Are you dealing with high blood pressure or heart issues? These problems can put your health at risk every day. It might feel overwhelming not knowing which medicine is best for you. Metoprolol offers two options: Metoprolol Tartrate and Metoprolol Succinate.
The main difference between them is that Metoprolol Tartrate is immediate-release and needs to be taken twice daily, while Metoprolol Succinate is extended-release and is dosed only once a day.
Because of this, their dosages and uses vary, and they cannot be switched easily. In this article, you will compare both medications, understand their benefits, and learn how to use them safely.
| 🔑 Key Takeaways ➤ Metoprolol Tartrate needs to be taken twice daily because it releases the medicine quickly. ➤ Metoprolol Succinate is taken once a day since it releases the medicine slowly over time. ➤ They have different dosages and uses, so you cannot switch between them without your doctor’s advice. ➤ Both medicines help lower high blood pressure and reduce chest pain from heart problems. ➤ If you have heart failure, Metoprolol Succinate might be a better choice for you. ➤ Take your medication with food to help it work better and reduce side effects. |
Usage and Indications
Let’s explore the different forms of Metoprolol and how they can benefit you.
Metoprolol Tartrate
Metoprolol Tartrate is a beta-blocker medicine. It helps treat heart problems. Here are some it is used for:
High Blood Pressure
Metoprolol Tartrate blocks signals in your body that speed up your heart. It slows your heartbeat and reduces the work your heart does. This lowers your blood pressure and keeps your heart healthy over time.
You might take Metoprolol Tartrate twice a day. It works quickly. Unlike other metoprolol types that last longer and are taken once daily, this one needs multiple doses. Your doctor chooses it because it fits your health needs well.
Angina Pectoris
Metoprolol Tartrate also treats angina pectoris, which is chest pain from the heart. It blocks specific receptors in your heart, lowering the effects of stress hormones like adrenaline. This makes your heart beat slower and less forcefully. As a result, your heart needs less oxygen and works better when blood flow is low.
By needing less oxygen, Metoprolol Tartrate helps prevent angina episodes. This is especially helpful during exercise or when you’re stressed. It eases chest pain and stops your heart from being overworked. Your heart stays healthier, and you feel better overall.
Heart-related Issues
After a heart attack, staying stable is crucial. Doctors recommend Metoprolol Tartrate for patients who have had a heart attack. It lowers the risk of death from heart problems, whether used alone or with other treatments.
Studies with 903 patients across 13 trials showed that Metoprolol Tartrate helps people live longer. These results matched larger studies with 4,532 patients using metoprolol succinate. This means the benefits come from metoprolol itself, no matter the form.
However, for heart failure, Metoprolol Tartrate has some limits. In the COMET trial, patients took about 85 mg daily. It was less effective and had more side effects than carvedilol (another beta blocker). Around 75% of patients reached their target doses for both drugs, but carvedilol showed better survival rates and fewer side effects.
Using higher doses of Metoprolol Tartrate could lead to more side effects and make it harder to tolerate. Because of this, carvedilol is often chosen for managing heart failure.
Metoprolol Succinate
On the other hand, Metoprolol Succinate extended-release tablets offer a wider range of benefits.
High Blood Pressure
Just like Metoprolol Tartrate, Metoprolol Succinate helps lower high blood pressure. This is crucial for effectively managing heart risks. Studies show that a 100 mg dose keeps your blood pressure steady all day without big swings.
When you combine it with diuretics, it lowers your blood pressure even more. This combination is ideal for patients who need multiple medications. Keeping your blood pressure well-controlled reduces the risk of heart attacks, strokes, and other heart problems.
Angina Pectoris
Metoprolol Succinate also treats angina pectoris. It cuts down on chest pain attacks and helps you exercise better. This means you can stay active and enjoy life without frequent heart-related interruptions.
One study focused on Chinese patients with stable angina who were already taking low-dose beta-blockers but struggled with heart rate control. They tested two doses of Metoprolol Succinate: 95 mg and 190 mg. After eight weeks, the 190 mg dose performed better. It lowered the 24-hour average heart rate by 2.99 beats per minute compared to 0.62 bpm for the 95 mg dose.
Additionally, 40% of patients on the 190 mg dose reached a resting heart rate of 60 bpm or lower, compared to just 24.1% on the 95 mg dose. Lowering your heart rate like this can lead to better outcomes in managing angina.
Heart Failure
What sets Metoprolol Succinate apart is its approval for managing heart failure. It not only lowers the risk of death from heart issues but also reduces the chances of being hospitalized due to heart failure.
