Met XL (Metoprolol Succinate / Tartrate)
Also sold as: Met XL, Metolar XR, Lopressor, Betaloc
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 25/50/100mg (succinate ER) +2
Indications
- Hypertension
- Stable angina
- Heart failure (HFrEF — succinate)
- Post-MI
- Atrial fibrillation rate control
- Migraine prophylaxis
- Essential tremor
Adult Dosing
HTN/Angina (succinate)
25-100 mg PO OD; titrate to max 200 mg/day
HF (succinate)
Start 12.5-25 mg OD; double every 2 weeks to target 200 mg/day
AF rate control (tartrate)
25-100 mg BD
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| No adjustment needed | No CrCl-based dose adjustment required |
Hepatic Adjustment
Caution — extensive hepatic metabolism; reduce dose in severe
Pregnancy & Lactation
Pregnancy: Category C
Generally safe; commonly used for HTN in pregnancy.
Lactation: Caution
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Diltiazem, Verapamil | Severe bradycardia, AV block | Major |
| Clonidine | Rebound HTN if either stopped abruptly | Major |
| Digoxin | Additive bradycardia | Moderate |
| NSAIDs | Reduced antihypertensive effect | Moderate |
| Insulin/oral hypoglycemics | Mask hypoglycemia symptoms | Moderate |
| Fluoxetine, paroxetine (CYP2D6 inhibitors) | Increased metoprolol levels | Moderate |
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Side Effects
Common
- Fatigue
- Bradycardia
- Cold extremities
- Erectile dysfunction
- Bronchospasm (rare with selective)
Serious / Discontinue If
- Severe bradycardia, heart block
- Acute heart failure decompensation (high dose start)
- Bronchospasm in asthmatics
- Masking of hypoglycemia in diabetics
Contraindications
- 2nd/3rd degree AV block
- Symptomatic bradycardia
- Acute decompensated HF
- Cardiogenic shock
- Severe peripheral arterial disease
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Met XL 50 | Ajanta | 15 tab ₹95 |
| Metolar XR 50 | Sun Pharma | 15 tab ₹105 |
| Betaloc XL 50 | AstraZeneca | 14 tab ₹125 |
Monitoring Required
- HR, BP, signs of HF decompensation, glucose in diabetics
Patient Counseling Points
- Do not stop abruptly — risk of rebound tachycardia, MI
- Take same time daily
- Caution with first dose — may cause dizziness
- Inform doctor of fatigue, breathlessness, slow pulse
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References
- BNF
- Lexicomp Drug Information
- Indian National Formulary
- Specialty society guidelines (RSSDI/CSI/IAP)