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Dr. Bridget
Dr. Bridget, Pharmacist
Category: Pharmacy
Satisfied Customers: 1011
Experience:  Clinical Geriatric Pharmacist; Pharmacy Practice Residency training with extensive knowledge in pharmacological treatment of diseases;Special interest in alternative remedies.
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I was prescribed 25mg of metoprolol to take once a day in

Customer Question

I was prescribed 25mg of metoprolol to take once a day in the morning for a slightly elevated heartrate. Sarurday night, as I was falling asleep, I woke up with a start, felt like my heart stopped and started again, beating hard (Hypnic jerk?). Could not get to sleep without this happening, so I took a 25mg metoprolol pill at 4am Sunday. Same thing happened the next night and I took another pill at 11:40pm Sunday. I skipped taking my pill Monday morning because I figured it had only been 8 hours. Woke up Tuesday morning (yesterday) and my heart started pounding fast and hard and I was shaky. Took pill. Then last night, 12:50am Wednesday morning, same thing. I woke up and then heart started pounding. Took pill. Is it ok to take metoprolol in this manner or do I need to get back to only taking it once in the morning? Also, since I took one last night, should I take another this morning?
Submitted: 1 year ago.
Category: Pharmacy
Expert:  Dr. Bridget replied 1 year ago.

Hi there..please wait a moment while I prepare my answer for you:)

Expert:  Dr. Bridget replied 1 year ago.

There is a possibility that the Metoprolol is reducing your blood pressure low enough that your body is reacting by increasing your heart rate. It is called reflex tachycardia. Have you tried taking your blood pressure when you feel your heart racing?

Customer: replied 1 year ago.
I don't have a way to take my blood pressure at home.
Expert:  Dr. Bridget replied 1 year ago.

Ok, no problem. If you can, you may want to invest in an at home blood pressure cuff. The automated ones are great...all you do is strap the cuff on and press a button and the machine does all the work. I highly recommend these to anyone who is on blood pressure medication.

To answer your original question if it is ok to take Metoprolol as you are, it is probably safe if you are taking the immediate release formulation. The immediate release can be dosed every 8 to 12 hours safely. If you are taking the extended release, you would only want to take this once a day. The best thing to do in your case is get on a fixed dose that will eliminate your problem with tachycardia. I can advise, but need to know if you are on immediate release or extended release.

Customer: replied 1 year ago.
It's metoprolol succinate extended release.
Expert:  Dr. Bridget replied 1 year ago.

Ok, great. Thanks for that info. If your blood pressure is not dropping low, you may actually need a higher dose of the Metoprolol ER or more frequent dosing. Although the extended release should theoretically be taken only once a day, some patients genetically have a quicker metabolism of this drug and may possibly need to take it twice a day instead of once a day.

Customer: replied 1 year ago.
I typically take a pill between 7-8am. I took one last night at 12:50am. I'm still uncertain as to whether I can/should take another one this morning. (?)
Expert:  Dr. Bridget replied 1 year ago.

Sorry, I got off topic a bit, but I needed to confirm some information with you prior to giving my final answer. So to directly answer your questions: 1) Continuing to take it as you have been (taking additional doses when you have tachycardia) is not advised. With oversight by your doctor, I advise that you establish a stable and consistent dose (which may include increasing to twice daily dosing) to prevent the breakthrough tachycardia you have been experiencing. 2) As you may be one of those fast metabolizers, taking another one this morning should not be a problem.

Expert:  Dr. Bridget replied 1 year ago.

Hi! I am checking in with you to see how everything is going with your Metoprolol ER. Have you been able to get your rapid heartbeat under control? Hope everything is going well! Please let me know:)


Dr. Bridget