This page shows what was measured, who it was measured in, and what that does not settle.
What Metoprolol does in the body
The heart slows, works less hard and uses less oxygen.
Adrenaline docks onto receptors on heart muscle and tells the heart to beat faster and harder. Metoprolol occupies those receptors so adrenaline cannot. In a heart that is failing, taking away that constant lash is what lets the muscle recover, which is why the drug helps despite doing the opposite of what intuition suggests.
Why people take it. High blood pressure, chest pain, heart failure, and the period after a heart attack
What happened in people
No difference in death or reinfarction in 5,020 patients with preserved ejection fraction after a modern heart attack
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The recorded finding that sits closest to something a person would notice. Written into the record, not signed off, and it carries no population or interval.
That the MERIT-HF survival benefit extends to immediate-release metoprolol tartrate — a cross-formulation extrapolation
Where it acts
Cardiac myocyte sarcolemma and juxtaglomerular cells of the kidney
Kind of result
Living longer, or avoiding a major event
Supervision
RNAWiki has not recorded a supervision or regulatory status for this substance.
Where each sentence above came from
A person wrote this explanation into the record, with the studies named in the path below.
The recorded use, written for a reader without medical training. Not signed off.
A limit recorded against this substance. Not signed off as a reviewed claim.
The four opening statements run to 97 words.
Words this page uses
Four words worth knowing first
Chosen from what this page shows, with each one explained before the word it depends on.
Stand-in result
A stand-in result is a number measured because the real result takes too long.
A picture of it, and where the picture fails
It is like judging a journey by the speedometer rather than by arriving.
Where that stops being true. Speed does predict arrival. Many stand-in results do not predict the real one.
What people get wrong. A stand-in result is often reported as the result itself.
A surrogate endpoint substituted for a clinical endpoint, valid only where the substitution has been shown to hold.
Randomisation
Randomisation means chance decides who gets which treatment.
A picture of it, and where the picture fails
It is like a coin toss deciding the groups.
Where that stops being true. A coin toss is fair once. Fairness here comes from doing it for everyone.
What people get wrong. It is thought to make groups identical. It makes them similar on average, including on things nobody measured.
Allocation of participants to arms by a chance process, so that unmeasured factors are balanced in expectation.
Confidence interval
A confidence interval is the range the true answer is likely to sit in.
A picture of it, and where the picture fails
It is like a weather forecast giving a range rather than one number.
Where that stops being true. A forecast range covers tomorrow. This one covers what the study could resolve.
What people get wrong. The middle number is read as the answer. A range crossing zero means no change is still possible.
An interval estimate that would contain the true parameter in a stated proportion of repeated studies.
Pathway
A pathway is a chain of steps inside a cell, each one setting off the next.
A picture of it, and where the picture fails
A pathway is like a row of dominoes.
Where that stops being true. Dominoes fall one way. Pathways loop back and can switch themselves off.
What people get wrong. Changing one step is read as changing the outcome. Other steps often absorb it.
An ordered series of molecular interactions producing a defined cellular change.
What happened in people◇Read from sources, not yet reviewed
What was measured, goal by goal
One row for each goal a registered study measured something for. One column for each kind of thing that could be measured.
Registered studies list 40 outcome measures that RNAWiki could read. A registered study says what someone planned to measure. It does not say what they found. 0 of the matched studies tested this substance, and 0 posted a result.
There is no single score. A strong test result and a weak life result are different facts.
Goals down the side, kinds of measurement across the top. Each cell says what kind of thing was registered, not what was found.
Goal
Life outcome
What a body can do
How a person feels
A test result
A step in the body
Harms
How long
Who was studied
Focus
∅Nothing in the sources checkedNo registered study lists a life outcome for this goal.
∅Nothing in the sources checkedNo registered study lists a performance measure for this goal.
∅Nothing in the sources checkedNo registered study lists a symptom measure for this goal.
∅Nothing in the sources checkedNo registered study lists a test result for this goal.
∅Nothing in the sources checkedNo registered study lists a body-step measure for this goal.
—Not recordedHarms were not a registered measure for this goal.
—Not recordedNo finished study window is recorded.
…Waiting for a reviewerWho was studied is listed further down the page.
Cholesterol
∅Nothing in the sources checkedNo registered study lists a life outcome for this goal.
∅Nothing in the sources checkedNo registered study lists a performance measure for this goal.
∅Nothing in the sources checkedNo registered study lists a symptom measure for this goal.
△Only a number moved1 registered test measure.
∅Nothing in the sources checkedNo registered study lists a body-step measure for this goal.
—Not recordedHarms were not a registered measure for this goal.
—Not recordedNo finished study window is recorded.
…Waiting for a reviewerWho was studied is listed further down the page.
Blood sugar
∅Nothing in the sources checkedNo registered study lists a life outcome for this goal.
∅Nothing in the sources checkedNo registered study lists a performance measure for this goal.
∅Nothing in the sources checkedNo registered study lists a symptom measure for this goal.
△Only a number moved1 registered test measure.
∅Nothing in the sources checkedNo registered study lists a body-step measure for this goal.
—Not recordedHarms were not a registered measure for this goal.
—Not recordedNo finished study window is recorded.
…Waiting for a reviewerWho was studied is listed further down the page.
Healthy ageing
…Waiting for a reviewer1 registered study measure of this kind. No reviewed result yet.
∅Nothing in the sources checkedNo registered study lists a performance measure for this goal.
∅Nothing in the sources checkedNo registered study lists a symptom measure for this goal.
∅Nothing in the sources checkedNo registered study lists a test result for this goal.
∅Nothing in the sources checkedNo registered study lists a body-step measure for this goal.
—Not recordedHarms were not a registered measure for this goal.
—Not recordedNo finished study window is recorded.
…Waiting for a reviewerWho was studied is listed further down the page.
Body weight
∅Nothing in the sources checkedNo registered study lists a life outcome for this goal.
∅Nothing in the sources checkedNo registered study lists a performance measure for this goal.
∅Nothing in the sources checkedNo registered study lists a symptom measure for this goal.
△Only a number moved1 registered test measure.
∅Nothing in the sources checkedNo registered study lists a body-step measure for this goal.
—Not recordedHarms were not a registered measure for this goal.
—Not recordedNo finished study window is recorded.
…Waiting for a reviewerWho was studied is listed further down the page.
Fertility and sexual health
∅Nothing in the sources checkedNo registered study lists a life outcome for this goal.
∅Nothing in the sources checkedNo registered study lists a performance measure for this goal.
∅Nothing in the sources checkedNo registered study lists a symptom measure for this goal.
∅Nothing in the sources checkedNo registered study lists a test result for this goal.
∅Nothing in the sources checkedNo registered study lists a body-step measure for this goal.
—Not recordedHarms were not a registered measure for this goal.
—Not recordedNo finished study window is recorded.
…Waiting for a reviewerWho was studied is listed further down the page.
