What is Metostad?
Metostad is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. A lower blood pressure can reduce the risk of strokes and heart attacks.
Metostad is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, Metostad is used to treat patients with heart failure.
Metostad is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.
Metostad is available only with your doctor's prescription.
Metostad indications
Hypertension
Metostad tablets, USP are indicated for the treatment of hypertension. They may be used alone or in combination with other antihypertensive agents.
Angina Pectoris
Metostad tablets, USP are indicated in the long-term treatment of angina pectoris.
Myocardial Infarction
Metostad tablets, USP are indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality when used alone or in conjunction with intravenous Metostad.
Oral Metostad tablets, USP therapy can be initiated after intravenous Metostad therapy or, alternatively, oral treatment can begin within 3 to 10 days of the acute event.
How should I use Metostad?
Use Metostad as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Metostad is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Metostad at home, a health care provider will teach you how to use it. Be sure you understand how to use Metostad. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
- Do not use Metostad if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
- Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
- If you miss a dose of Metostad, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
Ask your health care provider any questions you may have about how to use Metostad.
Uses of Metostad in details
Use: Labeled Indications
Angina: Long-term treatment of angina pectoris.
Heart failure with reduced ejection fraction (ER oral formulation): Treatment of stable, symptomatic (NYHA class II or III) heart failure of ischemic, hypertensive, or cardiomyopathic origin to reduce the rate of mortality plus hospitalization in patients already receiving angiotensin-converting enzyme inhibitors, diuretics, and/or digoxin.
Hypertension: Management of hypertension. Note: Beta-blockers are not recommended as first-line therapy (ACC/AHA [Whelton 2017]).
Myocardial infarction: Treatment of hemodynamically stable acute myocardial infarction to reduce cardiovascular mortality (injection to be used in combination with Metostad oral maintenance therapy).
Off Label Uses
Atrial fibrillation/flutter
Based on the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for the management of patients with atrial fibrillation (AF), the use of beta-blockers, including Metostad, for ventricular rate control in patients with paroxysmal, persistent, or permanent AF is effective and recommended.
Atrial fibrillation prevention after cardiac surgery
Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for coronary artery bypass graft surgery, beta-blockers are recommended to help prevent postoperative atrial fibrillation.
Hypertrophic cardiomyopathy
Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for the diagnosis and treatment of hypertrophic cardiomyopathy, a beta blocker (eg, Metostad) is an effective and recommended agent for the treatment of symptoms (eg, angina, dyspnea) in patients with obstructive or nonobstructive hypertrophic cardiomyopathy.
Marfan syndrome with aortic aneurysm
Based on the American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery (ACCF/AHA/AATS) guideline for the diagnosis and management of patients with thoracic aortic disease, a beta blocker (eg, Metostad) is an effective and recommended agent to reduce the rate of aortic dilatation in patients with Marfan syndrome and aortic aneurysm, unless a contraindication exists.
Migraine prophylaxis
Data from small, randomized, active-controlled trials support the use of Metostad for prevention of migraines.
Based on evidence-based guidelines for pharmacologic treatment for episodic migraine prevention in adults from the American Academy of Neurology and the American Headache Society, Metostad is effective for migraine prevention in adults.
Supraventricular tachycardia (eg, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia)
Based on the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) guidelines for the management of adult patients with supraventricular tachycardia, the use of an oral or intravenous beta-blocker, including Metostad, is effective and recommended for a variety of symptomatic supraventricular tachycardias (atrioventricular nodal reentrant tachycardia [AVNRT], atrioventricular reentrant tachycardia [AVRT], focal atrial tachycardia [AT], and multifocal atrial tachycardia [MAT]). In patients without pre-excitation, intravenous Metostad is recommended for acute treatment in hemodynamically stable patients and oral Metostad is recommended for ongoing management of symptomatic supraventricular tachycardias in patients who are not candidates for, or prefer not to undergo, catheter ablation.
