Metomac

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What Is Metomac?

Metomac is an oral immediate-release tablet containing metoprolol 25 mg (tartrate) from Macleods Pharmaceuticals, supplied in 30-180 tablets. Metoprolol is a cardioselective (beta-1 predominant). Introduced 1975; one of the most widely-prescribed beta-blockers worldwide. Two salt forms with different pharmacokinetics: metoprolol tartrate (IR, short half-life, BD dosing) is used for hypertension and angina; metoprolol succinate (ER, 24-h half-life, once-daily) is the only metoprolol formulation with MERIT-HF evidence in heart failure with reduced ejection fraction (HF-REF).

How Metoprolol Lowers Blood Pressure

Beta-blockers reduce blood pressure through four mechanisms:

• Reduction of cardiac output — beta-1 blockade in the sinoatrial node reduces heart rate, and blockade in ventricular myocardium reduces contractility. Lower cardiac output = lower blood pressure.
• Renin-angiotensin suppression — beta-1 blockade in juxtaglomerular cells reduces renin release, lowering angiotensin II and aldosterone over 2-4 weeks. This accounts for much of the long-term BP effect.
• Central sympathetic reduction — lipophilic beta-blockers cross the blood-brain barrier and reduce central sympathetic outflow.

Beta-blockers are moderately lipophilic. Plasma half-life of metoprolol is 3-7 hours (tartrate IR), 24 hours (succinate ER).

Approved and Evidence-Based Uses

• Hypertension (primary indication)
• Angina pectoris
• Post-MI secondary prevention
• Heart failure with reduced ejection fraction (HF-REF) — metoprolol succinate only; titrate from 12.5/25 mg to 200 mg once daily over 8-12 weeks
• Atrial fibrillation rate control
• Supraventricular tachycardia
• Migraine prophylaxis — lipophilic beta-blockers work; atenolol does not

Metomac Dosage

Adult hypertension dose: Metoprolol tartrate IR: 100-200 mg/day in two divided doses. Metoprolol succinate ER: 100-200 mg once daily.

Start low, titrate upward over 2-4 weeks to target BP (typically <140/90 in uncomplicated hypertension; <130/80 in diabetes, chronic kidney disease, or established cardiovascular disease). Check resting pulse before each dose-increase — do not titrate if <55 bpm.

Παρακολούθηση:

• Resting pulse and BP at 2, 4, and 8 weeks after starting or dose change
• Baseline ECG if any cardiac history; periodic ECG if symptoms change
• For HF-REF use: echocardiogram at 3 and 6 months; titrate toward target dose if tolerated

Administration: swallow whole with water. Take at approximately the same time each day.

Discontinuation: NEVER stop abruptly. Taper over 1-2 weeks (reduce by 25-50% every 3-5 days). Abrupt discontinuation causes rebound tachycardia, worsened angina, and — in patients with coronary disease — can precipitate myocardial infarction. This is one of the most important safety points for beta-blockers.

Παρενέργειες

Common (>5%):

• Fatigue, lethargy — often adapts over 2-4 weeks
• Cold hands and feet (peripheral vasoconstriction)
• Bradycardia (check pulse; stop if <50 bpm)
• Exercise intolerance — maximum heart rate is blunted by beta blockade
• Dizziness, postural hypotension
• Sleep disturbance, vivid dreams / nightmares (lipophilic beta-blockers cross the blood-brain barrier)
• Reduced libido, erectile dysfunction (mostly at higher doses)

Λιγότερο συχνές: depression, reduced libido / erectile dysfunction, gastrointestinal upset, Raynaud-like cold intolerance, bronchospasm (more common with non-selective agents).

Important but uncommon:

• Masked hypoglycaemia in diabetics — beta-blockers blunt the tachycardia / tremor warning signs of low blood sugar. Monitor glucose more carefully; prefer nebivolol ή bisoprolol in insulin-treated diabetes.
• Bronchospasm — can be severe in asthma / COPD. Absolute contraindication for non-selective agents; relative for cardioselective.
• Heart block or worsening heart failure — in susceptible patients. Start low, titrate slowly.

Contraindications & Cautions

• Severe asthma / severe COPD — relative contraindication (cardioselectivity is relative, not absolute)
• Second or third-degree atrioventricular block (without pacemaker)
• Sinus bradycardia <50 bpm
• Cardiogenic shock, decompensated heart failure requiring inotropes
• Severe peripheral arterial disease, Raynaud’s syndrome (relative)
• Phaeochromocytoma without prior alpha-blockade — paradoxical hypertensive crisis (never use a beta-blocker before alpha-blocker)
• Severe hepatic impairment (for extensively hepatic-metabolised agents: propranolol, metoprolol, carvedilol, labetalol)
• Severe renal impairment — dose adjustment needed for renal-excreted agents (atenolol, nadolol)
• Hypersensitivity to metoprolol

Pregnancy: Category C; cross the placenta; small risk of intrauterine growth restriction, neonatal bradycardia, and hypoglycaemia. Use only if benefit clearly outweighs risk; labetalol is the pregnancy-preferred beta-blocker.

