March 28, 2023

Hi I’m Kel, a clinical pharmacist & aortic dissection survivor – here’s a quick overview of the basics of metoprolol from someone who actually takes metoprolol! Have an amazing day 🙂

Hi guys welcome back this is kel if you’re new here my name is kell i am a pharmacist and also a type a aortic dissection survivor as of a few months ago um so today i’m going to be talking a little bit about metoprolol i had made a video last week about warfarin and a lot of people found it really useful so i thought it would be a good idea to make one about

Metoprolol because i’ve had a lot of questions from people about metoprolol and just beta blockers and what they do and just everyone seems to be curious about beta blockers so today i’m going to be talking a little bit about that before i do i’d really appreciate if you subscribe to my channel if you’re interested in hearing more videos like this and also liking

This video if you do find it useful and so we’ll go ahead and get started with that so the first thing that we’re going to go over is the mechanism of action of metoprolol so metoprolol is what’s called a beta blocker you may have heard this term before and that just refers to basically how material works so as the name suggests a beta blocker is blocking beta

So you may be asking yourself what does that mean and i’m going to explain it to you so there are different beta receptors in our body for this video we’re going to talk about beta 1 receptors and beta 2 receptors so in terms of beta blockers not all beta blockers are created equally so there’s very there’s a very wide range of beta blockers you may have seen

Metoprolol carvedalol like all the ones that end in lol basically are beta blockers for the most part so there are beta blockers that are what’s called cardioselective and there’s beta blockers that are non-cardioselective in this case for metoprolol that belongs to the class that is cardioselective so what does that mean so that means that metoprolol is focusing

On the beta receptors that are in our heart there are different beta receptors in our body there’s beta-1 receptors which are predominantly found in the heart there is beta-2 receptors which are predominantly found in the smooth muscles of our airways and not to say that that’s exactly where they are and that’s the only place you can find them of course they are

In other areas but for the sake of this video we’re going to focus on those areas so for metoprolol because it’s a cardioselective beta blocker it’s focusing on the beta 1 receptors which are located predominantly in the heart essentially metoprolol is just working on those cardiac beta receptors so it’s really honing in it’s going in there and it’s blocking those

Receptors and when those receptors are blocked that’s what leads to less norepinephrine epinephrine in our body and helps calm our heart and it helps lower our blood pressure so metoprolol by itself really isn’t that great at lowering blood pressure if you are taking it it’s most likely more for your heart rate and more to just decrease the stress on your heart

There’s something called shear stress and metoprolol helps to decrease that it’s essentially kind of probably what first comes to your mind when you hear that word sheer stress just the stress from the blood hitting the walls of your heart oftentimes if you have very high shear stress in your body that can cause damage to your heart over a long period of time so

That would be in the case that you have high blood pressure that increases the shear stress occurring in your heart so it’s very important for patients like myself who have had an aortic dissection and who are trying to decrease the stress on the heart to take metoprolol or to take a cardioselective beta blocker in order to prevent that stress and prevent another

Aneurysm from developing so there are other indications for which a beta blocker like metoprolol can be used so it can be used in heart failure it can like i said it can be used for hypertension or high blood pressure but it’s typically not the first line because it really doesn’t have that great of an effect on lowering blood pressure and it also is often prescribed

After a patient has a heart attack and like i said it’s mostly to just prevent that stress on the heart to just keep our hearts nice and relaxed and smooth sailing because we really don’t want to aggravate our heart any more than it already is so a lot of people are often very interested to know the side effects of metoprolol of course we all want to know the side

Effects of the medications that we’re putting into our body so that’s a natural question to ask for any medication there’s always a laundry list full of side effects so i’m gonna just go over the big ones of course metoprolol has lots of side effects i’m not gonna sugarcoat it and say that it’s a perfect drug and it’s not going to cause anything because of course

It’s an unnatural substance that we’re putting into our body there’s always going to be side effects but when it comes to medications and when it comes to medicine it’s always weighing out the benefits versus the risk and really the benefits of metoprolol and of beta blockers is so much more than any minuscule risk that it can cause a lot of the side effects that

Are listed on a package insert or like when your pharmacist gives you your medication and they have that whole paper full of side effects um it can sound scary and you might look at that and be like why am i taking this medication but to be honest the chance of a lot of those happening is less than one percent the biggest side effect that does occur with metoprolol

Is what’s called bradycardia which is just a fancy word for a slow heart rate so this might sound expected to you it’s not completely unexpected that you would have a slow heart rate especially when the way that we learned that metoprolol works and it’s really decreasing a lot of the the norepinephrine and the epinephrine in our body which would make our heart rate

Go up so because we’re lowering that then our heart rate is going down because our heart is much more calm and it makes sense too that we want to keep our heart rate low because that’s going to decrease the stress on our heart as well so really this side effect isn’t that concerning because honestly it’s kind of what we would want to happen with metoprolol and it

