Metoprololsuccinat (Ph.Eur.) Teva (Metoprolol Tartrate)

Metoprolol is indicated for several cardiovascular conditions that involve excessive sympathetic stimulation.

• Hypertension: reduces systolic and diastolic blood pressure by decreasing cardiac output.
• Angina pectoris: lowers myocardial oxygen demand, relieving chest pain during exertion.
• Chronic heart failure: improves ventricular function and reduces hospitalisation risk.
• Post‑myocardial infarction prophylaxis: decreases the likelihood of recurrent cardiac events.

• Metoprolol selectively antagonises β1‑adrenergic receptors in cardiac tissue, inhibiting catecholamine‑induced stimulation of adenylate cyclase. This reduces intracellular cyclic AMP, leading to decreased heart rate, contractility and conduction velocity, which together lower cardiac output and myocardial oxygen consumption.

Metoprolol may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Fatigue or tiredness
• Dizziness, especially on standing
• Cold extremities
• Gastrointestinal upset (nausea, abdominal discomfort)
• Bradycardia (slow heart rate)
• Sleep disturbances or vivid dreams

Serious or Rare Side Effects

• Severe bradycardia or heart block
• Hypotension unresponsive to treatment
• Acute heart failure exacerbation
• Bronchospasm in patients with asthma or COPD
• Allergic reactions such as rash, angioedema or anaphylaxis

Before initiating therapy, clinicians should evaluate patient‑specific factors and monitor for adverse events.

• Cardiovascular assessment: review history of heart block, severe bradycardia or decompensated heart failure.
• Respiratory status: avoid in uncontrolled asthma or severe chronic obstructive pulmonary disease.
• Diabetes monitoring: watch for masking of hypoglycaemia symptoms.
• Renal or hepatic impairment: dose adjustment may be required based on organ function.
• Pregnancy and lactation: use only if potential benefit justifies potential risk, as safety data are limited.
• Store at ambient temperature: keep below 25°C in the original container, protect from moisture and direct sunlight.

Metoprolol can interact with several medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Non‑selective β‑blockers or other agents that markedly lower heart rate (e.g., digoxin) – risk of severe bradycardia.
• Strong CYP2D6 inhibitors (e.g., paroxetine, quinidine) – may increase plasma metoprolol levels.

Moderate Interactions (Monitor Closely)

• Calcium channel blockers (verapamil, diltiazem) – additive negative inotropic and AV‑node effects.
• Antidiabetic drugs (insulin, sulfonylureas) – may mask hypoglycaemia signs.
• Antihypertensives (ACE inhibitors, diuretics) – can enhance blood‑pressure lowering.
• NSAIDs – may reduce antihypertensive efficacy.
• Antidepressants (tricyclics) – increased risk of cardiac conduction abnormalities.