The MERIT-HF trial studied 3,991 patients with chronic heart failure. They took either Metoprolol Succinate or a placebo along with their regular treatment. After one year, those taking Metoprolol Succinate had a 34% lower risk of death. Hospitalizations for worsening heart failure dropped by 19%. Patients felt better and had fewer symptoms.
Importantly, the medication was safe and didn’t cause serious side effects. This shows that Metoprolol Succinate is both effective and well tolerated for most people.
Dosing and Administration
Metoprolol Tartrate and Metoprolol Succinate are two formulations with distinct dosing and administration guidelines specific to their indications.
Metoprolol Tartrate
Metoprolol Tartrate is carefully dosed to treat different heart conditions.
High Blood Pressure
For high blood pressure, adults usually start with 50 mg twice daily, for a total of 100 mg per day. Doctors may adjust your dose every week or so until your blood pressure is well controlled.
The total daily dose can range from 100 mg to 450 mg. Since Metoprolol Tartrate is usually taken twice a day, it’s best to take it with food or after a meal.
Remember, doses above 400 mg haven’t been studied, so stick to the recommended amounts. To ensure your blood pressure stays down, it’s important to check it towards the end of the dosing period.
Angina Pectoris
When treating angina pectoris, the starting dose is also 100 mg daily, but split into two 50 mg doses. Your doctor will slowly increase the dose each week until your chest pain decreases and you can exercise more comfortably. The effective dose for angina ranges from 100 mg to 400 mg per day.
If you need to stop taking Metoprolol Tartrate, your doctor will reduce your dose gradually over one to two weeks to prevent your angina from getting worse.
After a Heart Attack
After a heart attack, metoprolol tartrate is typically given every 6 to 12 hours in varying doses. Over time, a maintenance dose is given and increased up to 200 mg daily as tolerated.
It’s recommended to continue this treatment for at least three months, and possibly up to one to three years.
| Condition | Starting dose | Dosage range | Important notes |
| Hypertension | 100 mg daily | 100 mg to 450 mg/day | Take once daily with food or after a meal. Adjust weekly until blood pressure is controlled. |
| Angina pectoris | 100 mg daily (split doses) | 100 mg to 400 mg/day | Start with two doses a day. Increase weekly until chest pain decreases and exercise improves. |
| Myocardial infarction | 50 mg every 6 hours after IV dose | Start with 50 mg every 6 hours, reduce to 25 mg if needed | Continue for at least 3 months, possibly up to 1-3 years. Gradually reduce dose if stopping. |
Metoprolol Succinate
Metoprolol Succinate capsules have their own dosing guidelines.
High Blood Pressure
For high blood pressure, adults typically start with 25 mg to 100 mg once a day. Just like with Metoprolol Tartrate, the dose is adjusted weekly until your blood pressure is under control. The maximum daily dose studied is 400 mg.
For children six years and older, the starting dose is 1 mg per kilogram of body weight each day, but it should not exceed 50 mg once daily.
Doses above 2 mg per kilogram or 200 mg once daily haven’t been studied, and this medication isn’t approved for children under six.
Angina Pectoris
When treating angina pectoris with Metoprolol Succinate ER, the initial dose is 100 mg once daily. Your doctor will gradually increase the dose each week until your symptoms improve or your heart rate slows down enough.
The effective range is 100 mg to 400 mg per day. If you need to stop taking this medication, the dose should be reduced slowly over one to two weeks to avoid any negative effects.
Heart Failure
For heart failure, Metoprolol Succinate ER requires a more personalized approach. Patients with NYHA Class II heart failure should start with 25 mg once daily for two weeks. Those with more severe heart failure begin with 12.5 mg once daily. The dose is then doubled every two weeks up to the highest level you can tolerate, or up to 200 mg per day. It’s crucial to monitor your condition closely during this period and stabilize other heart failure treatments first.
If you experience symptoms like slow heart rate or worsening heart failure, your doctor might adjust your diuretics, lower your dose, or temporarily stop the medication. Only increase the dose once your symptoms have stabilized.
| Condition | Starting dose | Dosage range | Important notes |
| Hypertension | 25 mg to 100 mg once daily | Up to 400 mg/day | Adjust weekly until blood pressure is controlled. For children ≥6 years: 1 mg/kg/day, max 50 mg. |
| Angina pectoris | 100 mg once daily | 100 mg to 400 mg/day | Start with a single dose. Increase weekly until symptoms improve or heart rate slows. |
| Heart failure | 25 mg once daily (NYHA Class II) or 12.5 mg once daily (more severe) | Up to 200 mg/day | Double the dose every two weeks based on tolerance. Monitor closely and stabilize other treatments first. |
| ⚠️ Important Considerations Both Metoprolol Tartrate and Metoprolol Succinate ER have specific instructions for taking the tablets. Metoprolol Tartrate should be taken once daily with food or after a meal. Metoprolol Succinate ER tablets can be split if needed, but never crush or chew them to keep the extended-release effect intact. |
Side Effects
Let’s look at what you might experience with each medication.