Breastfeeding: small amounts in breast milk; generally considered compatible with monitoring.

Αλληλεπιδράσεις Φαρμάκων

• Verapamil, diltiazem (non-dihydropyridine CCBs) — additive bradycardia, heart block, and negative inotropy; generally avoid combination. Dihydropyridine CCBs (amlodipine, nifedipine) are safer to combine with beta-blockers.
• Other beta-blockers — do not combine; additive bradycardia
• Clonidine — if stopping clonidine, stop the beta-blocker first (several days before) to avoid rebound hypertensive crisis
• Insulin and sulphonylureas — mask hypoglycaemia warning signs; monitor glucose closely
• Μη στεροειδή αντιφλεγμονώδη φάρμακα (NSAIDs) — reduce the antihypertensive effect of beta-blockers; avoid chronic combination
• CYP2D6 inhibitors (fluoxetine, paroxetine, quinidine, bupropion) — raise metoprolol levels; reduce dose or monitor closely
• Αλκοόλ — additive hypotension and CNS depression (particularly for lipophilic agents)

Beta-Blocker Class at a Glance

Cardioselectivity is relative — at doses above 100 mg the beta-1 selectivity diminishes and bronchospasm risk rises. Prefer nebivolol in asthmatic or COPD patients where a beta-blocker is essential.

Αποθήκευση

Store Metomac below 25°C. Keep out of reach of children — accidental paediatric beta-blocker ingestion can cause life-threatening bradycardia and hypoglycaemia.

Συχνές Ερωτήσεις

How long does Metomac take to lower blood pressure?

You should see some BP reduction within 1-2 days of starting; the full antihypertensive effect takes 2-4 weeks (driven by the gradual renin-angiotensin suppression, not the immediate heart-rate effect). Measure BP at home at the same time each day to track response.

Can I take Metomac if I have asthma?

Metoprolol is cardioselective, so it is relatively safer in asthma than non-selective agents. However, cardioselectivity is relative — at higher doses beta-2 blockade can still occur. In severe or brittle asthma, avoid all beta-blockers if possible. In mild asthma or COPD, use with monitoring and inhaler access.

Why should I never stop Metomac abruptly?

Abrupt discontinuation causes rebound tachycardia and worsened angina within 24-48 hours, driven by up-regulation of beta receptors during chronic blockade. In patients with coronary artery disease, this can precipitate myocardial infarction or unstable angina. Always taper over 1-2 weeks when stopping.

Will Metomac affect my exercise performance?

Yes — beta blockade blunts the heart-rate response to exercise, so your maximum pulse is lower and you fatigue faster at high intensities. For recreational exercise most people adapt; for competitive endurance athletes, beta-blockers can meaningfully impair performance and are banned in precision sports (shooting, archery — where they reduce physiological tremor).

Will Metomac affect my blood sugar if I have diabetes?

Beta-blockers mask the tachycardia / tremor / palpitation warning signs of hypoglycaemia, making low blood sugar harder to detect. They can also blunt the counter-regulatory glucose response. Monitor glucose more frequently on a beta-blocker, particularly if on insulin or sulphonylureas. Nebivolol και bisoprolol have the best metabolic profile.

Can I drink alcohol on Metomac?

Moderate alcohol is generally acceptable but alcohol potentiates the hypotensive and CNS-depressant effects. Stand up slowly after drinking. Alcohol is also an independent BP-raiser; reducing intake can improve BP control independent of Metomac.

Does Metomac cause weight gain?

Older beta-blockers (propranolol, atenolol, metoprolol) are associated with modest weight gain (1-3 kg) and worsening of insulin sensitivity over time. Nebivolol and carvedilol are weight-neutral or slightly weight-favourable due to their vasodilator components. For patients with metabolic syndrome, nebivolol is the preferred beta-blocker when one is needed.

Is Metomac safe in pregnancy?

Category C. Use only if benefit clearly outweighs risk. For antihypertensive use in pregnancy, labetalol is the preferred beta-blocker; methyldopa and nifedipine are the two other pregnancy-safe options.

Can I take Metomac with other BP medications?

Yes — beta-blockers combine well with dihydropyridine calcium-channel blockers (amlodipine), Αναστολείς ACE (ramipril, lisinopril), ARBs (losartan, telmisartan, olmesartan), and thiazide diuretics (HCTZ). Avoid combination with non-dihydropyridine CCBs (verapamil, diltiazem) — additive bradycardia and heart-block risk.

Where can I buy Metomac online?

You can buy Metomac (metoprolol 25 mg (tartrate) immediate-release tablet, 30-180 tablets) from MedsBase with discreet packaging and worldwide shipping.

Related Beta-Blockers & Antihypertensives

• Ciplar — Propranolol 10 mg (Cipla)
• Embeta XR 25 — Metoprolol XR 25 mg
• Inderal — Propranolol IR 20/40 mg (AstraZeneca)
• Lobet — Labetalol 100 mg
• Nebilong — Nebivolol 2.5 mg
• P-Nolol — Propranolol 20/40 mg
• Browse all High Blood Pressure Medications

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