Metoprolol

Beta blockers are a well established class of antihypertensive medication used across a range of cardiovascular conditions. Metoprolol tablets are a prescription-only selective beta-1 adrenoceptor blocker used in adults for several licensed indications including hypertension, angina, cardiac arrhythmias, and migraine prevention. Metoprolol targets the heart with relative selectivity, making it one of the cardioselective beta blockers used in cardiovascular therapy. A prescription can only be issued following a clinical consultation.

Metoprolol tablets are an oral prescription medicine containing metoprolol tartrate as the active ingredient. Metoprolol belongs to the beta blocker class of medicines. Specifically, metoprolol is a cardioselective (beta-1 selective) adrenoceptor blocker, meaning it preferentially blocks beta-1 adrenoceptors found predominantly in the heart, rather than beta-2 adrenoceptors in the lungs and blood vessels. This selectivity reduces but does not eliminate the risk of adverse effects on the airways, which is an important consideration in patients with respiratory conditions.

Metoprolol tartrate standard release tablets are licensed in the UK for several indications. These include the management of hypertension (high blood pressure), angina pectoris (chest pain from reduced heart blood flow), cardiac arrhythmias (abnormal heart rhythms), adjunctive treatment of hyperthyroidism, and prophylaxis of migraine. This page focuses primarily on the use of metoprolol for hypertension and heart rate control, as these are the most common clinical contexts in which this service is likely to be used. All indications are covered factually in line with the current UK SmPC.

Metoprolol is available as a generic medicine from multiple manufacturers. Two strengths are available through this service: 50 mg and 100 mg tablets.

Metoprolol lowers blood pressure and controls heart rate by acting selectively on beta-1 adrenoceptors in the heart.

Beta-1 Adrenoceptors and the Heart

Beta-1 adrenoceptors are found predominantly in the heart. When stimulated by catecholamines such as adrenaline and noradrenaline, they increase heart rate and the force of cardiac contraction. In patients with hypertension, a sustained elevation in heart rate and cardiac output contributes to raised blood pressure. In angina, a fast heart rate increases the oxygen demand of the heart muscle and can precipitate chest pain.

Metoprolol and Cardiac Selectivity

Metoprolol selectively blocks beta-1 receptors. By doing so, it reduces heart rate, reduces the force of cardiac contraction, and lowers cardiac output. The fall in cardiac output reduces blood pressure. The reduction in heart rate also decreases the oxygen demand of the heart, which helps to prevent angina episodes.

The cardioselectivity of metoprolol means it has less effect on beta-2 adrenoceptors in the airways than non-selective beta blockers. However, this selectivity is relative, not absolute. Metoprolol can still cause bronchospasm in susceptible patients, and it remains contraindicated in asthma. In patients with heart rhythm problems, metoprolol slows conduction through the atrioventricular node, helping to control arrhythmias. Its mechanism in migraine prevention is less well understood but relates to beta receptor modulation and effects on cerebrovascular tone.

Always take metoprolol exactly as your prescriber instructs. The information below summarises key points from the current UK SmPC. Read the Patient Information Leaflet supplied with your medicine before starting treatment.

• Metoprolol tablets may be taken once or twice daily depending on the indication and the dose prescribed. For hypertension, once or twice daily dosing is used. Follow your prescriber's specific instructions on timing.
• Take metoprolol with or just after a meal. Food increases the absorption of metoprolol and produces more consistent blood levels.
• Swallow the tablet whole with a glass of water. The tablets can be halved along the score line if your prescriber has instructed a half tablet dose.
• If you miss a dose, take it as soon as you remember on the same day. If it is close to the time of your next scheduled dose, skip the missed dose and continue as normal. Do not take two doses at once.
• Do not stop taking metoprolol suddenly without speaking to your prescriber first. Stopping a beta blocker abruptly can cause a rebound increase in heart rate and blood pressure. In patients with angina or coronary artery disease, sudden withdrawal can trigger chest pain or other serious cardiac events. Your prescriber will guide you on how to reduce the dose gradually if stopping is necessary.
• Your prescriber may start you on a lower dose and increase it gradually based on your blood pressure response and heart rate. Attend all follow up appointments so your treatment can be assessed and adjusted safely.

