intermittent claudication; memory loss; photosensitivity reaction; taste altered; tinnitus With oral use Alertness decreased; arthritis; auditory disorder; personality disorder; skin reactions Frequency not known With oral use Peyronie's disease; retroperitoneal fibrosis
Interactions
**Other interactions (12):**
- Metoprolol is a metabolic substrate for the Cytochrome P450 isoenzyme CYP2D6.
- Enzyme-inducing agents (e.g.
- Patients receiving concomitant treatment with sympathetic ganglion blocking agents, other beta-blockers (i.e.
- In patients treated with beta-blockers intravenous administration of calcium antagonists of the verapamil-type should not be given.
- Beta-blockers may enhance the negative inotropic and negative dromotropic effect of antiarrhythmic agents (of the quinidine type and amiodarone).
- Digitalis glycosides, in association with beta-blockers, may increase atrioventricular conduction time and may induce bradycardia.
Pregnancy
For all beta-adrenoceptor blockers (systemic) Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension.
Breast feeding
For all beta-adrenoceptor blockers (systemic) With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants.
Hepatic impairment
Manufacturer advises caution in severe impairment (bioavailability may be increased in patients with liver cirrhosis). Dose adjustments Manufacturer advises consider dose reduction in severe impairment.
Medicinal forms
Capsule,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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