Which registered measures put each goal on this table
Focus
cognitive assessment trail making test part b; cognitive assessment forward digit span test
Cholesterol
low density lipoprotein cholesterol
Blood sugar
hba1c
Healthy ageing
mortality
Body weight
body weight from baseline to 24 week endpoint
Fertility and sexual health
female sexual function index
Sorted by fixed word lists, version v1. A name the rules do not recognise stays unsorted rather than moving to the nearest column.
What each mark on this table means
∅ Nothing in the sources checked
No registered study lists a life outcome for this goal.
— Not recorded
Harms were not a registered measure for this goal.
… Waiting for a reviewer
Who was studied is listed further down the page.
△ Only a number moved
1 registered test measure.
What happened in people◇Read from sources, not yet reviewed
What happened in people
Each card is one study: the exact question it asked, who was in it, and whether it showed what it set out to show.
All-cause mortality in chronic heart failure with ejection fraction ≤0.40
✓ The study showed what it set out to show
Who was studied
MERIT-HF
How many people
3991
Study design
Randomised double-blind placebo-controlled trial, stopped early, mean 1 year
Compared against
A dummy treatment
Kind of result
Living longer, or avoiding a major event
What was found
RR 0.66 (95% CI 0.53-0.81), P = 0.00009; P = 0.0062 adjusted for interim analyses
Repeated elsewhere
Replicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. The trial was stopped early for benefit, which inflates measured effect sizes. The result belongs to the extended-release succinate formulation only.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Oral immediate-release tablet (tartrate), oral extended-release tablet (succinate), and intravenous solution for acute use
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Composite of cardiovascular death, non-fatal myocardial infarction and non-fatal cardiac arrest after non-cardiac surgery
✓ The study showed what it set out to show
Who was studied
POISE (NCT00182039)
How many people
8351
Study design
Randomised double-blind placebo-controlled trial, 30 days
Compared against
A dummy treatment
Kind of result
Living longer, or avoiding a major event
What was found
HR 0.84 (95% CI 0.70-0.99), P = 0.0399
Repeated elsewhere
Unreplicated
What this does not prove. Meeting one endpoint in one population does not carry to other goals or other people.
The limits of this study, and where it came from
Main limit. All-cause death 3.1% against 2.3% (HR 1.33, p=0.0317) and stroke 1.0% against 0.5% (HR 2.17, p=0.0053). The endpoint was met and the drug caused net harm.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Oral immediate-release tablet (tartrate), oral extended-release tablet (succinate), and intravenous solution for acute use
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
Co-primary: death, reinfarction or cardiac arrest; and death from any cause during treatment
✗ The study did not show it
Who was studied
COMMIT/CCS-2 (NCT00222573)
How many people
45852
Study design
Randomised placebo-controlled trial, up to 4 weeks in hospital
Compared against
A dummy treatment
Kind of result
Living longer, or avoiding a major event
What was found
OR 0.96 (95% CI 0.90-1.01), P = 0.1 for the composite; OR 0.99 (0.92-1.05), P = 0.69 for death
Repeated elsewhere
Replicated
What this does not prove. A study that did not show an effect does not show that no effect exists anywhere.
The limits of this study, and where it came from
Main limit. 11 more cases of cardiogenic shock per 1,000 treated (OR 1.30, p<0.00001), concentrated in the first day, against 5 fewer reinfarctions and 5 fewer ventricular fibrillations.
How far it carries. This study is recorded from the curated record, not from the registry match.
Form and route. Oral immediate-release tablet (tartrate), oral extended-release tablet (succinate), and intravenous solution for acute use
Interval reported. 95% CI 0
Written into the record, not signed off as a reviewed claim.
RNAWiki holds 5 written-up human studies for this substance, each with the question it asked.
How we know it
Each card names the study, the number of people and what the study set out to measure.
What this does not prove
These summaries were written by a person and have not been signed off as reviewed claims.
Why it matters
A study that failed is as informative as one that worked, and both are here.
What we still do not know
No reviewed claim exists, so no exact population, effect size or interval is published yet.
What happened in people◇Read from sources, not yet reviewed
How close this is to real life
The top step is something a person would feel or care about. The bottom is a guess from software. Filled steps are where evidence exists for this substance.
■Living longer, or avoiding a major eventEvidence recorded. Death, a heart attack, a stroke, a hospital stay.1 registered measure of this kind. 3 written-up studies measured this and did not show a benefit.
□What a body can do day to dayNo evidence recorded. Walking, dressing, breathing, recovering.No registered study measures this.
□Measured performanceNo evidence recorded. How much was lifted, how far was run, how fast.No registered study measures this.
■Symptoms and quality of lifeEvidence recorded. Pain, tiredness, mood, sleep, as the person rated it.1 registered measure of this kind.
■A number that stands in for healthEvidence recorded. Cholesterol, blood sugar, bone density. A stand-in, not the thing itself.18 registered measures of this kind.
■A step measured inside a personEvidence recorded. Something measured in human tissue or human cells.A human record sits on the stored organism ladder.
■AnimalsEvidence recorded. Mice, rats, dogs. Useful for ideas, not proof about people.Stored records in Drosophila (fruit fly), Mouse, Rat. A result in animals says what to test next. It does not say what happens in people.
■Cells in a dishEvidence recorded. Cells or chemistry on a bench, far from a whole body.Stored mechanism abstracts describe steps measured in cells or tissue.
□A guess from softwareNo evidence recorded. Nobody measured it. RNAWiki never publishes one as a finding.RNAWiki stores no prediction for this record. Software can suggest a link. RNAWiki does not publish one as a finding.
Higher on these steps means closer to something a person would feel. It does not mean better done.
What it changes in the body◇Read from sources, not yet reviewed
The path through the body
From what a person takes to what changes. A solid line is a step measured in people. A dashed line is a step nobody has measured that way.
Where a source records it acting
Heart: Blocks catecholamine-induced increases in heart rate, in velocity and extent of myocardial contraction, and in blood pressure, reducing the oxygen requirements of the heart
US prescribing information · 00940cc5-d2eb-4841-9138-de97d7b1c674 · read 2026-08-27
Start
Metoprolol
What a person takes: Oral immediate-release tablet (tartrate), oral extended-release tablet (succinate), and intravenous solution for acute use.
The measurement behind this step
The tartrate is taken with or immediately after food and is usually twice daily; the succinate is a controlled-release multiple-unit pellet system taken once daily and is the formulation with the heart failure evidence. The two are not interchangeable milligram for milligram and do not carry the same indications.
Getting in
Absorbed completely, then mostly destroyed by one liver enzyme
Almost all of the tablet is absorbed, but a single enzyme in the liver removes most of it before it reaches the circulation. People who inherit a weak version of that enzyme end up with several times more drug.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Absorption is essentially complete, but first-pass metabolism leaves systemic bioavailability around 50% for the tartrate. Clearance is dominated by CYP2D6, which is highly polymorphic: poor metabolisers have several-fold higher exposure and a longer half-life, and the enantiomers are cleared at different rates so the active (S)-fraction shifts as well.