Metoprolol tartrate tablets are available in two strengths. The dose and frequency will be determined by your prescriber based on the indication being treated, your blood pressure, your heart rate, and your individual clinical response.

Metoprolol 50 mg Tablets

The 50 mg tablet is commonly used as a starting dose across several indications. For hypertension, an initial dose of 50 mg once or twice daily is typical. For angina, 50 mg twice or three times daily may be used as a starting point, with the dose adjusted based on symptom control and heart rate response. For migraine prophylaxis, 50 mg twice daily is within the usual dose range. The 50 mg strength allows careful initial dose titration before any increase to 100 mg.

Metoprolol 100 mg Tablets

The 100 mg tablet supports higher doses for patients requiring more intensive blood pressure control or heart rate management. For hypertension, the usual maintenance dose is 100 mg to 200 mg once daily. The 100 mg tablet may be taken once daily or in divided doses depending on your prescriber's instructions. For angina, higher doses up to 200 mg per day may be used under prescriber direction. All dose adjustments are clinical decisions made by your prescriber. Do not change your dose without medical advice.

Because metoprolol is available in both standard release (tartrate) and modified release (succinate) forms, it is important that patients and prescribers specify and dispense the intended formulation. This service provides the standard release tartrate formulation. The dosing schedules for the two formulations are different. If you are unsure which formulation you have been prescribed, check with your pharmacist.

Like all medicines, metoprolol can cause side effects, although not everyone experiences them. The information below is based on the current UK SmPC. Refer to the Patient Information Leaflet for the full list of side effects.

Common Side Effects (may affect up to 1 in 10 people)

• Fatigue or tiredness, particularly in the first weeks of treatment
• Slow heart rate (bradycardia). If your heart rate falls significantly, contact your prescriber.
• Dizziness or lightheadedness, particularly on standing
• Cold hands or feet. This relates to the effect of beta blockade on peripheral blood vessels.
• Headache

Uncommon Side Effects (may affect up to 1 in 100 people)

• Breathlessness or wheeze in patients with or without known respiratory conditions. Contact your prescriber if you develop breathing difficulties.
• Nausea or abdominal discomfort
• Sleep disturbances or vivid dreams
• Low blood pressure (hypotension)

Serious Side Effects: Seek Urgent Medical Attention

Go to your nearest accident and emergency department or call 999 immediately if you experience:

• Significant worsening of breathlessness or wheeze, which may indicate bronchospasm
• A very slow heart rate causing fainting, collapse, or extreme dizziness
• Signs of a severe allergic reaction such as sudden swelling of the face, lips, tongue, or throat
• Signs of worsening heart failure such as increasing breathlessness when lying flat, ankle swelling, or rapid weight gain due to fluid retention

Report any suspected side effect to your prescriber, pharmacist, or via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk.

Metoprolol Tablets May Be Suitable If You:

• Are an adult aged 18 or over with a confirmed diagnosis of hypertension, angina, cardiac arrhythmia, or another condition for which metoprolol is licensed
• Are already prescribed metoprolol tartrate standard-release tablets and require a repeat prescription through an online prescribing service

Metoprolol Tablets Are Not Suitable If You:

• Have asthma or significant obstructive airways disease. Metoprolol is contraindicated in these patients due to the risk of bronchospasm, even though it is cardioselective. Have uncontrolled heart failure or acute heart failure requiring intravenous inotropic therapy
• Have a very slow resting heart rate (bradycardia below 45 to 50 beats per minute) or certain heart rhythm problems including second or third degree heart block or sick sinus syndrome
• Have severe peripheral artery disease or Raynaud's phenomenon
• Have untreated phaeochromocytoma
• Have metabolic acidosis
• Are under 18 years of age
• Have a known allergy or hypersensitivity to metoprolol or any excipient listed in the SmPC

Patients with diabetes should be aware that metoprolol, like other beta blockers, can mask some signs of hypoglycaemia (low blood sugar), particularly the fast heart rate that typically signals a low glucose episode. Sweating is not masked and remains a useful warning sign. Inform your prescriber that you have diabetes before starting metoprolol. Your prescriber will factor this into their clinical assessment.

