Does metoprolol lower resting heart rate?
Yes, metoprolol can lower resting heart rate. It is a beta-blocking medication that is used to lower blood pressure, as well as relieve chest pain from angina pectoris. It is also used for the treatment of heart failure and heart attack. Metoprolol comes in both immediate-release and long-acting formulations.
How Does Metoprolol Lower Heart rRate?
Metoprolol is a beta-blocker medication that works by blocking the effects of adrenaline (epinephrine) and noradrenaline (norepinephrine) on the heart. These hormones, also known as catecholamines, normally increase heart rate and force of contraction. By blocking their effects, metoprolol helps to slow down the heart rate.
How Much Does Metoprolol Lower Heart Rate?
The effect of metoprolol on heart rate depends on the dose, underlying health conditions, and individual response to the medication. The effects on heart rate are similar between the different formulations of metoprolol.
The 12.5 mg dose represents the lowest common starting point for metoprolol therapy and typically reduces heart rate by about 5 beats per minute. This conservative dosage is often prescribed for elderly patients, those with borderline low blood pressure, or individuals who have shown sensitivity to beta-blockers in the past. Metoprolol 25 mg typically reduces resting heart rate by 10-20 beats per minute, though individual responses can vary significantly based on factors like baseline heart rate, overall health, and individual sensitivity to the medication. Higher doses of metoprolol generally produce a more substantial heart rate reduction of around 15-25 beats per minute from baseline.
Clinical Studies on Effects of Metoprolol on Heart Rate
- In a study of around 31,000 adults, the immediate-release form of metoprolol (50 mg twice a day) lowered heart rate by 19.1%. Additionally, people taking the long-acting form (100 mg once a day) had a 13.4% reduction from their starting heart rate.
- In another study of about 4,000 adults living with heart failure, the extended-release form of metoprolol reduced heart rate by about 8-14 beats per minute (BPM). Average doses ranged from 146 mg to 167 mg per day in the five different groups researchers studied.
- Researchers found that resting heart rate was 14 BPM lower in a group of people taking a beta-blocker compared to those that were not in a study looking at the effect of beta blockers on the heart and respiratory system. And in a separate study of people who took 200 mg of extended-release metoprolol per day after a heart attack showed it decreased heart rate by about 15 BPM.
- In children ages 6 to 16 years old, metoprolol typically reduces heart rate by around 5 to 7 BPM. However, the response can vary and some children might have an even larger drop in heart rate.
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How Soon Does Metoprolol Lower Heart Rate?
How quickly metoprolol works depends on the formulation you are taking. Metoprolol lowers heart rate within one hour after taking a dose by mouth. When injected into the veins, metoprolol lowers heart rate within 20 minutes. The full acute effects stabilize during the first week of therapy. Patients should see consistent heart rate reduction patterns by day 7 of treatment.
When Heart Rate Becomes Too Low
While metoprolol effectively reduces heart rate for therapeutic benefit, excessively low heart rates can become dangerous and require immediate attention. Generally, a resting heart rate below 50 beats per minute (bradycardia) while taking metoprolol warrants careful monitoring and potential medical intervention. However, some patients, particularly athletes or those with naturally slow heart rates, may tolerate rates in the 45-55 bpm range without symptoms.
If your resting heart rate drops below 50 bpm, or if you experience symptoms such as dizziness, lightheadedness, fatigue, or chest discomfort, it is important to contact your healthcare provider promptly. Always follow your healthcare provider's instructions for safe medication use and reporting.
Establish clear guidelines with your healthcare provider about when to hold doses and when to seek medical attention. Many providers recommend keeping a heart rate log, especially when starting metoprolol or adjusting doses.
This is not all the information you need to know about metoprolol for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.
References
- Andersson, B., Aberg, J., Lindelöw, B., Täng, M. S., & Wikstrand, J. (2001). Dose-related effects of metoprolol on heart rate and pharmacokinetics in heart failure. Journal of cardiac failure, 7(4), 311–317. https://doi.org/10.1054/jcaf.2001.28230
- Gullestad, L., et. al. 2005. What resting heart rate should one aim for when treating patients with heart failure with a beta-blocker?: Experiences from the Metoprolol Controlled Release/Extended Release Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). In: Journal of the American College of Cardiology. DOI: https://doi.org/10.1016/j.jacc.2004.10.032
- Lopressor [package insert]. Updated September 2023. Validus Pharmaceuticals LLC. Accessed 10/28/2024 at https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=0283bc9d-6998-493a-824a-d4c85f704111&type=display
- Morris, J., et. al. 2024. Metoprolol. In: StatPearls [Internet]. Accessed 10/28/2024 at https://www.ncbi.nlm.nih.gov/books/NBK532923/
- Priel, E., et. al. 2021. The Impact of beta blockade on the cardio-respiratory system and symptoms during exercise. In: Current Research in Physiology. DOI: https://doi.org/10.1016/j.crphys.2021.10.002
- Shin, J., et. al. 2014. Risk of Emergent Bradycardia Associated with Initiation of Immediate- or Slow-Release Metoprolol. In: Pharmacotherapy. DOI: https://doi.org/10.1002/phar.1319
- Toprol XL [package insert]. Updated April 2023. Aralez Pharmaceuticals US Inc. Accessed 10/28/2024 at https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=991fe00b-498b-400e-9e5b-921cb07d9b2c&type=display
- Tuininga, Y. S., et. al. 1995. Evaluation of Importance of Central Effects of Atenolol and Metoprolol Measured by Heart Rate Variability During Mental Performance Tasks, Physical Exercise, and Daily Life in Stable Postinfarct Patients. In: Circulation. DOI: https://doi.org/10.1161/01.CIR.92.12.3415
- Wikstrand, J., Hjalmarson, A., Waagstein, F., Fagerberg, B., Goldstein, S., Kjekshus, J., Wedel, H., & MERIT-HF Study Group (2002). Dose of metoprolol CR/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR/XL randomized intervention trial in chronic heart failure (MERIT-HF). Journal of the American College of Cardiology, 40(3), 491–498. https://doi.org/10.1016/s0735-1097(02)01970-8
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