Metoprolol Tartrate
Taking Metoprolol Tartrate can cause some side effects. Here are the most common ones:
- Tiredness and dizziness: About 10% of people feel unusually tired or dizzy.
- Depression: Around 5 out of 100 patients may experience feelings of depression.
- Shortness of breath and slow heart rate: Approximately 3% might have difficulty breathing or a slower heart rate.
- Cold extremities and rash: About 1% could experience cold hands or feet, itching, or a rash.
- Digestive issues: Diarrhea occurs in about 5% of patients, while nausea and stomach pain are less common.
- Other reactions: Some may have headaches, trouble sleeping, or skin sensitivity.
In more serious cases, especially after a heart attack, some patients might experience:
- Low blood pressure: About 27.4% of patients saw their systolic blood pressure drop below 90 mm Hg.
- Severe slow heart rate: Around 15.9% had a heart rate below 40 beats per minute.
- Heart block: About 4.7% experienced second- or third-degree heart block.
- Heart failure: Interestingly, 27.5% of patients had heart failure, similar to the placebo group.
After using Metoprolol Tartrate for a while, some rare but serious side effects might occur, such as:
- Severe depression: This can progress to a state called catatonia.
- Confusion and memory loss: Patients might feel disoriented or have trouble remembering things.
- Blood issues: Conditions like agranulocytosis (a drop in white blood cells) can happen.
- Allergic reactions: Severe reactions might include difficulty breathing or swelling of the throat.
Metoprolol Succinate
Metoprolol Succinate Extended-Release (ER) has similar side effects to Metoprolol Tartrate, with a few additional ones:
- Tiredness and dizziness: Like the tartrate form, about 10% feel very tired or dizzy.
- Depression: Around 5 out of 100 might feel depressed.
- Breathing problems and slow heart rate: About 3% could experience shortness of breath or a slower heart rate.
- Cold hands and rash: Approximately 1% may have cold extremities, itching, or a rash.
- Digestive issues: Diarrhea affects about 5%, while nausea and stomach pain are less common.
- Additional side effects: Some might feel anxious, see things that aren’t there (hallucinations), or experience muscle pain.
More serious side effects for Metoprolol Succinate ER include:
- Severe mental effects: These can include confusion, memory loss, and emotional instability.
- Blood problems: Conditions like agranulocytosis and severe allergic reactions can occur.
- Heart issues: Similar to the tartrate form, some may experience heart block or worsening heart failure.
Special Considerations
Each formulation requires careful attention when prescribed to different patient groups to ensure safety and effectiveness.
Pregnancy
During pregnancy, metoprolol hasn’t been linked to bad outcomes for babies. For example, every pregnancy has a 3-5% chance of a birth defect. Metoprolol doesn’t seem to increase this risk.
However, managing high blood pressure and heart problems while you’re pregnant is really important. If these issues aren’t treated, they can harm both you and your baby. Metoprolol has been linked to smaller growth in babies, but it’s not clear if this is because of the medication or other factors. It’s important to work with your healthcare provider to keep both you and your baby healthy.
In the later stages of pregnancy, taking metoprolol might cause your baby to have a slower heart rate or low blood sugar. If you notice signs like your baby being too sleepy or having trouble feeding, you should contact your doctor right away.
When you’re breastfeeding, metoprolol passes into your breast milk in small amounts. So far, studies haven’t found any side effects in babies who are breastfed while their mothers take metoprolol. Still, if you see any unusual symptoms in your baby, talk to your healthcare provider to ensure everything is okay.
Men and Women of Reproductive Age
Both men and women of reproductive age should be aware that metoprolol might cause erectile dysfunction or affect sperm movement. While studies in animals did not show impaired fertility, these potential side effects are something to discuss with a healthcare provider.
Children
Metoprolol is a medicine that helps manage high blood pressure and heart problems in children.
Studies show it works well and is safe when used correctly. For example, a 2007 study found that kids aged 6 to 16 who took metoprolol saw their blood pressure drop by an average of 7.7 mmHg. Another study in 2017 looked at 13 children with severe high blood pressure. They received metoprolol through an IV, and their blood pressure decreased by up to 27.1% in one day. Importantly, none of the children had serious side effects from the treatment.
