Lopressor: Precision Beta-Blocker Therapy for Cardiovascular Control
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Synonyms | |||
Lopressor (metoprolol tartrate) is a cardioselective beta-1 adrenergic receptor blocker indicated for the management of hypertension, angina pectoris, and hemodynamic stability following myocardial infarction. As a foundational agent in cardiovascular pharmacotherapy, it modulates sympathetic nervous system activity, reducing heart rate, myocardial contractility, and cardiac output. Its well-established efficacy and safety profile make it a first-line choice among clinicians for long-term cardiovascular risk mitigation. This agent is particularly valued for its predictable pharmacokinetics and selective action, minimizing extracardiac effects when dosed appropriately.
Features
- Active ingredient: Metoprolol tartrate
- Available in 25 mg, 50 mg, and 100 mg oral tablets
- Cardioselective beta-1 adrenergic blockade
- Rapid onset of action with peak plasma concentrations within 1–2 hours
- Half-life of approximately 3–7 hours
- Hepatic metabolism via CYP2D6 isoenzyme
- Renal excretion of metabolites
Benefits
- Effectively lowers systolic and diastolic blood pressure, reducing long-term cardiovascular risk
- Decreases myocardial oxygen demand, providing prophylactic management of angina episodes
- Improves survival and reduces reinfarction rates when administered early in acute myocardial infarction
- Attenuates inappropriate sinus tachycardia and controls ventricular rate in atrial fibrillation
- Reduces sympathetic overactivity, alleviating symptoms in hyperadrenergic states such as hyperthyroidism or anxiety-induced palpitations
- May improve left ventricular function and remodeling in chronic heart failure when used as part of guideline-directed medical therapy
Common use
Lopressor is commonly prescribed for the management of essential hypertension, either as monotherapy or in combination with other antihypertensive agents. It is also indicated for the long-term treatment of chronic stable angina, improving exercise tolerance and reducing ischemic episodes. In the setting of acute myocardial infarction, it is used to limit infarct size, prevent arrhythmias, and decrease mortality. Off-label uses include rate control in supraventricular tachyarrhythmias, symptom management in hypertrophic cardiomyopathy, migraine prophylaxis, and situational anxiety.
Dosage and direction
For hypertension, the initial dose is typically 50 mg twice daily, which may be increased at weekly intervals to a maximum of 400 mg per day in divided doses. For angina, dosing usually begins at 50 mg twice daily, titrated to a maximum of 400 mg daily. In post-myocardial infarction management, therapy is initiated with 25–50 mg every 6 hours starting 15 minutes after the last intravenous dose, continued for 48 hours, followed by a maintenance dose of 100 mg twice daily. Tablets should be taken with or immediately following meals to enhance bioavailability and minimize peak-trough fluctuations. Dosage adjustments are necessary in hepatic impairment and poor CYP2D6 metabolizers.
Precautions
Abrupt discontinuation of Lopressor should be avoided due to risk of rebound hypertension, tachycardia, and angina exacerbation. Use with caution in patients with compensated heart failure, bronchospastic disease, diabetes mellitus, or thyrotoxicosis. May mask signs of hypoglycemia (e.g., tachycardia) in diabetic patients. Can exacerbate symptoms of peripheral vascular disease or Raynaud’s phenomenon. Regular monitoring of heart rate, blood pressure, and clinical response is advised. Electrolyte imbalances, particularly hypokalemia, should be corrected before initiation.
Contraindications
Lopressor is contraindicated in patients with severe bradycardia (heart rate <45–50 bpm), second- or third-degree heart block without a functioning pacemaker, cardiogenic shock, decompensated heart failure, and sick sinus syndrome. It is also contraindicated in individuals with a history of hypersensitivity to metoprolol or any component of the formulation. Should not be used concurrently with other beta-blockers.
Possible side effect
Common adverse reactions include fatigue (∼10%), dizziness (∼10%), depression (∼5%), bradycardia, and cold extremities. Gastrointestinal effects such as diarrhea and nausea may occur in 1–5% of patients. Less frequently, patients may experience bronchospasm, vivid dreams, insomnia, or erectile dysfunction. Serious but rare side effects include heart failure exacerbation, severe bradycardia, AV block, claudication, and bronchoconstriction. Rash and dry eyes have been reported in isolated cases.
Drug interaction
Lopressor exhibits significant interactions with other agents metabolized by CYP2D6, including fluoxetine, paroxetine, and quinidine, which may increase metoprolol concentrations. Concomitant use with calcium channel blockers (e.g., verapamil, diltiazem) may potentiate bradycardia and AV block. Concurrent administration with clonidine may exacerbate rebound hypertension upon withdrawal. NSAIDs may diminish the antihypertensive effect. Insulin and oral hypoglycemics require careful monitoring due to masked hypoglycemic symptoms. Avoid use with other negative chronotropic or inotropic agents.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Doubling the dose is not recommended. Patients should be advised not to discontinue therapy abruptly without medical supervision.
Overdose
Symptoms of overdose include severe bradycardia, hypotension, heart failure, bronchospasm, hypoglycemia, and coma. Management includes gastric lavage if presented early, followed by activated charcoal. Atropine may be administered for bradycardia. Glucagon has been used to reverse cardiovascular effects. In refractory cases, transvenous pacing or vasopressors such as dopamine or dobutamine may be required. Hemodialysis is not effective due to high protein binding.
Storage
Store at controlled room temperature (20–25°C or 68–77°F). Protect from light and moisture. Keep in the original container and ensure the cap is tightly closed. Do not store in bathrooms or damp areas. Keep out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting or altering any medication regimen. Individual patient responses may vary. Not all uses or precautions are covered in this summary.
Reviews
Lopressor has been extensively studied in clinical trials such as the Gothenburg Metoprolol Trial and the MIAMI trial, demonstrating significant mortality benefits in post-infarction patients. It remains a widely endorsed therapeutic option in major cardiology guidelines including those from the ACC/AHA and ESC. Patient satisfaction is generally high regarding its efficacy in symptom control, though some report tolerability issues such as fatigue or cold extremities. Long-term real-world evidence supports its role in reducing cardiovascular events and hospitalizations.