Metoprolol is a selective beta-1 blocker that reduces heart rate, myocardial contractility, and blood pressure. Available in immediate-release and extended-release formulations.
Also known as: Lopressor, Toprol-XL
Beta-blocker + SSRI: CYP2D6 inhibition increases metoprolol levels.
Fluoxetine potently inhibits CYP2D6, increasing metoprolol plasma levels 2-5 fold. Risk of bradycardia and hypotension.
DailyMed/FDA (NIH/NLM) — approved Metoprolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5466243e-1e3d-175e-e063-6394a90a5dee
Beta-blocker + antiarrhythmic: risk of severe bradycardia and AV block.
Both reduce AV conduction and heart rate. The combination can cause severe bradycardia, AV block, and cardiac arrest.
DailyMed/FDA (NIH/NLM) — approved Metoprolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5466243e-1e3d-175e-e063-6394a90a5dee
Beta-blocker + non-dihydropyridine CCB: risk of AV block and heart failure.
Both reduce AV conduction and contractility. The combination can cause severe AV block, bradycardia, and heart failure.
DailyMed/FDA (NIH/NLM) — approved Metoprolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5466243e-1e3d-175e-e063-6394a90a5dee
No documented food or drink interactions.
May cause bronchospasm in asthmatic patients. Prefer cardioselective beta-blocker.
Avoid in severe asthma. Use minimum dose if necessary.
DailyMed/FDA (NIH/NLM) — approved Metoprolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5466243e-1e3d-175e-e063-6394a90a5dee
Use only if benefit justifies risk. May cause neonatal bradycardia and hypoglycaemia.
Avoid in 3rd trimester if possible.
Excreted in breast milk. Generally compatible with breastfeeding.
Monitor neonate for bradycardia and hypoglycaemia at delivery.
DailyMed/FDA (NIH/NLM) — approved Metoprolol label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5466243e-1e3d-175e-e063-6394a90a5dee
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Selective beta-1 blocker that reduces heart rate, contractility, and AV conduction. Minimal effect on pulmonary beta-2 receptors.
Selectively blocks cardiac beta-1 receptors, reducing heart rate, myocardial contractility, and AV conduction. Dose-dependent effect.
Oral bioavailability: ~50% (extensive first-pass hepatic metabolism). Food increases absorption. Tmax: 1-2 hours.
Extensively metabolised by CYP2D6. Inhibited by fluoxetine, paroxetine, quinidine. Induced by rifampicin. CYP2D6 genetic polymorphism.
3-7 hours. Elimination: ~95% urine (metabolites), <5% unchanged. Adjust in hepatic impairment.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
