Metoprolol Tartrate

Metoprolol Tartrate is a beta-blocker (cardioselective, beta-1) medicine available in Bangladesh under many brand names. Below are its uses, side effects and precautions — and every brand with its current price.

• High blood pressure (hypertension) — alone or with other medicines
• Angina pectoris — to reduce the frequency of chest pain attacks
• Heart rhythm disorders — controlling fast heart rates such as atrial fibrillation or SVT
• After a heart attack — to protect the heart and reduce the risk of another attack
• Stable chronic heart failure — under specialist guidance
• Other uses — migraine prevention, symptoms of overactive thyroid, tremor (as advised)

Most side effects are mild and settle as the body adjusts:

• Tiredness, fatigue, dizziness — common in the first weeks
• Slow pulse (bradycardia)
• Cold hands and feet
• Vivid dreams or sleep disturbance
• Stomach upset, nausea
• Reduced exercise capacity; occasionally low mood or erectile difficulty

Contact your doctor promptly if you develop:

• Pulse persistently below the set limit, fainting or severe dizziness
• New or worsening breathlessness, wheeze, or swelling of ankles (possible heart failure worsening or airway narrowing)
• Very low blood sugar warning signs being masked (in diabetics, sweating may remain the main clue)

• Learn to check your pulse and record it as your doctor advises.
• Tell your doctor if you have asthma or COPD — beta-blockers can narrow airways; cardioselective ones like metoprolol are used cautiously if essential.
• Diabetics: metoprolol can mask the racing-heart warning of low blood sugar — monitor glucose more closely.
• Tell your doctor about heart failure, slow heart rhythms, thyroid disease, liver disease or poor leg circulation.
• Inform any surgeon or anaesthetist that you take a beta-blocker before an operation — it is usually continued, not stopped.
• Rise slowly to avoid dizziness; limit alcohol.
• Do not exercise to exhaustion just because your heart "feels calm" — the medicine limits your maximum heart rate.

• Verapamil and diltiazem: dangerous slowing of the heart — this combination needs specialist supervision
• Digoxin, amiodarone, ivabradine: additive slowing of heart rate
• Other blood pressure medicines: additive pressure drop
• Insulin and diabetes tablets: low-sugar warning signs may be masked
• NSAID painkillers: can blunt the blood-pressure effect
• CYP2D6 inhibitors (fluoxetine, paroxetine, propafenone): raise metoprolol levels
• Clonidine: special care when stopping either drug
• Salbutamol inhalers: effects may oppose each other; tell your doctor if you use both

Tell your doctor about all medicines, supplements and herbal products you use.

• Allergy to metoprolol or other beta-blockers
• Very slow heart rate (severe bradycardia), second- or third-degree heart block without a pacemaker, sick sinus syndrome
• Cardiogenic shock or severe decompensated heart failure
• Severe low blood pressure
• Severe asthma with previous beta-blocker reaction
• Untreated phaeochromocytoma (adrenal tumour)
• Severe peripheral arterial disease with rest pain

Pregnancy: Metoprolol is used in pregnancy only when the doctor judges the benefit outweighs the risk — for example, for significant hypertension or rhythm problems. Babies exposed near delivery are monitored for slow heart rate, low blood sugar and small size. Never start or stop it in pregnancy without medical advice.

Lactation: Only small amounts pass into breast milk, and metoprolol is generally considered compatible with breastfeeding. Watch the baby for unusual sleepiness, poor feeding or slow pulse and inform the paediatrician if these occur.

Store below 30°C in a cool, dry place away from direct sunlight and moisture. Keep in the original pack until use, and keep out of the reach of children. Do not use after the expiry date.