It reaches beta-1 receptors on the outside of heart muscle cells
The receptors it blocks sit on the surface of heart muscle cells and on kidney cells that release the hormone starting the blood-pressure cascade.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Beta-1 adrenergic receptors are class A G-protein-coupled receptors on cardiac myocyte sarcolemma and on renal juxtaglomerular cells. Beta-2 receptors, which metoprolol blocks about 70-fold less avidly at low exposure, predominate in bronchial and vascular smooth muscle — the selectivity margin that matters in airways disease and that narrows as dose rises.
It occupies the adrenaline pocket without switching anything on
The drug fits the same slot adrenaline uses but does not activate it, so as long as it is sitting there the body's own adrenaline has nowhere to act.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Metoprolol is a competitive, reversible antagonist at the orthosteric catecholamine site, with essentially no intrinsic sympathomimetic activity. Because the antagonism is competitive, a sufficiently large surge of endogenous catecholamine can still displace it — which is the pharmacological basis of rebound after abrupt withdrawal, on receptors that chronic blockade has upregulated.
Cyclic AMP falls, so the heart slows and contracts less forcefully
The blocked receptor stops producing its internal messenger. Calcium handling slows, the heart rate falls, each beat is less forceful, and the heart's oxygen demand drops.
╌╌Described, with no measurement named. No measurement is named for this step, so it is drawn as an unconfirmed link.
The measurement behind this step
Loss of Gs-mediated adenylate cyclase activation lowers cyclic AMP and protein kinase A activity, reducing phosphorylation of L-type calcium channels, phospholamban and ryanodine receptors. Heart rate, contractility and atrioventricular conduction velocity all fall, cutting myocardial oxygen consumption. In the kidney, reduced beta-1 signalling on juxtaglomerular cells lowers renin release.
In chronic heart failure that produced a third fewer deaths — and elsewhere, harm
Where the heart has been under constant adrenaline drive for months, removing that drive lets it recover, and deaths fall. Where the body needs adrenaline right now — during surgery, or in a heart already tipping into shock — blocking it costs lives.
──Measured in people. Written by a person from the study named beside the step. Not signed off as a reviewed claim.
The measurement behind this step
In MERIT-HF, all-cause mortality was 7.2% per patient-year on metoprolol CR/XL against 11.0% on placebo (RR 0.66, p=0.00009). In POISE, 30-day mortality was 3.1% against 2.3% (HR 1.33) and stroke 1.0% against 0.5% (HR 2.17). In COMMIT, 11 extra cases of cardiogenic shock per 1,000 offset 5 fewer reinfarctions and 5 fewer ventricular fibrillations.
No suggested links are held for this record, so nothing is hidden from this path.
What we know
The record describes 5 steps from taking it to an effect in a person.
How we know it
Each step names the study behind it in the technical detail beside it.
What this does not prove
A change inside the body is a reason to look. It is not a result in a person.
Why it matters
A reader can see exactly where the chain stops being measured in people.
What we still do not know
No reviewed claim binds any of these steps to a named population.
What it would be like to take◇Read from sources, not yet reviewed
Felt, measured, or meaningful
Three different things that get called the same word. Registered studies measured all three, and mixing them is how a blood test becomes a health claim.
Felt
Things a person could notice without a test.
symptoms questionnaire derived
Measured
Things only a test, a scale or a device shows.
flow mediated dilation
decrease in supine systolic blood pressure
low density lipoprotein cholesterol
systolic blood pressure
hba1c
blood pressure response
plasma renin concentration
trough sitting diastolic blood pressure
achieving blood pressure goals
glycosylated hemoglobin at week 26
and 8 more.
Meaningful
Things that change how a life goes, not only a number.
mortality
A registered study says what someone planned to measure. It does not say what they found. A number moving is not the same as a life going better. The two are shown apart here.
Felt, but not shown to help. A person notices a change. No study showed it leads anywhere good.
Measured, but not felt. A number moves. The person notices nothing. Both can be true.
Measured, but not shown to matter. A number moves in the good direction. Nobody showed that lives went better.
Matters, but takes years. The result that counts may take longer than anyone would keep watching.
Names that fit none of the three (20)
retinal endothelial function
cardiovascular morbidity
respiratory function
return of spontaneous circulation
episodes of non sustained ventricular tachycardia
cognitive assessment trail making test part b
cognitive assessment forward digit span test
bioequivalence
area under the curve of etsev over the first hour
marker of fibrinolysis
central arterial pressure
female sexual function index
central and peripheral arterial and pulse wave velocity
pulse wave velocity
left ventricular end diastolic radius to wall thickness
left ventricular ejection fraction
left ventricular end diastolic volume
international index of erectile function
incidence of postoperative atrial fibrillation
a clinical or laboratory adverse experience
These are harms, study-process measures, or names the rules did not recognise. They are shown rather than dropped.
What it would be like to take◇Read from sources, not yet reviewed
How long anything takes
Nine different lengths of time that get confused with each other. None of them is worked out from another.
Before anything is noticed.RNAWiki does not store this separately, and never works it out from another figure on this page.
Before a test result moves.RNAWiki does not store this separately, and never works it out from another figure on this page.
Before performance moves.RNAWiki does not store this separately, and never works it out from another figure on this page.
How long the result was watched.No finished study window is recorded for a study that tested this substance.
How long people took it.How long people actually took it is not stored. The study window is not the same thing.
How long people were followed.Follow-up length is not stored separately. It is never read off the study window, which would be a different thing.
How fast the body clears it. 3 to 4 hours (7 to 9 hours in poor CYP2D6 metabolizers) hours
Read from the label, which states: “The mean elimination half-life of metoprolol is 3 to 4 hours; in poor CYP2D6 metabolizers the half-life may be 7 to 9 hours.”
How long effects linger.RNAWiki does not store this separately, and never works it out from another figure on this page.
Beyond the studies. Nothing is recorded about the long term.
The longest finished study sets the edge of what anyone measured.
A study window is not how long people took it, and neither is how long they were followed. Where RNAWiki holds only one of the three, it shows one.
What is missing or unclear◇Read from sources, not yet reviewed
Were people like you studied?
RNAWiki cannot tell whether a study fits you. It can show who was in it, and where the result stops carrying.
Who was studied
People similar to this profile were included.
One of the most-prescribed drugs in the world. The tartrate and succinate salts are not interchangeable: the survival evidence in heart failure belongs to the extended-release succinate, and only that salt carries the heart failure indication.
Who is missing from the studies
Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What the label states about particular groups
On pediatric, the label states: “Safety and effectiveness of metoprolol succinate extended-release have not been established in patients less than 6 years of age.”
US prescribing information · 64c65611-d5c9-4802-9edd-32c7c67ce6f4 · read 2026-08-30
On older people, the label states: “Clinical studies of metoprolol succinate extended-release in hypertension did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.”
