From the Guidelines
Metoprolol tartrate is a recommended medication for coronary artery disease (CAD) management, with a typical starting dose of 25-50 mg twice daily, which can be gradually increased to 100-200 mg daily as needed and tolerated. For CAD management, metoprolol works by blocking beta-1 adrenergic receptors, reducing heart rate, blood pressure, and myocardial oxygen demand, which helps prevent angina and improves outcomes after heart attacks 1. Patients should take metoprolol consistently, with or without food, and never stop abruptly as this can worsen cardiac symptoms. Common side effects include fatigue, dizziness, and bradycardia. Blood pressure and heart rate should be monitored regularly. Metoprolol is often used alongside other CAD treatments such as aspirin, statins, and lifestyle modifications including regular exercise, heart-healthy diet, smoking cessation, and stress management.
Some key considerations for metoprolol tartrate use in CAD management include:
- Patients with marked first-degree AV block, any form of second- or third-degree AV block, a history of asthma, severe LV dysfunction or HF, or at high risk for shock should not receive beta blockers on an acute basis 1
- Patients with significant chronic obstructive pulmonary disease should be given beta blockers very cautiously, initially with low doses of a beta-1–selective agent 1
- The target resting heart rate is 50 to 60 beats per minute unless a limiting side effect is reached 1
- Selection of the oral agent should include the clinician’s familiarity with the agent 1
According to the most recent guidelines, beta blockers, including metoprolol tartrate, are recommended as a first-line therapy in the treatment of hypertension when it occurs in patients with stable ischemic heart disease (SIHD) 1. Additionally, the use of beta blockers after MI reduced all-cause mortality by 23% 1. Overall, metoprolol tartrate is a valuable medication for CAD management, and its use should be considered in conjunction with other evidence-based treatments.
From the FDA Drug Label
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.
In a large (1,395 patients randomized), double-blind, placebo-controlled clinical study, metoprolol was shown to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction
The precise mechanism of action of metoprolol in patients with suspected or definite myocardial infarction is not known.
Metoprolol tartrate is used in the treatment of Coronary Artery Disease (CAD), specifically in patients with myocardial infarction, to reduce cardiovascular mortality. The drug has been shown to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction 2. The precise mechanism of action of metoprolol in patients with suspected or definite myocardial infarction is not known, but it is believed to work by reducing the oxygen requirements of the heart and decreasing cardiac output 2. Metoprolol tartrate can be initiated as soon as the patient’s clinical condition allows, and treatment can begin within 3 to 10 days of the acute event 2.
From the Research
Metoprolol Tartrate for Coronary Artery Disease (CAD)
- Metoprolol tartrate is a beta-blocker commonly used in the management of CAD, particularly in patients with a history of myocardial infarction (MI) 3, 4.
- Studies have shown that metoprolol can be used safely in CAD patients with chronic obstructive pulmonary disease (COPD) without significant decreases in forced expiratory volume in 1 s (FEV1) 5.
- A fixed-dose combination of metoprolol, telmisartan, and chlorthalidone has been found to be effective and well-tolerated in patients with hypertension and stable CAD who respond inadequately to dual therapy 6.
Efficacy of Metoprolol in CAD
- Metoprolol has been shown to reduce the risk of nonfatal reinfarction and sudden death in patients with MI 4.
- A meta-analysis comparing metoprolol and carvedilol found that both drugs significantly reduced composite cardiovascular events and re-infarction in patients with MI, but neither showed significant benefits on all-cause death, cardiovascular death, revascularization, and rehospitalization 7.
- Another study found that patients treated with metoprolol had improved survival compared to those treated with carvedilol, particularly in patients with left ventricular ejection fraction >40% 3.