Really is kind of the goal in a sense not to say that if your heart rate is like 30 that that’s okay if you are having very low heart rates i would say less than about 50 kind of depending on the age for me i’m only 30 years old so a heart rate of 50 is okay but for a person who may be a little bit older maybe in their 70s or 80s a heart rate of 50 might be a little

Bit too low so in terms of that you really should consult with your cardiologist and with your doctor who’s taking care of you and who’s prescribing your medications to make sure that that’s okay for you because metoprolol lowers heart rate it can cause dizziness that’s when age kind of plays a factor as well but of course it can cause dizziness for everyone but

In older populations this dizziness can be a little bit more concerning because a person who may be a little bit older and a little bit less mobile when they’re taking monterpolo they may stand up very quickly and feel a little bit dizzy and it puts you at a higher risk for falls but of course you should always use caution when first taking a metoprolol or first

Taking a beta blocker see how it makes you feel before you start doing anything crazy i wouldn’t suggest taking metoprolol and then going skydiving for the first time if you do let me know how that goes because i don’t know that actually sounds kind of cool so it is expected to have a little bit of dizziness maybe a little bit of drowsiness with metoprolol that’s

Perfectly normal of course if it’s anything excessive that’s when you would want to let your doctor know and that being said if you do experience a low heart rate or low blood pressure their chances are that your doctor has already given you some parameters for which to hold your beta blocker a lot of times the doctor will write on your prescription hold like skip

Your dose of metoprolol if your heart rate is less than 50. so if your doctor has given you those parameters and discussed that with you then make sure that you are following that to prevent your heart rate or your blood pressure from dropping too low so something else that’s really important about beta blockers is that they should never be stopped abruptly what

I mean by this is never stop taking metoprolol just all of a sudden just one day you wake up and you’re like i don’t want to take my toefl anymore and you just stop taking it and you throw your bottle in the trash don’t do that please i mean really don’t do that with any medication unless your doctor tells you to but for metoprolol for beta blockers specifically

When it is stopped abruptly especially if you’ve been on a high dose it can cause rebound effects and rebound effects would be it can cause basically the opposite of what it’s doing so by stop so your body gets used to being on this medication all of a sudden you stop it then it can cause your heart rate to shoot up it could cause your blood pressure to shoot up and

That’s not something that we want obviously so it’s always important to gradually taper off the medication of course at the discretion in the direction of your provider and once that you’re on a lower dose it can be tapered off but essentially if you’re on a stable dose and you’ve been on that maintenance dose for a long time please don’t stop taking it because we

Really don’t want those rebound effects to happen so like i mentioned earlier not all beta blockers are created equal so actually within the cardioselective beta blockers and even within meteorpill itself not all metoprolol is created equal so there’s a little bit of metoprolol inception going on here i’m just kidding i really don’t know what that means so when

It comes to metoprolol there are two different kinds of formulations there’s ir which stands for immediate release and er which stands for extended release so like the names pretty much say immediate release is something when you take it it’s just immediately releasing into your body and starting to help you whereas the extended release is going into your body

And it’s formulated in a way that it releases over a longer period of time so metoprolol has two different names so if you look on your prescription bottle you might see metoprolol tartrate and you might see metoprolol succinate so metoprolol tartrate is the ir that’s the immediate release formulation and often times you can also tell because this one is dosed

Multiple times a day so if you’re taking metoprolol twice a day chances are you’re taking metoprolol tartrate which is the immediate release if you’re taking a metoprolol once a day then chances are that it’s metropolis succinate and that’s the extended release not to say that that is the black and white rule of course there can be some people who are taking the

Meteor at least once a day or extend or release twice a day i don’t know if you have specific reasons for that so if you are taking it differently than i just mentioned don’t freak out just talk to your doctor i’m sure they have a good reason for what they’re doing but that’s the general rule that immediate release is typically twice a day extended release is

Typically once a day other than that there really isn’t a huge difference between the two formulations you may be asking why would i take one and not the other and really the answer to that is just patient preference so with medications a huge thing that is often an obstacle is getting patients to actually take their medication so that’s why the extended release

Often is preferred for people who don’t really want to take a lot of medications multiple times a day a lot of times people your doctor may start you out on the immediate release formulation and eventually once you get to a good stable dose they’ll transition you over to the extended release so that you don’t have to be taking medications twice a day some people

Just don’t care and they’re like you know what i’m taking medications anyways if i have to take it two times a day what’s the big deal and so they’re okay with taking it that way and that’s perfectly fine too for me i take the metoprolol tartrate the immediate release one twice a day and that works for me but eventually my cardiologist does want me to transition

To the once a day so that i don’t have to be living my life revolving around taking medications something to mention is in terms of administration of these medications the only other difference that kind of stands out is that the immediate release is better absorbed with food so it is recommended to take the immediate release formulation with food or just not