US prescribing information · 64c65611-d5c9-4802-9edd-32c7c67ce6f4 · read 2026-08-30
On people who are pregnant, the label states: “Teratogenic Effects: Pregnancy Category C Metoprolol tartrate has been shown to increase post-implantation loss and decrease neonatal survival in rats at doses up to 22 times, on a mg/m 2 basis, the daily dose of 200 mg in a 60-kg patient.”
US prescribing information · 64c65611-d5c9-4802-9edd-32c7c67ce6f4 · read 2026-08-30
On people who are breastfeeding, the label states: “Metoprolol is excreted in breast milk in very small quantities.”
US prescribing information · 64c65611-d5c9-4802-9edd-32c7c67ce6f4 · read 2026-08-30
On people with reduced liver function, the label states: “No studies have been performed with metoprolol succinate extended-release in patients with hepatic impairment.”
US prescribing information · 64c65611-d5c9-4802-9edd-32c7c67ce6f4 · read 2026-08-30
On people with reduced kidney function, the label states: “The systemic availability and half-life of metoprolol in patients with renal failure do not differ to a clinically significant degree from those in normal subjects.”
US prescribing information · 64c65611-d5c9-4802-9edd-32c7c67ce6f4 · read 2026-08-30
Where the result stopped carrying
POISE: fewer myocardial infarctions, 33% more deaths and 117% more strokes, and an explicit author conclusion that patients would not accept the trade
COMMIT: neither co-primary endpoint reduced in 45,852 patients, with the benefit and the harm arriving at different times
REDUCE-AMI: a practice followed for four decades produced a hazard ratio of 0.96 when finally tested in the modern era
This is a scope explorer, not a diagnosis engine.
It shows who was studied so you can see whether people similar to you were included.
RNAWiki cannot tell whether a study fits you. It can show who was in it.
What it would be like to take◇Read from sources, not yet reviewed
Why it might seem to do nothing
A real effect and a noticed effect are different things. These are the recorded reasons the two come apart.
It was studied for a different goal
The studies measured something else entirely.
On this record: Some registered studies measured things that match no goal on this page.
It was studied in different people
The people in the studies were not much like the reader.
On this record: Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
There was nothing to correct
Where a level is already normal, topping it up may change nothing.
On this record: COMMIT changed practice from starting beta blockade immediately on admission to waiting until the patient is haemodynamically stable
The evidence may simply be wrong
Small early studies often do not hold up.
On this record: RNAWiki has not yet published a reviewed conclusion for this use.
Other reasons RNAWiki checked and found nothing for (9)
A different form was studied
The studied form is not the form on the shelf. Nothing in this record points to this reason.
Something else had to happen too
In the studies it was paired with training, a diet or another treatment. Nothing in this record points to this reason.
The change is too small to feel
A real change can still sit below what a person notices. Nothing in this record points to this reason.
Day-to-day swing hides it
Sleep, food, stress and time of day move most numbers more than this would. Nothing in this record points to this reason.
Not enough time yet
The studies ran longer than the person has waited. Nothing in this record points to this reason.
It was not taken as studied
Missed days change the result, and studies count them. Nothing in this record points to this reason.
Something else changed at the same time
Two changes at once cannot be told apart afterwards. Nothing in this record points to this reason.
The product may not be what it says
Contents of a sold product are not always what the label states. Nothing in this record points to this reason.
No recorded reason
RNAWiki has nothing stored that would explain it. Nothing in this record points to this reason.
None of these is a reason to take more. Taking more is not a step this page ever suggests.
What it would be like to take◇Read from sources, not yet reviewed
What taking it involves
The recorded facts about getting hold of it and using it. Nothing here is a suggestion about what you should do.
How it is supplied
Given by a clinician
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
Read from the recorded approval status.
No source is stored against this line.
Form and route
Oral immediate-release tablet (tartrate), oral extended-release tablet (succinate), and intravenous solution for acute use
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form and route recorded on this substance.
No source is stored against this line.
Who oversees it
RNAWiki has not recorded a supervision or regulatory status for this substance.
❝ Quoted from a source
Where this came from
Copied from a source RNAWiki stored, with the source named.
No register row and no identity class settled the question.
No source is stored against this line.
What is in the pack
The tartrate is taken with or immediately after food and is usually twice daily; the succinate is a controlled-release multiple-unit pellet system taken once daily and is the formulation with the heart failure evidence.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on how this is sold. The rest of the recorded wording: The two are not interchangeable milligram for milligram and do not carry the same indications.
No source is stored against this line.
Where it is registered
Regulatory records are listed in the technical disclosure at the foot of this page.
# Counted from records
Where this came from
A count of rows RNAWiki holds. It describes our records, not your body.
Register entries are stored per jurisdiction and shown with their dates.
No source is stored against this line.
Why people stop
Not recorded.
∅ Nothing recorded
Where this came from
RNAWiki holds nothing here and says so rather than guessing.
No record of why people stopped taking it is stored for this substance.
No source is stored against this line.
What it would be like to take◇Read from sources, not yet reviewed
What can go wrong
Sorted by where each line came from. A regulator's label and a report somebody sent in are not the same kind of fact.
·Worth asking a clinician aboutWritten into the record from the studies named on this page
The US label warns explicitly against abrupt cessation in patients with coronary artery disease, because chronic blockade upregulates the receptor and sudden removal can precipitate angina or infarction. Bradycardia, fatigue, dizziness and cold extremities are common. Beta-1 selectivity is relative and is lost at higher exposure, so bronchospasm is a real risk in asthma. Blockade can mask the adrenergic warning symptoms of hypoglycaemia. Clearance is by CYP2D6, so genotype and CYP2D6 inhibitors substantially change exposure.
Nobody counted how many people took this and were fine, so this cannot be turned into a rate.
These are reports people sent to a regulator. They do not show the medicine caused the reaction.
Nobody counted how many people took the medicine and reported nothing.
The same event can be reported more than once, and many reports are incomplete.
News coverage, lawsuits and new warnings change how often people report.
A count is not a rate and not a risk.
Metoprolol appears in spontaneous reports to regulators. Across the 10 most-reported reaction terms, 8020 reaction mentions were counted. One report can name several reactions.
The recorded terms (10)
bradycardia — 1541 reaction mentions
hypotension — 1505 reaction mentions
dizziness — 1124 reaction mentions
dyspnoea — 857 reaction mentions
syncope — 769 reaction mentions
fall — 629 reaction mentions
drug interaction — 447 reaction mentions
atrial fibrillation — 408 reaction mentions
toxicity to various agents — 397 reaction mentions
general physical health deterioration — 343 reaction mentions
open-targets-adr · recorded 2026-06-24 · a recorded source, not a stored snapshot
Over a long time. No completed tested study window is recorded, so long-term effects are not established by the registry record.
Groups the studies covered thinly. Which groups were under-represented in the studies has not been recorded for this substance. Pregnancy, breastfeeding, children, older adults, and people with liver or kidney conditions are commonly excluded from trials; nothing here says whether they were.
What is missing or unclear◇Read from sources, not yet reviewed
Does the exact form matter?