Intravenous or oral Metostad may be useful for rate control in the acute treatment or ongoing management of hemodynamically stable patients with atrial flutter.
Thyrotoxicosis
Based on the American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis, beta-blockers, including Metostad, are effective and recommended in the treatment of symptomatic thyrotoxicosis. Beta-blockers should also be considered in asymptomatic patients who are at increased risk of complications due to worsening hyperthyroidism.
Ventricular arrhythmias
Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for management of patients with ventricular arrhythmias and prevention of sudden cardiac death, beta-blockers are effective for control of ventricular arrhythmias and ventricular premature beats.
Metostad description
Metostad is a cardioselective β1-adrenergic blocking agent used for acute myocardial infarction (MI), heart failure, angina pectoris and mild to moderate hypertension. It may also be used for supraventricular and tachyarrhythmias and prophylaxis for migraine headaches. Metostad is structurally similar to bisoprolol, acebutolol and atenolol in that it has two substituents in the para position of the benzene ring. The β1-selectivity of these agents is thought to be due in part to the large substituents in the para position. At low doses, Metostad selectively blocks cardiac β1-adrenergic receptors with little activity against β2-adrenergic receptors of the lungs and vascular smooth muscle. Receptor selectivity decreases with higher doses. Unlike propranolol and pindolol, Metostad does not exhibit membrane-stabilizing or intrinsic sympathomimetic activity. Membrane-stabilizing effects are only observed at doses much higher than those needed for β-adrenergic blocking activity. Metostad possesses a single chiral centre and is administered as a racemic mixture.
Metostad dosage
Metostad Dosage
Generic name: Metostad SUCCINATE 25mg
Dosage form: tablet, extended release
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Metostad is an extended-release tablet intended for once daily administration. For treatment of hypertension and angina, when switching from immediate-release Metostad to Metostad, use the same total daily dose of Metostad. Individualize the dosage of Metostad. Titration may be needed in some patients.
Metostad tablets are scored and can be divided; however, do not crush or chew the whole or half tablet.
Hypertension
Adults: The usual initial dosage is 25 to 100 mg daily in a single dose. The dosage may be increased at weekly (or longer) intervals until optimum blood pressure reduction is achieved. In general, the maximum effect of any given dosage level will be apparent after 1 week of therapy. Dosages above 400 mg per day have not been studied.
Pediatric Hypertensive Patients ≥ 6 Years of age: A pediatric clinical hypertension study in patients 6 to 16 years of age did not meet its primary endpoint (dose response for reduction in SBP); however, some other endpoints demonstrated effectiveness. If selected for treatment, the recommended starting dose of Metostad is 1 mg/kg once daily, but the maximum initial dose should not exceed 50 mg once daily. Dosage should be adjusted according to blood pressure response. Doses above 2 mg/kg (or in excess of 200 mg) once daily have not been studied in pediatric patients.
Metostad is not recommended in pediatric patients < 6 years of age.
Angina Pectoris
Individualize the dosage of Metostad. The usual initial dosage is 100 mg daily, given in a single dose. Gradually increase the dosage at weekly intervals until optimum clinical response has been obtained or there is a pronounced slowing of the heart rate. Dosages above 400 mg per day have not been studied. If treatment is to be discontinued, reduce the dosage gradually over a period of 1 - 2 weeks.
Heart Failure
Dosage must be individualized and closely monitored during up-titration. Prior to initiation of Metostad, stabilize the dose of other heart failure drug therapy. The recommended starting dose of Metostad is 25 mg once daily for two weeks in patients with NYHA Class II heart failure and 12.5 mg once daily in patients with more severe heart failure. Double the dose every two weeks to the highest dosage level tolerated by the patient or up to 200 mg of Metostad. Initial difficulty with titration should not preclude later attempts to introduce Metostad. If patients experience symptomatic bradycardia, reduce the dose of Metostad. If transient worsening of heart failure occurs, consider treating with increased doses of diuretics, lowering the dose of Metostad or temporarily discontinuing it. The dose of Metostad should not be increased until symptoms of worsening heart failure have been stabilized.