Take it on an empty stomach the extended release doesn’t seem to have that issue it seems to be okay with just taking it on an empty stomach with or without food it doesn’t tend to change the absorption of the medication too much so if you have been taking the metoprolol immediately at least without food for years and you’re like oh my gosh i’ve been taking it

Wrong it’s okay you can just start taking it with food now or just keep taking it like you’re taking it if it’s working for you it’s really okay i mean as long as you’re consistent taking it with food or consistently taking it without food whatever is working for you works for you but again it does suggest taking it with food just to increase the absorption of

The medication in your body in regards to the immediate release versus extended release as well it’s important to remember that for extended release tablets you should never cut them or try to crush them or anything like that that destroys the extended release formulation in the tablet itself so it’s recommended to always take those whole when it comes to the

Immediate release it’s okay to cut the tablet or crush it if you need to but if you don’t need to just take the whole tablet something to know as well is that beta blockers like metoprolol can mask the symptoms of low blood sugar metoprolol can cause some of those side effects like dizziness um and it’s keeping your heart rate really low and so sometimes if you

Have low blood sugar you may experience dizziness and a higher heart rate and so when you’re taking the topolo it’s kind of counteracting those effects or maybe in the case of dizziness creating the same effect so it may mask some of your symptoms of low blood sugar so if you are diabetic be sure to just continue checking your blood sugar make sure your doctor is

Aware that i mean i’m sure your doctor is aware that you have diabetes if you do and just kind of look out for that also like i mentioned earlier beta blockers sometimes do have an issue when patients have asthma so like i kind of talked about with the cardioselective versus non-cardioselective in the case of metoprolol because it is cardioselective that risk of

Asthma being worsened is much much lower however at really high doses of metoprolol it can have an effect on those beta receptors that are in the airways so it could aggravate asthma a little bit but again your doctor should be aware of your medical history and should be really looking at that but in terms of cardio selective beta blockers like metoprolol that’s

Not as much of a concern now if you do have asthma and your doctor prescribes you a beta blocker that is not cardio selective then it can worsen asthma and that is something to be mindful of and just make sure you talk to your doctor about that so if you’re curious on what the cardio selective beta blockers are i can just tell you the quick acronym that i learned

Is beeman and there’s also another acronym that’s man babe choose whichever one you want to learn if you really do want to learn this honestly you don’t need to but they are metoprolol i’m going to read it because okay um metoprolol antennalol nebivolol bisoprolol acid butylol bataxolol and esmolol and those are all the cardioselective beta blockers meaning

They work on the heart predominantly and just from my personal experience i mean i’ve been taking metoprolol for almost four months now and from my experience i really haven’t had many side effects from metoprolol i haven’t noticed really anything different other than my heart rate is being kept down before i took my toprolol and after my aortic dissection repair

My heart rate was constantly high i even had moments where you know my anxiety would really trigger my heart to just kind of go out of control beating very fast and i would get heart rates of it up into the 150s and 160s but since taking metoprolol it’s really stabilized my heart i feel so much calmer even after i started taking it i kind of felt like my anxiety got

Better too in a way maybe that’s just like a placebo effect or maybe it’s i mean it makes sense it’s also calming my body as well but i really haven’t had any major side effects of course i have the dizziness and occasionally drowsiness but it’s livable and you kind of learn what to do and not to do to help that dizziness but overall i think material was a pretty

Great drug i mean it’s been around for a very long time has a lot of trials a lot of studies involving its usage and different indications so i think it’s a a great drug and i really in taking it as a pharmacist who has taken metoprolol i haven’t seen anything concerning um of course i haven’t been taking it that long i know that there’s plenty of people out there

Who have been taking it for much longer and you may have had a completely different experience which i totally understand but this is just kind of from my perspective that it’s been okay so far and i do think it’s a good medication to take and always the benefits outweigh the risks so thank you guys so much for watching i really appreciate it i i’m having a lot

Of fun making these youtube videos and i’m really happy that people are finding them useful um i just wanted to say if anybody has a specific request for a video that you would like me to make please leave me a comment down below or message me and just let me know because i’m always looking for new ideas and i’m kind of just trying to figure out what’s going to

Help people the most i’d be happy to take suggestions so please just let me know and as always if you do enjoy this video please give it a thumbs up and just like the video that would be greatly appreciated and also if you just could subscribe to my channel if you would like to see more videos like this i would be so so grateful for that as well thank you so much

For watching i really appreciate it and i hope that everyone has an amazing day and if you do have extra questions about metoprolol or beta blockers or anything just comment below and i will try my best to answer it but thank you guys and i’ll see you on the next video bye you

Transcribed from video
PHARMACIST TAKES METOPROLOL | Medication Explained By Kels Vegan Life