Evidence belongs to the exact thing that was tested. A different salt, a different mixture or a different preparation is a different question.
The form that was studied
Oral immediate-release tablet (tartrate), oral extended-release tablet (succinate), and intravenous solution for acute use
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
The form used in the studies cited on this page.
No source is stored against this line.
What is sold
The two are not interchangeable milligram for milligram and do not carry the same indications.
✎ Source-linked record
Where this came from
A person wrote this into the record with the study named beside it. No reviewer has signed it off.
Recorded notes on which forms are sold and how they compare.
No source is stored against this line.
What is recorded as being sold
567 products list this as an active ingredient in the United States drug directory. 553 of them contain it and nothing else.
FDA National Drug Code directory · 71610-138 · read 2026-08-29
They are sold as capsule, extended release, injection, injection, solution, powder, solution and tablet, taken intravenous and oral.
FDA National Drug Code directory · 71610-138 · read 2026-08-29
The regulator's established pharmacologic class for it is adrenergic beta-antagonists [moa] and beta-adrenergic blocker [epc].
FDA National Drug Code directory · 71610-138 · read 2026-08-29
355 published labels name it as an active ingredient. 350 of them describe this substance alone, which is where its own label text on this page comes from.
US prescribing information · 485f1fdb-6543-4f47-e063-6394a90a2459 · read 2026-08-29
Those labels are classed as human prescription drug.
US prescribing information · 485f1fdb-6543-4f47-e063-6394a90a2459 · read 2026-08-29
2 marketed supplement labels list this ingredient, classed as other combinations.
Those labels carry all other, nutrient and qualified health claims. A claim of that kind is written by the manufacturer and is not assessed by any regulator, so its presence says nothing about whether it is true.
METOPROLOL TARTRATE is film-coated tablets (functional scoring) at Metoprolol tartrate tablets having functional scoring: 25 mg, 50 mg and 100 mg, recorded as prescription product; fda label in effect 2026-07-27 in the United States.
US prescribing information · 00940cc5-d2eb-4841-9138-de97d7b1c674 · read 2026-08-27
Recorded price in US: 0.01597–2.84123 USD per one unit as the pricing file counts it — a tablet, capsule, patch or single item, across 79 priced products whose strengths and pack forms differ, as of 2026-08-26, paid by retail pharmacies buying the product, as surveyed by the Centers for Medicare & Medicaid Services. It is not a list price, an insurance price, or what anyone pays at a counter..
Recorded source · 2026-08-26 · read 2026-08-28
Evidence carries across two names for one substance. It does not carry across a salt, a mirror form or a mixture.
What it would be like to take◇Read from sources, not yet reviewed
What you could measure
This one is decided with a clinician, so this section holds questions to ask rather than a plan to run.
RNAWiki could not confidently classify this substance, so no self-experiment plan is offered.
Questions worth asking
Which of the trials of Metoprolol studied people like me?
What was measured, and for how long?
Was the result a laboratory value or a health outcome?
What would we watch for, and when would we stop?
Tracking can show whether something changed for you. It cannot show what caused it.
RNAWiki records evidence. It does not say whether this substance is right for you.
What is missing or unclear◇Read from sources, not yet reviewed
Claims that go past the evidence
Things said about this substance that sound reasonable, and the exact step that is missing between the evidence and the claim.
✗Goes past the evidence
That the MERIT-HF survival benefit extends to immediate-release metoprolol tartrate — a cross-formulation extrapolation
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That a met composite primary endpoint means net benefit — POISE met its endpoint while increasing death and stroke
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That the pre-2000 post-infarction beta blocker evidence applies to patients treated with modern reperfusion, statins and renin-angiotensin blockade — REDUCE-AMI tested that and found no benefit
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
✗Goes past the evidence
That REDUCE-AMI licenses stopping beta blockers in people already on them — ABYSS tested that separately and failed to show non-inferiority
Why it sounds right. It follows from something real on this page: a body step, an animal result or a related finding.
The missing step. Nobody measured this in people for this use, or the study that did measure it did not show it.
What would change this
A study in people, for this exact use, measuring this exact thing, that a reviewer signs off.
RNAWiki has not yet published a reviewed conclusion for this use.
What is missing or unclear◇Read from sources, not yet reviewed
What nobody knows yet
Open questions, each with why it is open and what would close it.
Missing populations
Which groups were under-represented in the studies has not been recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing long-term data
No completed tested study window is recorded.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
No reviewed conclusion
RNAWiki has not yet published a reviewed conclusion for this use.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Missing interaction studies
No interaction was found in the registers checked. Not finding one is not the same as showing there is none.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Formulation uncertainty
Several salts, forms or products of Metoprolol are recorded. Results from one form may not transfer to another.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
Mechanism not reviewed
No reviewed mechanism story exists for this substance.
Why it matters. Recorded by the evidence model as a gap on this record.
What would answer it
A study that measures it, and a reviewer to sign it off.
Last checked 2026-09-04. Searched: The sources listed in the receipts at the foot of this page.
What happened in people◇Read from sources, not yet reviewed
Check any of this yourself
Every line above traced back to the study it came from. This is the technical layer, and the vocabulary changes here.
Every line above can be traced to the study named beside it. Follow the link and read it.
MERIT-HF: 145 deaths against 217, and the trial was stopped early
In plain words
Nearly four thousand people with heart failure took extended-release metoprolol or placebo on top of their usual treatment. After about a year the safety committee stopped the trial because the treated group was clearly dying less.
What was measured
All-cause mortality over a mean 1 year in chronic heart failure
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
MERIT-HF enrolled 3,991 patients with chronic heart failure in NYHA class II-IV and ejection fraction of 0.40 or less, stabilised on optimum standard therapy, after a 2-week single-blind placebo run-in. 1,990 were assigned metoprolol CR/XL starting at 12.5 mg (class III-IV) or 25 mg (class II) once daily and up-titrated over 8 weeks toward a target of 200 mg; 2,001 received placebo. The independent safety committee recommended early stopping. Mean follow-up was 1 year. All-cause mortality was 145 deaths (7.2% per patient-year) on metoprolol against 217 (11.0%) on placebo: relative risk 0.66 (95% CI 0.53 to 0.81), p=0.00009, or p=0.0062 adjusted for interim analyses. Sudden deaths were 79 against 132 (0.59, 0.45 to 0.78, p=0.0002) and deaths from worsening heart failure 30 against 58 (0.51, 0.33 to 0.79, p=0.0023).
Written into the record, not signed off as a reviewed claim
POISE: the primary endpoint was met and the drug killed people
In plain words
Eight thousand people were given extended-release metoprolol before non-cardiac surgery. They had fewer heart attacks, exactly as intended. They also had a third more deaths and more than double the strokes.
