From the Guidelines
For a patient with low blood pressure who is currently on metoprolol tartrate 12.5 mg twice daily, I recommend reducing the metoprolol dose or discontinuing it entirely, depending on the severity of hypotension and the indication for beta-blocker therapy. This approach is based on the understanding that beta-blockers like metoprolol lower blood pressure by reducing heart rate and cardiac output, and in the context of hypotension, these effects may be excessive for the individual patient 1.
Key Considerations
- If the patient is taking metoprolol for hypertension, consider stopping the medication and monitoring blood pressure.
- If metoprolol is prescribed for another indication such as heart failure or post-myocardial infarction, reduce the dose to 6.25 mg twice daily or once daily and reassess, as bisoprolol and metoprolol succinate are preferred in patients with HFrEF, and abrupt cessation should be avoided 1.
- Ensure adequate hydration and advise the patient to rise slowly from sitting or lying positions to prevent orthostatic hypotension.
- Monitor electrolytes, particularly sodium, and assess for other causes of hypotension such as dehydration, adrenal insufficiency, or medication interactions.
Management of Hypotension
- The management should focus on addressing the underlying cause of hypotension, whether it be the beta-blocker therapy or another factor.
- For patients with symptoms like dizziness, lightheadedness, or syncope, these should be addressed urgently, potentially in an emergency setting if severe.
- Consideration of alternative medications or adjustments in dosage should be guided by the most recent and highest quality evidence available, prioritizing the patient's morbidity, mortality, and quality of life outcomes 1.
From the FDA Drug Label
Management There is no specific antidote In general, patients with acute or recent myocardial infarction may be more hemodynamically unstable than other patients and should be treated accordingly Hypotension Administer a vasopressor, e.g., norepinephrine or dopamine. The treatment and management for a patient with low blood pressure currently on metoprolol tartrate 12.5 mg BID is to:
- Administer a vasopressor, such as norepinephrine or dopamine, to manage hypotension 2
From the Research
Treatment and Management of Low Blood Pressure with Metoprolol Tartrate
- The patient is currently taking metoprolol tartrate 12.5 mg BID, which is a beta-blocker used to treat hypertension and angina pectoris 3.
- According to a study published in 1982, metoprolol can be effective in reducing blood pressure in hypertensive patients, with 60% to 85% of patients achieving a diastolic blood pressure of 12 kPa (90 mmHg) or lower during a 12-week trial 4.
- However, the patient is experiencing low blood pressure, which may be a side effect of metoprolol 5.
- A study published in 1992 found that controlled release metoprolol formulations can provide sustained and consistent metoprolol plasma concentrations and beta 1-blockade while retaining the convenience of once daily administration 6.
- In geriatric patients, metoprolol has been shown to have a variable effect on heart rate and blood pressure, with a significant decrease in systolic blood pressure observed after administration 7.
Possible Adjustments to Treatment
- The dosage of metoprolol tartrate may need to be adjusted to balance the patient's blood pressure 3, 4.
- Adding a diuretic to the treatment regimen may improve the overall response rate in hypertension 3.
- Switching to a controlled release metoprolol formulation may help to maintain consistent metoprolol plasma concentrations and reduce the risk of side effects 6.