Tell your prescriber about all medicines you take, including over the counter products and herbal supplements. The following interactions are of particular clinical importance:

• Verapamil and diltiazem: combining metoprolol with these calcium channel blockers can cause excessive slowing of the heart rate and impaired cardiac conduction. These combinations require careful prescriber assessment and are generally avoided.
• Other antihypertensive medicines: additive blood pressure lowering effects should be considered.
• Antiarrhythmic medicines such as amiodarone or flecainide: combined use can increase the risk of excessive heart rate slowing or conduction problems.
• Clonidine: if you are taking both clonidine and metoprolol and your prescriber advises stopping clonidine, the metoprolol should be discontinued several days before the clonidine is stopped to avoid a rebound rise in blood pressure.
• CYP2D6 inhibitors such as fluoxetine, paroxetine, and bupropion: these can significantly increase metoprolol blood levels and may enhance its effects.
• NSAIDs such as ibuprofen: regular use can reduce the blood pressure lowering effect of metoprolol.

Your prescriber will review all current medicines during the clinical assessment before any prescription is considered.

Metoprolol is a Prescription Only Medicine. The clinical consultation is the essential first step. A prescription will only be issued if a registered prescriber concludes, based on their individual assessment of your circumstances, that metoprolol is clinically appropriate for you.

During your online consultation with Pharmacy Planet, a registered prescriber will review your clinical information. This includes your blood pressure history, heart rate, any cardiac diagnoses, respiratory history, current medicines, and any other relevant medical conditions. Metoprolol requires careful assessment in patients with diabetes, asthma, heart disease, arrhythmias, and peripheral vascular conditions. The prescriber will assess all available information before deciding whether metoprolol is appropriate, which strength and dose are suitable, and whether online prescribing is appropriate for your situation.

If you are under the care of your GP, a cardiologist, or another specialist for a condition metoprolol is used to treat, please keep them informed of all medicines prescribed through online services. Coordinated care supports the safest approach to BP regulation, heart rate control, and overall cardiovascular therapy.

• Store below 25°C.
• Store in the original packaging to protect from moisture and light.
• Keep out of the sight and reach of children.
• Do not use after the expiry date printed on the packaging.
• Do not dispose of medicines via household waste or wastewater. Return unused or out of date tablets to your pharmacist for safe disposal.
• Full storage instructions are provided in the Patient Information Leaflet supplied with your medicine.

The table below compares beta blocker tablets available at Pharmacy Planet. Beta blockers reduce heart rate and cardiac output to lower blood pressure. They differ in cardioselectivity, additional properties, and licensed indications.

Important: This comparison is for general information only and does not replace medical advice. A prescriber will decide which treatment is suitable for you following an online consultation.

Pharmacy Planet is a GPhC-registered online pharmacy providing access to prescription medicines through a clinically led consultation process. Our registered prescribers and pharmacists are committed to patient safety, clinical accuracy, and responsible prescribing.

We follow GPhC standards, MHRA guidance, and ASA advertising regulations in all aspects of our service. Every prescription is reviewed and dispensed by qualified healthcare professionals. We provide clear, factual information to help patients understand their antihypertensive medication and make well-informed decisions about their cardiovascular therapy and heart health.

If you have questions about metoprolol or any other medicine, our pharmacy team is available to help. We are committed to transparent, patient centred care.

References

1. Electronic Medicines Compendium (eMC). Metoprolol tartrate 50 mg and 100 mg tablets — Summary of Product Characteristics. https://www.medicines.org.uk/emc. Accessed May 2026.
2. National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. NICE guideline NG136. https://www.nice.org.uk/guidance/ng136. Accessed May 2026.
3. NHS. High blood pressure (hypertension). https://www.nhs.uk/conditions/high-blood-pressure-hypertension. Accessed May 2026.
4. Joint Formulary Committee. British National Formulary (BNF). Metoprolol tartrate. BMJ Group and Pharmaceutical Press. https://bnf.nice.org.uk. Accessed May 2026.
5. Medicines and Healthcare products Regulatory Agency (MHRA). Yellow Card — report a side effect. https://yellowcard.mhra.gov.uk. Accessed May 2026.