What was measured
All-cause death and stroke at 30 days after non-cardiac surgery, alongside the composite primary endpoint
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
POISE randomised 8,351 patients with or at risk of atherosclerotic disease undergoing non-cardiac surgery to extended-release metoprolol succinate (n=4,174) or placebo (n=4,177), started 2 to 4 hours before surgery and continued for 30 days, across 190 hospitals in 23 countries. The composite primary endpoint of cardiovascular death, non-fatal myocardial infarction and non-fatal cardiac arrest occurred in 244 (5.8%) against 290 (6.9%): hazard ratio 0.84 (95% CI 0.70 to 0.99), p=0.0399 — the endpoint was met. Myocardial infarction fell from 239 (5.7%) to 176 (4.2%): 0.73 (0.60 to 0.89), p=0.0017. But there were 129 deaths (3.1%) on metoprolol against 97 (2.3%) on placebo: 1.33 (1.03 to 1.74), p=0.0317. Stroke occurred in 41 (1.0%) against 19 (0.5%): 2.17 (1.26 to 3.74), p=0.0053. The authors wrote that patients are unlikely to accept the risks associated with perioperative extended-release metoprolol.
Written into the record, not signed off as a reviewed claim
REDUCE-AMI: after a modern, uncomplicated heart attack, no benefit at all
In plain words
For decades everyone leaving hospital after a heart attack went home on a beta blocker. In 2024 a trial of five thousand patients with normal pumping function found it made no difference to death or reinfarction.
What was measured
Composite of death from any cause or new myocardial infarction over a median 3.5 years
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
REDUCE-AMI randomised 5,020 patients at 45 centres in Sweden, Estonia and New Zealand who had an acute myocardial infarction, had undergone coronary angiography and had a left ventricular ejection fraction of at least 50%, to long-term beta blocker (metoprolol or bisoprolol) or no beta blocker, open-label. Median follow-up was 3.5 years. The primary composite of death from any cause or new myocardial infarction occurred in 199 of 2,508 (7.9%) on beta blocker and 208 of 2,512 (8.3%) without: hazard ratio 0.96 (95% CI 0.79 to 1.16), p=0.64. No secondary endpoint favoured treatment either: death from any cause 3.9% against 4.1%, cardiovascular death 1.5% against 1.3%, myocardial infarction 4.5% against 4.7%, hospitalisation for atrial fibrillation 1.1% against 1.4%, hospitalisation for heart failure 0.8% against 0.9%. The evidence the practice rested on came from trials conducted before biomarker-based diagnosis, percutaneous intervention, high-intensity statins and renin-angiotensin blockade were standard.
Written into the record, not signed off as a reviewed claim
ABYSS: stopping an established beta blocker was not non-inferior to continuing
In plain words
A second trial published the same year asked the mirror question: is it safe to stop a beta blocker someone is already on? The answer was no, it did not meet the bar for non-inferiority, and quality of life did not improve either.
What was measured
Composite of death, non-fatal infarction, non-fatal stroke or cardiovascular hospitalisation, interruption versus continuation
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
ABYSS randomised 3,698 patients at 49 French sites with a history of myocardial infarction, an ejection fraction of at least 40% on long-term beta blocker and no cardiovascular event in the previous 6 months, to interruption (n=1,846) or continuation (n=1,852). Median time since the last infarction was 2.9 years and median follow-up 3.0 years. The primary composite of death, non-fatal myocardial infarction, non-fatal stroke or cardiovascular hospitalisation occurred in 432 of 1,812 (23.8%) in the interruption group against 384 of 1,821 (21.1%) in the continuation group: risk difference 2.8 percentage points (95% CI under 0.1 to 5.5), hazard ratio 1.16 (1.01 to 1.33), p=0.44 for non-inferiority against a 3-percentage-point margin. Interruption did not improve quality of life on the EQ-5D. REDUCE-AMI and ABYSS are not in conflict: one asked whether to start, the other whether to stop.
Written into the record, not signed off as a reviewed claim
COMMIT: in 45,852 patients, neither co-primary endpoint moved
In plain words
The largest trial of early beta blockade in acute heart attack found fewer reinfarctions and fewer dangerous rhythms, and exactly as many extra cases of circulatory collapse. Neither of the two main endpoints was reduced.
What was measured
Death, reinfarction or cardiac arrest, and death alone, during up to 4 weeks of treatment
Effect estimate
No reviewed effect estimate exists for this record.
Limits
This entry records a failure.
From the source
COMMIT/CCS-2 randomised 45,852 patients admitted within 24 hours of suspected acute myocardial infarction across 1,250 hospitals to metoprolol (up to 15 mg intravenous then 200 mg oral daily; n=22,929) or matching placebo (n=22,923), continued for up to 4 weeks. Neither co-primary outcome was significantly reduced: death, reinfarction or cardiac arrest occurred in 2,166 (9.4%) against 2,261 (9.9%), odds ratio 0.96 (95% CI 0.90 to 1.01), p=0.1; death alone in 1,774 (7.7%) against 1,797 (7.8%), 0.99 (0.92 to 1.05), p=0.69. Metoprolol produced 5 fewer reinfarctions per 1,000 treated (2.0% against 2.5%, p=0.001) and 5 fewer ventricular fibrillations per 1,000 (2.5% against 3.0%, p=0.001), counterbalanced by 11 more cases of cardiogenic shock per 1,000 (5.0% against 3.9%, odds ratio 1.30, 1.19 to 1.41, p<0.00001). The shock excess fell in days 0 to 1; the benefits emerged gradually afterwards. Net effect was significantly adverse on days 0 to 1 and significantly beneficial thereafter.
Written into the record, not signed off as a reviewed claim
The two metoprolol salts are treated as one drug and their evidence is not shared
In plain words
The survival benefit in heart failure was shown for the extended-release succinate salt. The immediate-release tartrate is a different product and does not carry that indication.
What was measured
That the MERIT-HF mortality benefit applies to immediate-release metoprolol tartrate — a cross-formulation extrapolation from a trial that studied the extended-release succinate
Effect estimate
No reviewed effect estimate exists for this record.
Limits
See the technical detail.
From the source
MERIT-HF studied metoprolol CR/XL, the controlled-release succinate formulation, dosed once daily and up-titrated over 8 weeks toward 200 mg. The US heart failure indication is written for the extended-release succinate product, not for the tartrate. The two salts differ in solubility, release profile and dosing frequency, and the peak-to-trough exposure ratio differs correspondingly — which matters for a drug whose beta-1 selectivity is concentration-dependent. Extrapolating the MERIT-HF mortality result to immediate-release metoprolol tartrate is an inference across formulations, not a finding, and prescribing databases that list "metoprolol" without the salt erase the distinction.
This order is fixed in code and does not count clicks or time on the page.
What is not here
3 questions this page could not answer
These sections were prepared and left out because there was nothing to put in them. They are listed rather than hidden, so the gaps in this record are visible.
What it may clash with — found nothing in the sources checked.
Other ways to the same goal — found nothing in the sources checked.
What changed on this page — found nothing in the sources checked.
The record as stored
The full record, for auditing
Everything above is built from what is below. This layer keeps the technical vocabulary, record identifiers and every stored row, so a reader who wants to check the page can.
