Metoprolol

Metoprolol is suitable for most adults and children, but always check before taking it.

Metoprolol is not suitable for some people. For example, check with your doctor if you have a liver condition.

Metoprolol comes as tablets that you'll usually take between 1 to 4 times a day. Always follow the instructions that come with your medicine.

Common side effects of metoprolol include headaches, feeling dizzy and cold hands or feet. More serious side effects can happen in rare cases.

It can cause problems to take metoprolol with some other medicines such as diabetes medicines and some antidepressants.

Most adults and children can take metoprolol. It's sometimes used for treating high blood pressure in children under 12 years old.

Metoprolol is not suitable for some people. To make sure it's safe for you, tell your doctor before taking it if you have:

• ever had an allergic reaction to metoprolol or any other medicine
• low blood pressure (hypotension) or a slow heart rate
• lung disease or severe asthma
• metabolic acidosis – when there's too much acid in your blood
• an overactive thyroid (hyperthyroidism or thyrotoxicosis) – metoprolol may make it more difficult to recognise the warning signs of having too much thyroid hormone in your body
• severe blood circulation problems in your limbs (such as Raynaud's), which may make your fingers and toes tingle or turn pale or blue, although this may be less obvious on black or brown skin
• a liver condition

Metoprolol comes as 25mg, 50mg and 100mg strength tablets.

The dose you take depends on why you need it:

• high blood pressure – 50mg to 100mg, taken twice a day
• chest pain – 50mg to 100mg, taken 2 to 3 times a day
• an irregular heartbeat – 50mg, taken 2 to 3 times a day
• preventing migraine – 50mg to 100mg, taken twice a day
• too much thyroid hormone (thyrotoxicosis) – 50mg, taken 4 times a day

If your child needs to take metoprolol, their doctor will work out the right dose by using their weight and age.

How to take it

You can take metoprolol with or without food.

Swallow the tablets whole with a drink of water.

Some tablets have a score line to help you break them in half and make it easier to swallow. Check the information leaflet for your brand to see if you can do this.

Your doctor may advise you to take your first dose before bedtime because it could make you feel dizzy.

If you do not feel dizzy after the first dose, take metoprolol in the morning.

If you have metoprolol more than once a day, try to space the doses evenly throughout the day.

These common side effects of metoprolol happen in more than 1 in 100 people. There are things you can do to help cope with them:

Make sure you rest and drink plenty of fluids. It's best not to drink too much alcohol. Take paracetamol or ask your pharmacist to recommend a painkiller.

Talk to your doctor if the headaches are severe or do not go away.

If metoprolol makes you feel dizzy or weak, stop what you're doing, and sit or lie down until you feel better. Do not drive, ride a bike or use tools or machinery if you're feeling tired or dizzy. Do not drink alcohol, as it may make your symptoms worse.

Put your hands or feet under warm running water, massage them, and wiggle your fingers and toes. Try not to smoke or have drinks with caffeine in – these can make your blood vessels narrower and restrict your blood flow. Smoking also makes your skin colder. Try wearing mittens (they're warmer than gloves) and warm socks. Do not wear tight watches or bracelets.

Stick to simple meals and do not eat rich or spicy food. It might help to take your tablets after you've eaten.

Try to rest and relax. It can help to eat and drink slowly and have smaller and more frequent meals. Putting a heat pad or covered hot water bottle on your stomach may also help.

If you're in a lot of pain, speak to your pharmacist or doctor.

Take small, frequent sips of water to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

If you take the  combined pill and you're being sick, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Drink plenty of water or squash to prevent dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee.

If you take the  combined pill and you have severe, watery diarrhoea, or diarrhoea that lasts for more than 24 hours, your contraception may not protect you from pregnancy. Check the pill packet for advice.

Talk to your doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

You can take metoprolol during pregnancy. If you're taking metoprolol for heart problems then it’s likely that you will be advised to keep taking it during pregnancy.

Metoprolol can sometimes affect your baby's growth and you will need to have extra growth scans (usually from 32 weeks) to monitor this.

If you're trying to get pregnant or you're already pregnant, talk to your doctor about whether metoprolol is right for you.

If your baby is healthy, and you need to take a medicine to treat high blood pressure, metoprolol is one of the best choices while breastfeeding, but talk to your doctor or pharmacist first.

Metoprolol passes into breast milk in very small amounts. It has not been known to cause any side effects in breastfed babies.

It's important to keep taking metoprolol to keep you well. Breastfeeding will also benefit both you and your baby.

It's very rare for breastfed babies to have side effects from medicines you're taking. But it's important to keep monitoring your baby if you're taking any medicine while breastfeeding.

Contact your healthcare professional or call 111 as soon as possible if you notice that your baby:

• is not feeding as well as usual or putting on weight as expected
• seems unusually sleepy, tired or weak
• looks much paler than usual
• seems sweaty or shaky
• changes their breathing

If your baby has any symptoms that are not listed, or you’re worried about them, you can also call 111 or contact any healthcare professional.

There are some medicines that may affect the way metoprolol works.

Tell your doctor if you're taking any other medicines, including:

• other medicines for high blood pressure (hypertension) – when taken together with metoprolol, this can lower your blood pressure too much, which may make you feel dizzy or faint. Tell your doctor if this keeps happening as they may change your dose
• other medicines that can lower your blood pressure – these include some antidepressants, nitrates (for chest pain), baclofen (a muscle relaxant), tamsulosin (for an enlarged prostate), and co-careldopa and levodopa (for Parkinson's disease)
• non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen – they can stop metoprolol working properly
• medicines for diabetes – metoprolol may make it more difficult to recognise the warning signs of low blood sugar
• medicines for allergies, such as ephedrine, noradrenaline or adrenaline

These are not all the medicines that may cause problems if you take them with metoprolol. For a full list, see the leaflet inside your medicine packet.