More about Metostad (Metostad)
- Side Effects
- During Pregnancy or Breastfeeding
- Dosage Information
- Drug Images
- Drug Interactions
- Support Group
- Pricing & Coupons
- En Espanol
- 41 Reviews - Add your own review/rating
- Generic Availability
Consumer resources
- Toprol
- Metostad extended-release tablets
- Metostad
- Metostad (Advanced Reading)
- Other brands: Metostad, Metostad Succinate ER, Lopressor
Professional resources
- Metostad (FDA)
- Metostad Succinate (AHFS Monograph)
Related treatment guides
- Heart Failure
- Angina
- Angina Pectoris Prophylaxis
- High Blood Pressure
- Left Ventricular Dysfunction
- More (2) »
Metostad interactions
See also:
What other drugs will affect Metostad?
Catecholamine Depleting Drugs
Catecholamine depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) may have an additive effect when given with beta-blocking agents. Observe patients treated with Metostad plus a catecholamine depletor for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension.
CYP2D6 Inhibitors
Drugs that inhibit CYP2D6 such as quinidine, fluoxetine, paroxetine, and propafenone are likely to increase Metostad concentration. In healthy subjects with CYP2D6 extensive metabolizer phenotype, coadministration of quinidine 100 mg and immediate-release Metostad 200 mg tripled the concentration of S-Metostad and doubled the Metostad elimination half-life. In four patients with cardiovascular disease, coadministration of propafenone 150 mg t.i.d. with immediate-release Metostad 50 mg t.i.d. resulted in two- to five-fold increases in the steady-state concentration of Metostad. These increases in plasma concentration would decrease the cardioselectivity of Metostad.
Digitalis, Clonidine, And Calcium Channel Blockers
Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate. Concomitant use with beta blockers can increase the risk of bradycardia.
If clonidine and a beta blocker, such as Metostad are coadministered, withdraw the beta-blocker several days before the gradual withdrawal of clonidine because beta-blockers may exacerbate the rebound hypertension that can follow the withdrawal of clonidine. If replacing clonidine by betablocker therapy, delay the introduction of beta-blockers for several days after clonidine administration has stopped.
Metostad side effects
See also:
What are the possible side effects of Metostad?
The following adverse reactions are described elsewhere in labeling:
- •
- Worsening angina or myocardial infarction.
- •
- Worsening heart failure.
- •
- Worsening AV block.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.
Hypertension and Angina: Most adverse reactions have been mild and transient. The most common (>2%) adverse reactions are tiredness, dizziness, depression, diarrhea, shortness of breath, bradycardia, and rash.
Heart Failure: In the MERIT-HF study comparing Metostad succinate in daily doses up to 200 mg (mean dose 159 mg once-daily; n=1990) to placebo (n=2001), 10.3% of Metostad succinate patients discontinued for adverse events vs. 12.2% of placebo patients.
The table below lists adverse reactions in the MERIT-HF study that occurred at an incidence of ≥ 1% in the Metostad succinate group and greater than placebo by more than 0.5%, regardless of the assessment of causality.
Adverse Reactions Occurring in the MERIT-HF Study at an Incidence ≥ 1% in the Metostad Succinate Group and Greater Than Placebo by More Than 0.5%
| Metostad Succinate n = 1990 % of patients | Placebo n = 2001 % of patients | |
| 1.8 | 1 |
| 1.5 | 0.4 |
Post-operative Adverse Events: In a randomized, double-blind, placebo-controlled trial of 8351 patients with or at risk for atherosclerotic disease undergoing non-vascular surgery and who were not taking beta–blocker therapy, Metostad succinate 100 mg was started 2 to 4 hours prior to surgery then continued for 30 days at 200 mg per day. Metostad succinate use was associated with a higher incidence of bradycardia (6.6% vs. 2.4%; HR, 2.74; 95% CI 2.19, 3.43), hypotension (15% vs. 9.7%; HR 1.55; 95% CI 1.37, 1.74), stroke (1% vs. 0.5%; HR 2.17; 95% CI 1.26, 3.74) and death (3.1% vs. 2.3%; HR 1.33; 95% CI 1.03, 1.74) compared to placebo.
