From the Guidelines
Metoprolol is a crucial medication in the treatment of heart failure, and its use is recommended for all patients with left ventricular systolic dysfunction, regardless of the severity of their symptoms, as it has been shown to reduce mortality, decrease hospitalizations, and improve quality of life 1. The role of metoprolol in heart failure treatment is well-established, with high-quality evidence demonstrating its benefits in reducing morbidity and mortality 1. Metoprolol works by blocking beta-adrenergic receptors, which slows heart rate, reduces blood pressure, and decreases the heart's oxygen demand. Some key points to consider when using metoprolol in heart failure patients include:
- Starting with a low dose (such as 12.5-25 mg once or twice daily) and gradually increasing every two weeks as tolerated to target doses of 200 mg daily for metoprolol succinate (extended-release) or 100 mg twice daily for metoprolol tartrate 1
- Monitoring heart rate, blood pressure, and clinical status after each dose titration to avoid adverse effects, such as symptomatic bradycardia and hypotension 1
- Using metoprolol in combination with other heart failure medications, such as ACE inhibitors, ARBs, diuretics, and aldosterone antagonists, to achieve optimal benefits 1
- Considering metoprolol therapy for all patients with left ventricular systolic dysfunction, including older adults and those with comorbid conditions, as the evidence base for beta-blockers in heart failure has been established for certain beta-blockers, including metoprolol succinate, bisoprolol, carvedilol, and nebivolol 1.
From the FDA Drug Label
WARNINGS Heart Failure Beta-blockers, like metoprolol, can cause depression of myocardial contractility and may precipitate heart failure and cardiogenic shock. If signs or symptoms of heart failure develop, treat the patient according to recommended guidelines. It may be necessary to lower the dose of metoprolol or to discontinue it The role of metoprolol in treating heart failure is not as a primary treatment, but rather metoprolol can precipitate heart failure and cardiogenic shock. If heart failure develops, the dose of metoprolol may need to be lowered or discontinued 2.
From the Research
Role of Metoprolol in Treating Heart Failure
- Metoprolol, a beta-blocker, has been shown to improve survival and reduce hospitalizations in patients with heart failure 3, 4, 5, 6.
- The Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) study demonstrated a 34% reduction in all-cause mortality and a 41% reduction in sudden death in patients with heart failure treated with metoprolol CR/XL compared to placebo 3, 4.
- Metoprolol CR/XL also improved NYHA functional class and quality of life in patients with heart failure 3, 5, 6.
- The drug is well tolerated when treatment is initiated in low dosages and gradually increased at intervals of 1 to 2 weeks 6.
Comparison with Other Beta-Blockers
- A study comparing carvedilol and metoprolol in patients with chronic heart failure found that carvedilol reduced all-cause mortality by 17% compared to metoprolol 7.
- However, metoprolol is still considered an effective treatment for heart failure, and the choice of beta-blocker may depend on individual patient characteristics and comorbidities.