💊 Metoprolol – Information for Older Adults
Plain-language information about metoprolol in older adults. This page is for older Canadians and their caregivers. It does not replace advice from your own health-care provider.
Metoprolol
Beta Blocker – Heart and Blood Pressure Medication
1. What is metoprolol used for?
Metoprolol is a beta blocker – a type of medication that works on the heart and blood vessels. It is one of the most commonly prescribed heart medications in Canada.
Metoprolol is used to:
- Lower high blood pressure (hypertension)
- Slow a fast heartbeat or help control heart rhythm problems (like atrial fibrillation)
- Protect the heart after a heart attack
- Treat chest pain (angina) by reducing the heart's workload
- Treat heart failure – helps the heart work more efficiently over time
- Prevent migraines in some people
💡 Good to know
Beta blockers like metoprolol have been used for decades and have been shown to help people live longer after heart attacks and with heart failure. The name "beta blocker" comes from the fact that they block certain receptors (called beta receptors) in the heart.
2. How does metoprolol usually help?
Metoprolol works by blocking the effects of adrenaline (stress hormones) on the heart:
Your heart beats more slowly and steadily
Each heartbeat requires less effort from the heart muscle
Less pressure in your blood vessels
Shields the heart from harmful effects of stress hormones
These effects can reduce chest pain, help control irregular heartbeats, and over time, help the heart become stronger in people with heart failure.
⏰ Give it time
For conditions like heart failure, the full benefits of metoprolol may take weeks to months to develop. Your provider will start with a low dose and increase it gradually. Don't be discouraged if you don't feel different right away.
3. Why metoprolol needs extra care in older adults
In older adults, metoprolol requires careful monitoring because it can:
- Slow the heart rate too much (bradycardia)
- Lower blood pressure too much, causing dizziness or falls
- Worsen symptoms in some lung conditions (like COPD or asthma)
- Cause more fatigue than in younger people
- Mask some symptoms of low blood sugar in people with diabetes
👨⚕️ Because of this, health-care providers often:
4. How metoprolol is usually taken
⚠️ Important
Follow the exact instructions from your doctor or pharmacist. Do not stop metoprolol suddenly – this can cause serious problems including a sudden increase in heart rate and blood pressure.
There are two main forms of metoprolol:
Usually taken twice daily – morning and evening
Usually taken once daily – often in the morning
Food helps your body absorb the medication better and reduces stomach upset
Swallow whole – crushing can release too much medication at once
⚠️ Never stop suddenly!
Stopping metoprolol suddenly can cause a dangerous "rebound" effect – your heart rate and blood pressure may spike, and you could experience chest pain or even a heart attack. If you need to stop, your provider will reduce the dose gradually over 1–2 weeks.
❓ If you miss a dose
Take it as soon as you remember, unless it's almost time for your next dose. Do not take two doses at once. If your heart rate is very slow or you feel unwell, contact your provider before taking the next dose.
5. Possible side effects older adults may notice
Not everyone has side effects. Common ones can include:
Very common, especially when starting – often improves over time
Especially when standing up quickly (due to lower blood pressure)
Expected effect, but tell your provider if it's too slow or you feel unwell
Beta blockers can reduce blood flow to extremities
Some people notice unusual dreams or trouble sleeping
Some people feel down or depressed – tell your provider if this happens
💡 About fatigue
Tiredness is the most common complaint with beta blockers. It often improves after a few weeks as your body adjusts. If it doesn't improve or is severe, talk to your provider – sometimes adjusting the dose or timing can help.
⚠️ Tell your provider right away if:
- Your heart rate is very slow (below the limit your provider gave you)
- You feel very dizzy, faint, or actually pass out
- You have new or worsening shortness of breath
- Your feet or ankles become more swollen
- You feel very depressed or have unusual mood changes
- You have wheezing or difficulty breathing (especially if you have asthma or COPD)
6. When to be extra careful with metoprolol
Talk to your health-care provider and be extra careful if you have:
💊 Drug interactions
Metoprolol can interact with many other medications. Always tell your provider about all medications you take, including:
- Other blood pressure or heart medications
- Calcium channel blockers (like diltiazem or verapamil) – can slow heart rate too much
- Some antidepressants
- Diabetes medications
- Erectile dysfunction medications
- Some cold and allergy medications (decongestants can raise blood pressure)
🍷 Alcohol note
Alcohol can increase the blood pressure-lowering effect of metoprolol and make you feel more dizzy or tired. If you drink alcohol, do so in moderation and be aware of how it affects you.
7. Habits and lifestyle that may help
Metoprolol works best as part of an overall heart-healthy plan. Your provider may recommend:
Learn to take your pulse or use a monitor – know your target range
Check at home if your provider recommends – keep a log
Rise gradually from sitting or lying to prevent dizziness
Reducing sodium can help control blood pressure
Regular gentle exercise as approved by your provider – your heart rate won't rise as much on beta blockers
Wear warm socks and gloves if you notice cold extremities
🏃 Exercise and heart rate
Because metoprolol slows your heart rate, your heart won't speed up as much during exercise. This is normal and expected. Don't worry if you don't reach the heart rate targets you used to – focus on how you feel during exercise instead. Ask your provider what level of activity is right for you.
8. When to call your doctor, nurse practitioner, or pharmacist
(Non-urgent)
Contact your health-care provider or pharmacist if:
- You feel much more tired than usual after starting or changing metoprolol
- You feel dizzy when you stand up, or have had near-falls
- Your home heart rate is often below the limit your provider gave you (often below 50–55 beats per minute)
- You have cold hands and feet that bother you
- You notice mood changes or feel depressed
- You have vivid dreams or trouble sleeping
- You have new wheezing or increased shortness of breath
- Your feet or ankles are more swollen than usual
- You have questions about taking metoprolol with lung conditions like COPD or asthma
- You need to start a new medication and want to check for interactions
- You're planning surgery and need to discuss your medications
9. When to call 911 or go to the emergency department
🚨 Call 911 immediately if:
- You have chest pain or pressure that does not go away
- You are very short of breath, even at rest
- You feel like you might faint, or you do faint
- Your heart rate is extremely slow and you feel very unwell
- You have severe wheezing or can't catch your breath
- You have signs of a stroke (sudden weakness, numbness, trouble speaking, severe headache)
If possible, do not drive yourself. Ask someone to call for you or call an ambulance.
📋 Be prepared
Know your target heart rate range. Keep a list of your medications with you. If you go to the emergency department, tell them you take a beta blocker – this is important information for the medical team.
10. Questions to ask your doctor or nurse practitioner
You can print these questions and bring them to your next appointment:
⚠️ Important Disclaimer
The information on SeniorHealthGuide.ca is general and may not fit your exact situation. It is for education only.
It does not replace medical advice, diagnosis, or treatment. Only a health professional who knows your medical history can tell you what is right for you.
Never start, stop, or change any medication, or make major changes to your diet or exercise, without checking with your doctor, nurse practitioner, or pharmacist.