Metoprolol
beta-blocker
Our referenceBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Metoprolol belongs to the category "beta-blocker". Beta-blockers slow and ease the heart and lower blood pressure. They are never stopped abruptly.
For Metoprolol, in practice: Slows the heart and lowers blood pressure. It is generally taken over the long term, within regular monitoring, and is not stopped on your own initiative.
Under which brands it is found
Metoprolol is part of the composition of about 8 presentations listed in France. It is available under various trade names and as generics.
- Logimax
- Metoprolol Accord
- Metoprolol Arrow Lab
- Metoprolol Sandoz
- Metoprolol Viatris
- Seloken
- Seloken L P
- Selozok Lp
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
Our product for this treatment
You take Metoprolol. For people who follow this type of treatment every day, we have designed a dedicated product.
Layer Nutrition Beta-Blockers
Melatonin helps you fall asleep faster. Magnesium and vitamin B6 help you reduce tiredness during the day.
- Contributes to the reduction of time taken to fall asleep (melatonin 1 mg, at bedtime)
- Contributes to the reduction of tiredness (magnesium, vitamin B6)
- Contributes to normal muscle function and to the normal functioning of the nervous system (magnesium)
Melatonin 1 mg · Magnesium 100 mg · B6 1.4 mg
One bottle, one dose per day. Reduced price from the second box, free delivery from two boxes.
How metoprolol works
Metoprolol is a so-called cardioselective beta-blocker: it preferentially blocks the beta-1 adrenergic receptors, which are found mainly in the heart. By occupying these receptors, it prevents catecholamines, adrenaline and noradrenaline, from stimulating the heart muscle. The result is seen directly in how the heart works: the heart rate slows, the force of each contraction decreases and cardiac output, the amount of blood ejected per minute, falls. It is this relative resting of the heart that explains most of its therapeutic effects.
On blood pressure, the mechanism remains partly debated. The official label proposes three complementary pathways: antagonism of catecholamines at cardiac adrenergic sites, which lowers output, a central effect that reduces sympathetic nerve outflow to the periphery, and a decrease in the secretion of renin, an enzyme that governs blood pressure regulation. Metoprolol is then transformed in the liver, mainly by the enzyme CYP2D6. It undergoes a strong first-pass hepatic effect, which limits its oral bioavailability to about 50%. Its elimination half-life is short, 3 to 4 hours, but it can reach 7 to 9 hours in people who metabolize slowly via CYP2D6.
Why it is prescribed
Metoprolol tartrate is indicated in three main situations. In arterial hypertension, it lowers blood pressure and reduces the accompanying cardiovascular risk. In angina, the pain that occurs when the heart lacks oxygen on exertion, it serves as maintenance treatment: by slowing the heart, it reduces the frequency of attacks and improves exercise tolerance. After a myocardial infarction, in patients whose circulatory condition is stable, it reduces cardiovascular mortality.
The two salts of metoprolol do not overlap exactly. Metoprolol succinate, an extended-release form, is used in compensated chronic heart failure, an indication where the weakened heart benefits from a gradual and steady slowing. Metoprolol tartrate, on the other hand, is not indicated in heart failure: it is used, for example, to control the heart rate in atrial fibrillation, a rhythm disorder. The prescribed salt therefore corresponds to a specific indication and a given dosing schedule.
How to take it day to day
The label recommends taking metoprolol tartrate tablets with meals or immediately afterward. The presence of food increases the amount of medicine actually absorbed, so taking the tablet always under the same conditions makes its effect more consistent from one day to the next. Regularity matters here as much as the dose: a beta-blocker works by keeping the heart at a stable pace, and skipping doses or shifting the timing makes this balance vary.
The most important point concerns stopping. You never stop metoprolol abruptly on your own initiative. The label reports that worsening of angina, and in some cases heart attacks, have occurred after an abrupt stop: the heart, used to being slowed, reacts to the sudden release of the brake. When a discontinuation is decided, the dose must be reduced in steps over one to two weeks, under medical supervision. If a bothersome effect appears, you talk to your doctor rather than stopping on your own.
The effects to know about
The most frequent adverse effects follow directly from the slowing of the heart and the nervous system. According to the label, fatigue and dizziness affect about 10% of patients: these are the most common manifestations, often pronounced at the start of treatment. Shortness of breath and bradycardia, a heart rhythm that has become too slow, each concern about 3% of people. These signs are precisely those that monitoring seeks to detect, because they reflect the expected action of the medicine pushed one notch too far.
Other effects are reported at a frequency close to 5%. A depressed mood occurs in about 5 people out of 100, diarrhea in about 5%, and itching or a skin rash in about 5% as well. Most of these effects are not serious and resolve, but following them makes it possible to adjust the dose or consider an alternative if the discomfort persists. Discomfort that lasts or worsens should be reported to the doctor rather than allowed to settle in.
On the plate
Metoprolol leaves two documented traces on the nutritional ground. The first concerns coenzyme Q10, a molecule essential to energy production in cells. A landmark study on bioenergetics showed that the clinically used adrenergic beta-blockers, including metoprolol, inhibit enzymes that depend on this coenzyme. The pharmacological effect is established, even if its concrete clinical translation remains debated. Food provides modest amounts of it, mainly through oily fish, such as salmon, sardines and mackerel, and through red meat. For the rest, the body makes most of its own coenzyme Q10.
