From the Guidelines
Metoprolol can be used in patients with chronic kidney disease (CKD), but careful consideration of kidney function and potential dose adjustments are necessary. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, metoprolol is a beta-blocker that can be used in patients with CKD. The guideline provides dosing information for metoprolol, including metoprolol tartrate and metoprolol succinate, but does not specifically address dose adjustments for CKD patients. However, it is known that metoprolol is primarily metabolized by the liver, with only about 5-10% of the drug eliminated by the kidneys, making it a relatively safe beta-blocker option for CKD patients.
When considering the use of metoprolol in CKD patients, it is essential to monitor for potential side effects such as bradycardia, hypotension, and worsening kidney function, especially when starting the medication or adjusting the dose. The KDOQI US commentary on the 2017 ACC/AHA hypertension guideline 1 suggests that for individuals without moderate or severely increased urine albumin excretion, any first-line BP-lowering agent can be used, and among patients with CKD, often multiple medications will be required.
Key considerations for using metoprolol in CKD patients include:
- Monitoring kidney function and adjusting the dose as needed
- Being aware of potential side effects such as bradycardia and hypotension
- Considering the use of other BP-lowering agents, such as thiazide diuretics, ACE inhibitors or ARBs, or CCBs, in addition to metoprolol
- Regular follow-up appointments to assess kidney function and adjust medication as needed. Always consult with a healthcare provider before starting or stopping any medication, as individual factors may affect the appropriateness of metoprolol for specific CKD patients.
From the FDA Drug Label
The systemic availability and half-life of metoprolol in patients with renal failure do not differ to a clinically significant degree from those in normal subjects. Consequently, no reduction in dosage is usually needed in patients with chronic renal failure No dose adjustment of metoprolol tartrate is required in patients with renal impairment
Key Points:
- The systemic availability and half-life of metoprolol are not significantly affected by renal failure.
- No dose adjustment is required for patients with renal impairment.
- CKD patients can take metoprolol, but caution and monitoring are advised, as with any medication in patients with renal impairment 2, 2.
From the Research
Metoprolol Use in CKD Patients
- Metoprolol is a beta-blocker that can be used in patients with chronic kidney disease (CKD) 3, 4.
- Water-soluble beta-blockers like metoprolol are dialyzable and may require supplementation to avoid exacerbation of arrhythmias following dialysis 3.
- The use of beta-blockers, including metoprolol, in CKD patients has been shown to have beneficial effects on cardiovascular risk and renal function 3, 4.
- However, the choice of beta-blocker and dosing should be individualized based on the patient's specific condition and kidney function 4, 5.
Considerations for CKD Patients
- Patients with CKD should be closely monitored for changes in renal function and cardiovascular risk when taking metoprolol or other beta-blockers 6, 5.
- The effectiveness and safety of metoprolol in CKD patients may depend on various factors, including the stage of CKD, presence of other comorbidities, and concomitant medications 4, 5.
- More research is needed to fully understand the benefits and risks of metoprolol use in CKD patients and to determine the optimal treatment strategies for this population 3, 4.