From the Guidelines
Metoprolol is primarily used to treat heart failure, hypertension, and angina.
Key Uses of Metoprolol
- Heart Failure: Metoprolol, specifically the sustained-release formulation (metoprolol succinate), is recommended for all patients with current or prior symptoms of heart failure with reduced ejection fraction (HFrEF), unless contraindicated, to reduce morbidity and mortality 1.
- Hypertension: Metoprolol is used to lower blood pressure and alleviate ischemia and angina in patients with hypertension-related left ventricular systolic dysfunction 2, 3.
- Angina: By reducing heart rate and myocardial oxygen demand, metoprolol helps alleviate angina symptoms 3.
Important Considerations
- The sustained-release formulation of metoprolol (metoprolol succinate) is specifically recommended for heart failure treatment, as it has been shown to reduce mortality in clinical trials 1, 4, 2.
- Dosage and Formulation: The target dose of metoprolol succinate varies, but it is typically titrated to achieve optimal heart rate control while minimizing side effects 4, 2.
- Comparison with Other Beta-Blockers: While metoprolol is effective, other beta-blockers like carvedilol may have additional benefits, such as alpha-blocking properties and a more favorable effect on glycemic control 2, 3.
From the FDA Drug Label
Metoprolol has been shown to be an effective antihypertensive agent when used alone or as concomitant therapy with thiazide-type diuretics, at oral dosages of 100 to 450 mg daily Metoprolol has been shown to be an effective antianginal agent, reducing the number of angina attacks and increasing exercise tolerance. Metoprolol was shown to reduce 3-month mortality by 36% in patients with suspected or definite myocardial infarction
Metoprolol is used for:
- Hypertension: as an antihypertensive agent
- Angina Pectoris: as an antianginal agent
- Myocardial Infarction: to reduce mortality in patients with suspected or definite myocardial infarction 5
From the Research
Uses of Metoprolol
Metoprolol is used for various cardiovascular conditions, including:
- Hypertension: Metoprolol is effective in treating mild to moderate hypertension, and its beta 1-selectivity makes it a suitable option for certain patients, such as asthmatics and diabetics 6.
- Angina pectoris: Metoprolol is used to treat stable angina, and its efficacy is comparable to other beta-blockers, diuretics, and calcium antagonists 6.
- Post-myocardial infarction: Metoprolol has been shown to reduce mortality rates in patients after a myocardial infarction, particularly in those with left ventricular systolic dysfunction 7, 8.
- Chronic heart failure: Metoprolol controlled-release/extended-release (CR/XL) has been found to decrease mortality and improve clinical status in patients with stable mild to moderate chronic heart failure due to left ventricular systolic dysfunction 7, 8.
- Atrial fibrillation: Metoprolol is used to control heart rate in patients with atrial fibrillation, although the evidence is not as extensive as for other conditions 9.
Dosage and Administration
The dosage of metoprolol varies depending on the condition being treated. For example:
- Hypertension: The usual dosage is 100-200 mg daily, given in a single or divided dose 6.
- Post-myocardial infarction: The target dose is 200 mg once daily, with doses up-titrated over 8 weeks 7.
- Chronic heart failure: The target dose is 200 mg once daily, with doses initiated at 12.5-25 mg once daily and gradually increased at 2-weekly intervals 8.
Efficacy and Safety
Metoprolol has been found to be effective in reducing mortality and improving clinical outcomes in various cardiovascular conditions. The drug is generally well-tolerated, with common side effects including temporary fatigue, dizziness, and headache 6, 7, 8.