Metoprolol

• For heart problems and high blood pressure (hypertension)
• Also for an overactive thyroid gland and migraine
• Tablets for oral use
• Caution with alcohol

Metoprolol belongs to a group of medicines called beta-blockers. Beta-blockers protect the heart by lowering pulse and blood pressure.

This medicine is used to treat various conditions, including:

• High blood pressure (hypertension)
• Angina pectoris (chest tightness or pain)
• Cardiac arrhythmia
• Heart attack prophylaxis
• Overactive thyroid gland (hyperthyroidism)
• Prevention of migraine attacks (migraine prophylaxis)

Metoprolol is available in two variants: Metoprolol Succinate and Metoprolol Tartrate. Your doctor will recommend the right variant for you.

Metoprolol tablets should be swallowed whole with water without chewing. Metoprolol Tartrate should be taken on an empty stomach (two hours before or two hours after a meal).

Dosage

Dosage varies per person and is determined by a doctor depending on the symptoms. The recommended dose in adults is:

Metoprolol Tartrate

• For high blood pressure (hypertension): 100-200 mg, taken one to two times a day. Maximum of daily dose: 400 mg.
• For chest tightness or pain (angina pectoris): 100-200 mg a day. Maximum of daily dose: 400 mg.
• For cardiac arrhythmia: 100-200 mg a day, divided in two to three doses. Your doctor may increase the dose if necessary.
• For an overactive thyroid (hyperthyroidism): 150-200 mg a day, divided in three to four doses. Your doctor may increase the dose if necessary.
• For migraine prophylaxis: 100-200 mg a day, divided in one to two doses.
• For heart attack: the starting dose is 50 mg, taken two to four times a day during two to three days. Maintenance dose: 100 mg, twice daily.

Metoprolol Succinate

• For high blood pressure (hypertension): the starting dose is one tablet Metoprolol Succinate Retard 50. This dose may be increased to a maximum of 100-200 mg once a day. The dose can be reduced by your doctor if you suffer from liver disease.
• For chest tightness or pain (angina pectoris): 100-200 mg once a day. Maximum of two tablets Metoprolol Succinate Retard 200 a day.
• For cardiac arrhythmia: 100-200 mg once a day. Your doctor may increase the dose if necessary.
• For an overactive thyroid (hyperthyroidism): 100-200 mg once a day. Your doctor may increase the dose if necessary.
• For migraine prophylaxis: 100-200 mg once a day.
• For heart attack: start with regular Metoprolol tablets. The maintenance dose is one tablet Metoprolol Succinate Retard 200, taken once a day.

For children and adolescents, the appropriate dose of metoprolol succinate should be determined by a doctor. For more information on use and dosage, please see the package leaflet.

Alcohol/driving

Be careful when drinking alcohol. Alcohol may intensify the effects of this medicine.

Metoprolol can cause side effects such as fatigue, dizziness and visual disturbances. If you experience these side effects, do not drive or use machinery until these effects have worn off.

Taken too much/forgot to take/stop taking Metoprolol

If you accidentally take more Metoprolol tablets than you were told to, contact your doctor or pharmacist immediately. Symptoms of an overdose of this medicine are listed in the package leaflet.

Do not use a double dose to make up for the forgotten one. If you have forgotten to take a dose, you may take the missed dose unless it is almost time for your next scheduled dose. In this case, you should continue as normal.

Do not stop using Metoprolol suddenly. Always consult your doctor first. When discontinuing the treatment, the dose should be reduced gradually over a period of at least two weeks.

Metoprolol is not suitable for everyone. Do not use this medicine if:

• If you are allergic any of the ingredients in this medicine (see section ‘What Metoprolol contains').
• You are allergic to other blood pressure reducers that belong to a class of medicines called betablockers.
• You have a disease of the cardiac conduction system (second and third-degree AV block).
• You have had acute heart failure or have uncontrolled heart failure, with fluid retention in the lungs (pulmonary oedema) or low blood pressure (hypotension).
• You suffer from septic shock with considerably impaired cardiac pump function.
• You have severe blood circulation problems.
• You have a slow resting heart rate (bradycardia).
• You are being treated continuously or intermittently with medicines that help to improve the heart's pumping action (socalled bèta-2-agonists).
• You have a type of heart rhythm disorder called sick sinus syndrome.
• You have a history of myocardial infarction in combination with a slow heart rate, low blood pressure and heart failure.
• You are being treated with verapamil by injection into a vein. This may lower your blood pressure and cause disturbance of cardiac conduction or heart failure.
• You suffer from lung problems such as asthma or other respiratory disorder.
• You have a tumour of the adrenal gland (phaeochromocytoma), which may cause irregular bursts in blood pressure, severe headache, sweating and a faster than normal heartbeat.

When should this medicine be used with caution?

In some situations, special care should be taken with Metoprolol. There is no experience with Metoprolol for the treatment of heart failure in certain patient groups. For more information, see the package leaflet.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine.

Other medicines and Metoprolol

Please tell your doctor or pharmacist if you are using, have recently used or might use any other medicines, including medicines obtained without a prescription, herbal medicines or other natural products.

Metoprolol may interfere with how other medicines work and vice versa. For a complete list of these medicines that interact with Metoprolol, see the package leaflet.

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Very common (may affect more than 1 in 10 people):

• Nervous system: fatigue.

Common (may affect 1 to 10 in every 100 people):

• Heart: slow resting heart rate (bradycardia), awareness of your heartbeat (palpitations).
• Arteries: orthostatic hypotension (form of low blood pressure that happens when standing after sitting or lying down, causing dizziness or sometimes temporary loss of consciousness).
• Nervous system: dizziness, headache.
• Respiratory system: shortness of breath with exertion.
• Gastrointestinal tract: nausea, vomiting, abdominal pain.
• General: fatigue.

Uncommon (may affect 1 to 100 in every 1,000 people):

• Heart: severe blood circulation problems (cardiogenic shock) in patients with heart attack, disturbances of cardiac conduction (firstdegree AV block), pain in the chest.

For a complete list of rare side effects, see the package leaflet. If the side effects are severe or if you get any side effects that are not listed in the package leaflet, contact your doctor or pharmacist.

The active substance in Metoprolol Tartrate is metoprolol tartrate.

• Metoprolol Tartrate 50 mg: each tablet contains 50 mg metoprolol tartrate.
• Metoprolol Tartrate 100 mg: each tablet contains 100 mg metoprolol tartrate.

The active substance in Metoprolol Succinate is metoprolol succinate.

• Metoprolol Succinate Retard 25: one tablet contains 23.75 mg metoprolol succinate, equivalent to 25 mg metoprolol tartrate.
• Metoprolol Succinate Retard 50: one tablet contains 47.5 mg metoprolol succinate, equivalent to 50 mg metoprolol tartrate.
• Metoprolol Succinate Retard 100: one tablet contains 95 mg metoprolol succinate, equivalent to 100 mg metoprolol tartrate.
• Metoprolol Succinate Retard 200: one tablet contains 190 mg metoprolol succinate, equivalent to 200 mg metoprolol tartrate.

Read the package leaflet before use.