There are some special things to remember when giving children metoprolol. First, the dose needs to match the child’s weight or age. In the 2007 study, doses ranged from 0.2 mg/kg to 2.0 mg/kg to ensure it was both effective and safe. Second, it’s essential to watch the child’s heart rate and blood pressure while taking metoprolol. In the 2017 study, doctors carefully monitored the kids to ensure their heart rates stayed normal even as their blood pressure dropped.
Another study from 2021 involved 78 children who took metoprolol before heart scans. At an average age of 13, these kids took about 1.5 mg/kg orally or 0.4 mg/kg intravenously. The medicine slowed their heart rates by about 19 beats per minute, making the heart scans clearer and safer by reducing radiation exposure.
No complications or side effects were reported, showing that metoprolol can be safely used in these situations.
Elderly
Metoprolol is a medicine that helps manage high blood pressure and heart problems in older adults. It works well and is generally safe when used correctly.
For example, a 1992 study examined 21,692 patients aged 50 to 75 who took metoprolol. After 4 weeks, their blood pressure dropped from an average of 162/95 mm Hg to 148/87 mm Hg. After 8 weeks, it dropped even more to 143/84 mm Hg. Most patients, about 94%, felt good or excellent while taking the medicine, and only less than 5% had any medical problems.
However, there are some special things to keep in mind for older adults using metoprolol. In 2002, a study reported that an 89-year-old man developed delirium, which is a state of confusion, after taking metoprolol. Out of 24 older patients in the study, most were over 60 years old, and some experienced symptoms like confusion, agitation, and hallucinations. While these side effects are rare, they are essential to watch for.
Another case from 2010 showed that an 81-year-old man had sleep problems, nightmares, depression, and anxiety after taking a low dose of metoprolol. These issues went away after stopping the medicine. This tells us that while metoprolol is effective, it’s crucial to monitor elderly patients closely for any unusual symptoms.
Patients with Liver Problems
Metoprolol is primarily metabolized by the liver. This means that if your liver isn’t working well, it can affect how metoprolol works in your body. For example, a 1981 study looked at 10 people with liver cirrhosis and found that their bodies cleared metoprolol a bit slower than healthy individuals.
Specifically, the elimination half-life of metoprolol increased from about 4.2 hours in healthy people to 7.2 hours in those with liver issues. This slower clearance means the drug stays in the body longer, which can increase its effects and the chance of side effects.
Another important point comes from a 2023 case report where a patient developed acute liver injury after taking metoprolol along with another medication called dacomitinib. This happened because dacomitinib can block an enzyme in the liver called CYP2D6, which is responsible for breaking down metoprolol. When this enzyme is blocked, metoprolol levels in the blood can rise, leading to potential side effects.
Because of these findings, doctors are careful when prescribing metoprolol to patients with liver problems. They might start with a lower dose and monitor liver function regularly to ensure the medication is safe and effective.
If you have liver disease or are taking other medications that affect liver enzymes, make sure to discuss this with your healthcare provider. They can adjust your metoprolol dose and closely monitor your liver health to help prevent any complications.
| ⚠️ Important Consideration Metoprolol tartrate and metoprolol succinate ER aren’t interchangeable because your body absorbs them differently. If you need to switch from one to the other, you must get a new prescription from your healthcare provider. Both forms have the same active ingredient, but they release it in different ways, come in various dosages, and are approved for different uses. Always talk to your healthcare team before making any changes to your medication. |
Wrap Up
Metoprolol Tartrate releases quickly and needs to be taken twice daily. On the other hand, Metoprolol Succinate releases slowly and is dosed only once a day. This means their dosages and uses are different, and you shouldn’t switch between them without talking to your doctor.
Both medicines lower high blood pressure and reduce chest pain. If you have heart failure, Metoprolol Succinate might work better for you.
Always take your medicine with food and follow your doctor’s instructions to keep your heart healthy.
Frequently Asked Questions
Can I take metoprolol for chest pain?
Yes, both forms are used to relieve chest pain (angina) caused by heart disease.
Does metoprolol treat heart failure?
Metoprolol succinate (extended-release) may benefit people with certain types of heart failure.
Can I use metoprolol for arrhythmias?
Yes, metoprolol tartrate is sometimes used to manage arrhythmias. There’s also an injectable form for emergencies.
Is metoprolol safe for people with breathing issues?
Metoprolol is a selective beta-blocker, so it’s less likely to affect breathing compared to nonselective beta-blockers.
Can metoprolol make me tired?
Yes, metoprolol may cause fatigue or drowsiness. Let your doctor know if it affects you too much.
Source
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