The second trace concerns sleep. The nighttime production of melatonin, the hormone that prepares for falling asleep, goes through beta-1 adrenergic receptors in the pineal gland, the same ones that metoprolol blocks. Beta-blockers therefore reduce this secretion. In a randomized controlled trial conducted in hypertensive patients treated with a beta-blocker, melatonin supplementation improved sleep. In addition, magnesium, found in pumpkin seeds, spinach and dark chocolate, and vitamin B6 take part in ordinary nerve function. The plate covers these minerals and these good fats well, but it provides very little melatonin, a hormone the body makes itself and whose production the treatment slows. It is on this precise point that a targeted intake, in addition to the treatment and never in its place, makes sense.
Interactions and monitoring
Because metoprolol is metabolized by CYP2D6, anything that slows this enzyme raises its concentration in the blood, and therefore its effect. This is the case with certain antidepressants such as paroxetine or fluoxetine, with bupropion or with quinidine. Combining it with other medicines that slow the heart can in turn increase bradycardia. Telling your doctor and pharmacist about all your treatments makes it possible to anticipate these additions of effects. Two simple markers guide monitoring: the heart rate and blood pressure, whose bradycardia and hypotension are the frequent deviations to watch.
Two situations call for particular vigilance. In a person with diabetes, metoprolol can mask early signs of hypoglycemia, notably the acceleration of the heart, and it can promote severe and prolonged hypoglycemia. In a person with hyperthyroidism, it can mask certain signs of the disease, and an abrupt stop risks precipitating a thyrotoxic crisis. These cases reinforce the same rule: metoprolol is managed with your doctor, on figures followed over time, and never through a solitary decision.
Sources
- Beta Blockers - StatPearls - NCBI Bookshelf
- Metoprolol Tartrate tablet label
- Bioenergetics in clinical medicine XV. Inhibition of coenzyme Q10-enzymes by clinically used adrenergic blockers of beta-receptors
- Repeated melatonin supplementation improves sleep in hypertensive patients treated with beta-blockers: a randomized controlled trial
Related molecules
To explore in the « Heart and blood pressure » family and its neighbours.
See the whole « Heart and blood pressure » family · Back to the atlas
Frequently asked questions
What is metoprolol used for?
Metoprolol is a beta-blocker. It is prescribed in particular for high blood pressure, angina, heart failure, after a heart attack, and sometimes to prevent migraine. For your specific indication, refer to the package leaflet and your doctor.
What are the most common side effects of metoprolol?
The package leaflet notably mentions fatigue, cold hands and feet, digestive problems, headaches, dizziness and sleep disturbances. The frequency and intensity vary from one person to another. Report any bothersome effect to your doctor or pharmacist and read the package leaflet.
Should you take metoprolol in the morning or at night, with or without food?
The timing depends on the formulation and your prescription: what matters is to take it regularly, always in the same way relative to meals. Follow the package leaflet and the guidance of your doctor or pharmacist, without changing the schedule on your own.
What does metoprolol interact with?
The package leaflet reports possible interactions, notably with certain non-steroidal anti-inflammatory drugs such as ibuprofen, with antidiabetic medicines and with other cardiovascular treatments. Give your doctor or pharmacist the full list of what you are taking, supplements included.
Can you drink alcohol while taking metoprolol?
The package leaflet states that alcohol can increase the drop in blood pressure and worsen feelings of dizziness. For your situation, ask your doctor or pharmacist for advice and refer to the package leaflet.
Can you stop taking metoprolol suddenly?
Abruptly stopping a beta-blocker is not advised and can be risky. Any interruption or reduction should be done gradually and on medical advice. Never stop the treatment on your own: talk to your doctor first.
What should you do if you miss a dose of metoprolol?
What to do is set out in the package leaflet, and you should never double a dose to make up for a missed one. If in doubt, your pharmacist can tell you how to proceed.
Is metoprolol safe during pregnancy or breastfeeding?
The package leaflet states that metoprolol is generally not recommended during pregnancy or breastfeeding, unless decided by a doctor. If you are pregnant, breastfeeding or planning a pregnancy, talk to your doctor before taking it.
Does metoprolol require precautions in older adults?
In older adults, fatigue, dizziness and drops in blood pressure can be more pronounced, which warrants appropriate monitoring. Your doctor adjusts follow-up accordingly: the package leaflet and their advice remain the reference.
Is metoprolol available as a generic?
Metoprolol is the common name of the molecule, available under several brand names and as generics. Your pharmacist can tell you the exact equivalent of your treatment.
Can metoprolol disrupt sleep and affect melatonin?
Research links beta-blockers to reduced nighttime melatonin secretion: Stoschitzky and colleagues, in 1999, observed an inhibition of melatonin secretion under beta-blocker therapy. This sleep angle is what we document on the nutrition side, alongside your medical follow-up.
Which form of melatonin and magnesium to consider with a beta-blocker like metoprolol?
The nutrition angle chosen for BB01 draws on melatonin, in connection with the nighttime secretion observed by Stoschitzky et al. (1999), and on magnesium, best taken in a well-absorbed form such as bisglycinate. Before adding a supplement to your treatment, ask your doctor or pharmacist for advice.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.