From the Guidelines
Metoprolol is indicated for several cardiovascular conditions, including hypertension, angina pectoris, acute myocardial infarction, and heart failure with reduced ejection fraction, as well as for rate control in atrial fibrillation, management of certain arrhythmias, and as prophylaxis for migraine headaches. The choice of metoprolol for an individual patient is based primarily on pharmacokinetic and side effect criteria, as well as on physician familiarity 1. For hypertension, typical dosing starts at 25-100 mg daily (immediate release) or 25-100 mg once daily (extended release), titrated to effect. For heart failure, lower initial doses of 12.5-25 mg twice daily are recommended with gradual titration 1. Metoprolol works by selectively blocking beta-1 adrenergic receptors, primarily affecting the heart by reducing heart rate, contractility, and blood pressure, which reduces myocardial oxygen demand, making it beneficial for angina and post-MI patients. Some key points to consider when using metoprolol include:
- Starting with a low dose and titrating up to effect, especially in patients with heart failure or those at risk of hypotension or bradycardia 1
- Monitoring for common side effects such as fatigue, dizziness, and bradycardia, and adjusting the dose as needed
- Avoiding abrupt discontinuation to prevent rebound hypertension or worsening angina
- Using metoprolol with caution in patients with bronchospastic disease, diabetes, and certain heart conduction disorders
- Considering alternative beta-blockers, such as bisoprolol or carvedilol, in patients who do not tolerate metoprolol or have specific comorbid conditions 1.
From the FDA Drug Label
INDICATIONS & USAGE Myocardial Infarction Metoprolol tartrate injection is indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality.
Indications for metoprolol include:
- Myocardial Infarction: to reduce cardiovascular mortality in hemodynamically stable patients with definite or suspected acute myocardial infarction
- Hypertension: metoprolol has antihypertensive effects, although the exact mechanism is not fully elucidated
- Angina Pectoris: metoprolol reduces oxygen requirements of the heart, making it useful in the long-term management of angina pectoris 2 2
From the Research
Indications for Metoprolol
Metoprolol is indicated for various cardiovascular conditions, including:
- Essential hypertension: Metoprolol is used to treat mild to moderate hypertension 3, 4, 5
- Angina pectoris: Metoprolol is effective in treating stable angina pectoris 3, 4, 5
- Chronic heart failure: Metoprolol is used to treat patients with stable, predominantly mild to moderate (NYHA functional class II to III) chronic heart failure due to left ventricular systolic dysfunction 3
- Post-infarction patients: Metoprolol has been shown to reduce mortality in post-infarction patients 4
Specific Patient Populations
- Patients with ischaemic or dilated cardiomyopathy: Metoprolol is effective in patients with chronic heart failure due to ischaemic or dilated cardiomyopathy 3
- Older adults with heart failure: Metoprolol tartrate, carvedilol, and bisoprolol have similar effects on mortality amongst older adults with heart failure 6, 7
- Patients with severe (NYHA functional class IV) chronic heart failure: Limited data indicate that metoprolol CR/XL is effective in patients with severe chronic heart failure, but more data are needed to confirm these findings 3