The older medicine-wide conclusion held in this record
Written for a clinical reader, and about the medicine as a whole rather than about one indication, population and set of trials. RNAWiki does not treat it as a programme conclusion and no reviewer has signed it off in that form. It is here word for word because it is what the record holds.
A beta-1 selective blocker with one of the cleanest mortality results in cardiology — 145 deaths against 217 in 3,991 heart failure patients — and one of the clearest demonstrations of harm, with 129 deaths against 97 and more than double the strokes in 8,351 patients given it before non-cardiac surgery, in a trial whose primary endpoint it technically met.
Recorded evidence blocks (15)
Q1
What did Metoprolol's largest trial (22213 people) and its longest (17 years) measure?
22213 people in Metoprolol's largest registered study, 17 years in its longest registered window, measuring Mortality. ClinicalTrials.gov · 2026-09-01
79 phase4, 42 phase3, 38 phase1, 31 phase2, 27 na, 11 na or unstated, 2 early phase1; NCT03778554; 2035-12-10. Last human test completed 2026, NCT03566667.
Interpretation These counts include studies where Metoprolol was a comparison treatment, a background treatment or an exposure in an observational study, and the longest window may be a planned end date. Trial roles have not yet been classified for this record.
Show the evidence
phase4
79
phase3
42
phase1
38
phase2
31
na
27
na or unstated
11
2 more recorded rows
early phase1
2
Last recorded human testNCT03566667
2026-04-30
recorded 2026-09-01 · last checked 2026-09-04
Q2
From Drosophila to human: where has Metoprolol shown lifespan?
Interpretation Mortality — the recorded outcome words.
Show the evidence
Drosophila
lifespan
mouse
lifespan
rat
lifespan
humanNCT00302692
lifespan; Mortality; 215
recorded 2026-09-01 · last checked 2026-09-04
Q3
30 of Metoprolol's trials stopped: safety, futility/efficacy, accrual/recruitment, funding/business, other?
safety (4), futility/efficacy (1), accrual/recruitment (9), funding/business (3) and other (13): Metoprolol's stop wording, clustered. ClinicalTrials.gov · 2026-09-01
"No patient could be recruited."; 30 of 215 registered studies
Show the evidence
Trial
NCT00152633
withdrawn; "No patient could be recruited."
NCT00384566
withdrawn; "In order to join forces with another study already running which aims to answer the same question."
NCT00401882
terminated; "Difficult accrual"
NCT00491387
terminated; "Adverse events reported with beta-blockers as primary therapy."
NCT00585871
withdrawn; "could not recruit"
NCT00589303
terminated; "Lack of funding"
14 further recorded trials
NCT00627861
terminated; "The renin laboratory used in the study is no longer available."
NCT00675714
terminated; "At the request of the study site, this study has been closed and access to study-related data is unavailable. We are unable to submit the results-data."
NCT00806390
terminated; "Poor enrollment"
NCT00849810
terminated; "Difficulty with recruiting willing participants."
NCT00993421
terminated; "Clinical trial terminated due to results from recent nonclinical studies"
NCT01051947
withdrawn; "Similar study already published"
NCT01330654
withdrawn; "no patients were enrolled. Study was closed prior to study start."
NCT01404767
terminated; "Enrollment slow over 2 years a change in the population less on metoprolol than initially anticipated"
NCT01441570
terminated; "due to slow enrollment"
NCT01605370
terminated; "Difficulty in identifying subjects satisfying the inclusion criteria."
NCT01837069
terminated; "Low recruitment / DSMB approval to halt recruitment"
NCT01902810
terminated; "At the request of the study site, this study has been closed and access to study-related data is unavailable. We are unable to submit the results-data."
NCT01957449
terminated; "At the request of the study site, this study has been closed and access to study-related data is unavailable. We are unable to submit the results-data."
NCT02269696
withdrawn; "Withdrawn"
recorded 2026-09-01 · last checked 2026-09-04
Q4
Human studies of Metoprolol used Metoprolol Tartrate Tablets 25 mg — over how long?
20 recorded entries; human; also "Lopressor® Tablets 50 mg", "Metoprolol Tartrate Tablets 100 mg", "Lopressor® Tablets 100 mg"
Show the evidence
human
NCT00648271
Metoprolol Tartrate Tablets 25 mg
NCT00648271
Lopressor® Tablets 50 mg
NCT00649116
Metoprolol Tartrate Tablets 100 mg
NCT00649116
Lopressor® Tablets 100 mg
NCT01044693
metoprolol tartrate 50 mg
NCT01884857
Metoprolol Succinate ER Tablets 50 mg
14 more recorded rows
humanNCT01884857
'TOPROL-XL®' ER Tablets 50 mg
humanNCT01884896
Metoprolol Succinate ER Tablet 200 mg
humanNCT01884896
'TOPROL-XL®' ER Tablets 200 mg
humanNCT02924454
Sodium chloride 0.9% solution - metoprolol dummy
humanNCT03072082
Metoprolol Tartrate Tab 25 MG
humanNCT03082352
BF-Metoprolol Tablet 100mg
humanNCT03082352
Metoprolol Tablet 100mg
humanNCT03082352
Betaloc Tablet 100mg
humanNCT03286829
Comperator 1 mg tesofensine, 25 mg commercial IR metoprolol, 75 mg commercial ER metoprolol, fasted condition.
humanNCT03384524
Metoprolol 25 MG
humanNCT03488719
Metoprolol Succinate 25 MG
humanNCT03488719
Metoprolol Succinate 50 MG
humanNCT03488719
Metoprolol Succinate 100 MG
humanNCT04425902
Metoprolol 100 mg
recorded 2026-09-01 · last checked 2026-09-04
Q5
Metoprolol's half-life is 3 to 4 hours (7 to 9 hours in poor CYP2D6 metabolizers) — which schedules were studied?
3 to 4 hours (7 to 9 hours in poor CYP2D6 metabolizers), the half-life Metoprolol's label states. openfda-label · 59ed0d9a-54c8-4c13-e063-6394a90a2aaa · 2026-08-27
bioavailability about 50% %.
Show the evidence
half life
3 to 4 hours (7 to 9 hours in poor CYP2D6 metabolizers) hours; The mean elimination half-life of metoprolol is 3 to 4 hours; in poor CYP2D6 metabolizers the half-life may be 7 to 9 hours.
bioavailability
about 50% %; The estimated oral bioavailability of immediate release metoprolol is about 50% because of pre-systemic metabolism which is saturable leading to non-proportionate increase in the exposure with increased dose.
metabolism
The peak plasma levels following oral administration of conventional metoprolol tablets, however, approximate 50% of levels following intravenous administration, indicating about 50% first-pass metabolism.
recorded 2026-08-27 · last checked 2026-09-04
Q6
Could one person measure Metoprolol's effect on flow mediated dilation?
Flow mediated dilation: measured in Metoprolol's trials.
Interpretation flow mediated dilation is the recorded endpoint.
