From the Guidelines
No, you should not discontinue metoprolol suddenly. Metoprolol, a beta-blocker commonly used for high blood pressure, heart failure, and other cardiac conditions, should be tapered off gradually under medical supervision. Stopping metoprolol abruptly can trigger a rebound effect, potentially causing a dangerous spike in blood pressure, increased heart rate, worsening chest pain (angina), or even heart attack in some patients.
Key Considerations
- The typical tapering process involves gradually reducing your dose over 1-2 weeks, but the exact schedule depends on your current dose, how long you've been taking it, and your underlying medical conditions.
- If you want to stop taking metoprolol, contact your healthcare provider first to create a safe discontinuation plan.
- This gradual approach allows your body to adjust to decreasing levels of the medication and helps prevent withdrawal symptoms.
- Even if you're experiencing side effects from metoprolol, continuing to take it until you have medical guidance is safer than stopping on your own, as supported by guidelines such as those from the American College of Cardiology/American Heart Association 1, 2.
Important Evidence
- Studies have shown that abrupt cessation of beta-blockers like metoprolol can lead to adverse outcomes, including increased risk of heart attack and stroke 3.
- The 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults recommends avoiding abrupt cessation of beta-blockers, especially in patients with heart failure with reduced ejection fraction (HFrEF) 1, 2.
Conclusion Not Applicable - Direct Answer Only
Do not stop metoprolol without medical supervision, as it may lead to severe health consequences. Always consult your healthcare provider before making any changes to your medication regimen, especially when it comes to critical medications like beta-blockers.
From the FDA Drug Label
Do not abruptly discontinue metoprolol therapy in patients with coronary artery disease. Severe exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following the abrupt discontinuation of therapy with beta-blockers When discontinuing chronically administered metoprolol, particularly in patients with coronary artery disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored Patients should be warned against interruption or discontinuation of therapy without the physician’s advice Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol therapy abruptly even in patients treated only for hypertension
Metoprolol should not be discontinued suddenly. The dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. Patients should be warned against interruption or discontinuation of therapy without the physician’s advice 4.
From the Research
Discontinuing Metoprolol
- Metoprolol is a beta1-selective adrenoceptor blocking drug used to treat hypertension and angina pectoris 5, 6.
- The effects of discontinuing metoprolol suddenly have been studied in several trials: + A study published in 1984 found that gradual withdrawal of metoprolol in patients with ischemic heart disease led to increased cardiac symptoms and mental symptoms, as well as a rebound increase in basal heart rate and heart rate response to orthostatic testing 7. + Another study published in 1982 compared the withdrawal phenomena after propranolol, metoprolol, and pindolol, and found that metoprolol was associated with a significant overshoot of heart rate after withdrawal, as well as withdrawal symptoms such as headache, palpitations, and tremor 8.
- These studies suggest that discontinuing metoprolol suddenly may lead to rebound phenomena and increased symptoms, and that gradual withdrawal may be necessary to minimize these effects 7, 8.
Recommendations for Discontinuation
- Based on the available evidence, it is recommended that metoprolol be discontinued gradually, rather than suddenly, to minimize the risk of rebound phenomena and increased symptoms 7, 8.
- The optimal rate of withdrawal has not been established, but a gradual tapering of the dose over a period of days or weeks may be necessary to minimize the risk of adverse effects 7, 8.