Post-Marketing Experience
The following adverse reactions have been identified during post-approval use of extended-release Metostad or immediate-release Metostad. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Cardiovascular: Cold extremities, arterial insufficiency (usually of the Raynaud type), palpitations, peripheral edema, syncope, chest pain and hypotension.
Respiratory: Wheezing (bronchospasm), dyspnea.
Central Nervous System: Confusion, short-term memory loss, headache, somnolence, nightmares, insomnia, anxiety/nervousness, hallucinations, paresthesia.
Gastrointestinal: Nausea, dry mouth, constipation, flatulence, heartburn, hepatitis, vomiting.
Hypersensitive Reactions: Pruritus.
Miscellaneous: Musculoskeletal pain, arthralgia, blurred vision, decreased libido, male impotence, tinnitus, reversible alopecia, agranulocytosis, dry eyes, worsening of psoriasis, Peyronie’s disease, sweating, photosensitivity, taste disturbance.
Potential Adverse Reactions: In addition, there are adverse reactions not listed above that have been reported with other beta-adrenergic blocking agents and should be considered potential adverse reactions to Metostad succinate.
Central Nervous System: Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, clouded sensorium, and decreased performance on neuropsychometrics.
Hematologic: Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura.
Hypersensitive Reactions: Laryngospasm, respiratory distress.
Metostad contraindications
See also:
What is the most important information I should know about Metostad?
You should not use this medication if you are allergic to Metostad, or if you have a serious heart problem such as heart block, sick sinus syndrome, or slow heart rate.
Before taking Metostad, tell your doctor if you have congestive heart failure, low blood pressure, circulation problems, pheochromocytoma, asthma or other breathing problems, diabetes, depression, liver or kidney disease, a thyroid disorder, or severe allergies.
Metostad may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can increase certain side effects of Metostad.
Do not stop taking Metostad without first talking to your doctor. Stopping suddenly may make your condition worse.
If you need surgery, tell the surgeon ahead of time that you are using Metostad.
Metostad is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Active ingredient matches for Metostad:
Metoprolol in Bulgaria, Philippines.
Metoprolol tartrate in Philippines.
| Unit description / dosage (Manufacturer) | Price, USD |
| Metostad 50 mg x 50's | $ 3.89 |
| Metostad 100 mg x 100's | $ 15.56 |
List of Metostad substitutes (brand and generic names): | |
| Metospec (Philippines) | |
| Metospec 100 mg x 100's (Pharmaspec) | $ 12.22 |
| Metostad CR (Bulgaria) | |
| Metostadol (Austria) | |
| Metosuccinat (Romania) | |
| MetoSuccinat Sandoz (Romania) | |
| Metotifi (Estonia, Lithuania) | |
| Metotrust | |
| Metotrust 25mg Tablet XL (Centaur Pharmaceuticals Pvt Ltd) | $ 0.05 |
| Metotrust 50mg Tablet XL (Centaur Pharmaceuticals Pvt Ltd) | $ 0.06 |
| METOTRUST XL | |
