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, requires gradual tapering to avoid potentially dangerous withdrawal effects, as noted in 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 1. To taper off metoprolol, work with your healthcare provider to develop a specific plan, which typically involves reducing your dose by about 25-50% every 1-2 weeks. For example, if you're taking 100mg twice daily, your doctor might reduce it to 50mg twice daily for 1-2 weeks, then 25mg twice daily, and so on until you can safely stop. Some key points to consider when tapering off metoprolol include:
- The risk of rebound hypertension, increased heart rate, chest pain, and in severe cases, heart attack or stroke if metoprolol is discontinued suddenly 1
- The importance of gradual tapering to allow your body to readjust to the loss of the medication's effects on your heart rate and blood pressure 1
- The need to work with your healthcare provider to develop a specific tapering plan, as the optimal tapering schedule may vary depending on your individual circumstances 1 Sudden discontinuation can cause rebound hypertension, increased heart rate, chest pain, and in severe cases, heart attack or stroke, as your body has adapted to the medication's effects on your heart rate and blood pressure, and needs time to readjust 1. Even if you're experiencing side effects from metoprolol, always consult your doctor before making any changes to your medication regimen.
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 Avoid abrupt withdrawal of beta-blockade, which might precipitate a thyroid storm.
Discontinuation of Metoprolol:
- Metoprolol should not be discontinued suddenly, especially in patients with coronary artery disease.
- The dosage should be gradually reduced over a period of 1 to 2 weeks.
- Patients should be carefully monitored during the discontinuation process.
- Abrupt withdrawal of metoprolol may precipitate severe exacerbation of angina, myocardial infarction, ventricular arrhythmias, or a thyroid storm 2.
From the Research
Discontinuing Metoprolol
- Metoprolol should not be discontinued suddenly, as it can lead to rebound increases in cardiac chronotropic sensitivity to isoproterenol and resting heart rate 3.
- A prolonged low-dose withdrawal schedule (50 mg/day for 10 days) can decrease but not completely prevent the changes observed after abrupt withdrawal 3.
Tapering Metoprolol
- Tapering metoprolol is recommended to prevent withdrawal phenomena, such as rebound increases in heart rate and blood pressure 4.
- The degree and duration of beta blockade appear to be related to drug potency, and withdrawal phenomena may occur after propranolol and metoprolol but not after pindolol 4.
Clinical Considerations
- Metoprolol is generally well tolerated, and its beta 1-selectivity may facilitate its administration to certain patients, such as asthmatics and diabetics 5.
- Temporary fatigue, dizziness, and headache are among the most frequently reported side effects of metoprolol 5.
- Metoprolol has been shown to be effective in reducing blood pressure in hypertensive patients, and its efficacy and tolerability have been demonstrated in several studies 6, 7.