| METOTRUST XL 25MG TABLET 1 strip / 10 tablet xls each (Centaur Pharmaceuticals Pvt Ltd) | $ 0.45 |
| METOTRUST XL 50MG TABLET 1 strip / 10 tablet xls each (Centaur Pharmaceuticals Pvt Ltd) | $ 0.64 |
| METOTRUST-XL (India) | |
| 25 mg x 10's (Centaur (Sankalp)) | $ 0.47 |
| 50 mg x 10's (Centaur (Sankalp)) | $ 0.66 |
| Metotrust-XL 25mg ER-TAB / 10 (Centaur (Sankalp)) | $ 0.47 |
| Metotrust-XL 50mg ER-TAB / 10 (Centaur (Sankalp)) | $ 0.66 |
| METOTRUST-XL modified-release tab 25 mg x 10's (Centaur (Sankalp)) | $ 0.47 |
| METOTRUST-XL modified-release tab 50 mg x 10's (Centaur (Sankalp)) | $ 0.66 |
| Metotrust-XL 25mg ER-TAB / 10 (Centaur (Sankalp)) | $ 0.47 |
| Metotrust-XL 50mg ER-TAB / 10 (Centaur (Sankalp)) | $ 0.66 |
| Metotyrol (Austria) | |
| METOX (WOC) | |
| METOX 50 MG TABLET ER 1 strip / 14 tablet ers each (Wockhardt Ltd) | $ 1.19 |
| Metox-AM (India) | |
| Metox-AM Metoprolol 25 mg, Amlodipine 5mg. TAB / 14 (Wockhardt (Cardio)) | |
| Metox-AM Metoprolol 50 mg, Amlodipine 5mg. TAB / 14 (Wockhardt (Cardio)) | |
| METOX-AM tab 14's (Wockhardt (Cardio)) | $ 1.02 |
| Metox-ER (India) | |
| Metox-ER 25mg TAB / 14 (Wockhardt (Cardio)) | |
| Metox-ER 50mg TAB / 14 (Wockhardt (Cardio)) | |
| Metox-ER 100mg TAB / 14 (Wockhardt (Cardio)) | |
| METOX-ER tab 25 mg x 14's (Wockhardt (Cardio)) | |
| METOX-ER tab 50 mg x 14's (Wockhardt (Cardio)) | |
| METOX-ER tab 100 mg x 14's (Wockhardt (Cardio)) | |
| METOZAAR | |
| METOZAAR 12.5 MG TABLET XL 1 strip / 10 tablet xls each (Corona Remedies Pvt Ltd) | $ 0.22 |
| METOZAAR 25 MG TABLET XL 1 strip / 15 tablet xls each (Corona Remedies Pvt Ltd) | $ 0.48 |
| METOZAAR 25 MG TABLET XL 1 strip / 10 tablet xls each (Corona Remedies Pvt Ltd) | $ 0.42 |
| METOZAAR 50 MG TABLET XL 1 strip / 10 tablet xls each (Corona Remedies Pvt Ltd) | $ 0.36 |
| Metozaar 12.5mg Tablet XL (Corona Remedies Pvt Ltd) | $ 0.02 |
| Metozaar 25mg Tablet XL (Corona Remedies Pvt Ltd) | $ 0.03 |
| Metozaar 50mg Tablet XL (Corona Remedies Pvt Ltd) | $ 0.04 |
| METOZAAR-XL (India) | |
| METOZAAR-XL film-coated tab 12.5 mg x 10's (Corona (Wellness)) | $ 0.21 |
| METOZAAR-XL film-coated tab 25 mg x 15's (Corona (Wellness)) | $ 0.48 |
| METOZAAR-XL film-coated tab 50 mg x 10's (Corona (Wellness)) | $ 0.36 |
| Metozoc (Russian Federation) | |
| Metozok (Estonia) | |
| METOZOX | |
| Metozox 50mg Tablet ER (Lloyd Healthcare Pvt Ltd) | $ 0.07 |
See 2711 substitutes for Metostad | |
References
- DailyMed. "METOPROLOL FUMARATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- PubChem. "metoprolol". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "metoprolol". http://www.drugbank.ca/drugs/DB00264 (accessed September 17, 2018).
Reviews
The results of a survey conducted on ndrugs.com for Metostad are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Metostad. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.User reports
Consumer reported useful
No survey data has been collected yetConsumer reported price estimates
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Information checked by Dr. Sachin Kumar, MD Pharmacology