Show the evidence
biomarkers
flow mediated dilation; 2026-09-01
retinal endothelial function; 2026-09-01
decrease in supine systolic blood pressure; 2026-09-01
low density lipoprotein cholesterol; 2026-09-01
systolic blood pressure; 2026-09-01
hba1c; 2026-09-01
14 more recorded rows
biomarkers
blood pressure response; 2026-09-01
biomarkers
mortality; 2026-09-01
biomarkers
cardiovascular morbidity; 2026-09-01
biomarkers
respiratory function; 2026-09-01
biomarkers
return of spontaneous circulation; 2026-09-01
biomarkers
symptoms questionnaire derived; 2026-09-01
biomarkers
episodes of non sustained ventricular tachycardia; 2026-09-01
biomarkers
cognitive assessment trail making test part b; 2026-09-01
2026-09-04; halfLife; hours; 3 to 4 hours (7 to 9 hours in poor CYP2D6 metabolizers); 2026-08-27
human trials at or under30
73
smallest human trial
0; NCT00152633; PHASE2/PHASE3; the smallest recorded human enrolment at or below 30; the registry states no direction of its result; WITHDRAWN
Q7
Which of a clinical or laboratory adverse experience, achieving blood pressure goals and area under the curve of etsev over the first hour did Metoprolol's trials measure?
a clinical or laboratory adverse experience, achieving blood pressure goals and area under the curve of etsev over the first hour lead 40 outcome terms across Metoprolol's trials. ClinicalTrials.gov · 2026-09-01
low density lipoprotein cholesterol, systolic blood pressure, hba1c, blood pressure response, mortality and cardiovascular morbidity follow.
Show the evidence
flow mediated dilation
1
retinal endothelial function
1
decrease in supine systolic blood pressure
1
low density lipoprotein cholesterol
1
systolic blood pressure
1
hba1c
1
14 more recorded rows
blood pressure response
1
mortality
1
cardiovascular morbidity
1
respiratory function
1
return of spontaneous circulation
1
symptoms questionnaire derived
1
episodes of non sustained ventricular tachycardia
1
cognitive assessment trail making test part b
1
cognitive assessment forward digit span test
1
plasma renin concentration
1
trough sitting diastolic blood pressure
1
bioequivalence
1
achieving blood pressure goals
1
glycosylated hemoglobin at week 26
1
recorded 2026-09-01 · last checked 2026-09-04
Q8
Which of Metoprolol's 20 ongoing trials reports first?
Plaque to Myocardial Ratio (PMR).; Metaprolol concentration in blood serum (area under curve (AUC)); latest 2035-12-10
Show the evidence
Trial
NCT03504956
"Coronary Atherosclerosis T1-Weighted Characterization (CATCH)"; n 150; "Plaque to Myocardial Ratio (PMR)."; 2027-12-31
NCT03519906
"Bariatric Surgery and Pharmacokinetics of Metoprolol"; n 12; "Metaprolol concentration in blood serum (area under curve (AUC))"; 2026-10
NCT03778554
"Danish Trial of Beta Blocker Treatment After Myocardial Infarction Without Reduced Ejection Fraction"; n 2760; "A composite of all-cause mortality, recurrent MI, revascularisation with PCI or CABG, ischemic stroke, incident heart failure, or malignant ventricular arrhythmia including resuscitated cardiac arrest of cardiac origin."; 2035-12-10
NCT04914234
"Premedication With Atenolol Versus Metoprolol for Controlled Hypotensive Anesthesia During Nasal Surgeries"; n 60; "Mean and Standard deviation of Blood loss (ml)(mean±SD)"; 2026-01-30
NCT04996550
"Are Carvedilol and Metoprolol Succinate Comparable Treatments in Heart Failure Patients With Reduced Ejection Fraction"; n 5600; "A combined endpoint of all-cause mortality or first hospitalization for worsening heart failure."; 2028-12-18
NCT05631730
"Effect and Safety of Flecainide and Metoprolol Versus Metoprolol Alone to Suppress Ventricular Arrhythmias in Arrhythmic Mitral Valve Prolapse"; n 50; "Number of ventricular tachyarrhythmias"; 2026-06
14 further recorded trials
NCT05931276
"CSP #2026 - Beta Blocker Dialyzability on Cardiovascular Outcomes"; n 2540; "Time to major cardiovascular event"; 2028-12-31
NCT06569212
"Beta-1 Adrenergic Inhibition to Reduce Cardiac Injury and Inflammation After Subarachnoid Hemorrhage (BADCATS)"; n 20; "Delta QTc length"; 2029-09
NCT06864234
"Effect of Beta-blockers on Coronary Flow and Resistance in Patients With ANOCA"; n 46; "Change from baseline in the absolute coronary flow 10 minutes after administration of the intervention"; 2025-12-31
NCT06964464
"Comparative Effectiveness of Carvedilol Versus Metoprolol Succinate in Heart Failure Patients With an Implantable Cardioverter Defibrillator"; n 2000; "Composite Endpoint: First Occurrence of ICD Therapy, Cardiovascular Hospitalization, or Cardiovascular Death"; 2031-07-01
NCT06967194
"Early Beta Blocker Administration in STEMI Patients With SCAI B Status"; n 200; "Number of patients progressed from SCAI B to SCAI C"; 2027-06
NCT07268170
"Heart Rate Control Before Cardiac Computed Tomography in Adults for the Evaluation of Coronary Artery Disease"; n 350; "Dose and type of drugs with the swiftest heart rate reduction in patients undergoing cardiac computed tomography"; 2028-09-30
NCT07298993
"Deprescribing Beta-Blockers in Elders With Heart Failure With Preserved Ejection Fraction (DEPRESCRIBE-HFpEF)"; n 240; "The Hierarchical Composite Endpoint"; 2029-04
NCT07490067
"Mechanistic Clinical Trial Comparing the Pharmacokinetics/Pharmacodynamics of Metoprolol in Heart Failure With Reduced Ejection Fraction Patients With Low vs. High Polygenic Score"; n 100; "Half Maximal Effective Concentration of Change in Exercise-Induced Heart Rate (EC50 of ΔEIHR)"; 2029-07
NCT07519161
"Pharmacological Intervention to Prevent NOAF After TAVR"; n 198; "New-Onset Atrial Fibrillation"; 2030-03-31
NCT07568574
"Impact of Medically Supervised Performance-Enhancing Substances (PES) on Elite Athletes"; n 60; "The incidence and severity of Treatment-related adverse events (TRAEs), including adverse events (AEs) and serious adverse events (SAEs), as assessed by the study physicians from baseline to 5.5 years after enrollment."; 2033-03-01
NCT07597564
"Dose-Response Interaction of Metoprolol and Sufentanil for Attenuating Hemodynamic Responses in Tracheal Intubation"; n 900; "Percentage of participants achieving hemodynamic stability after tracheal intubation"; 2027-05-22
NCT07706075
"Comparing Two Heart Medicines for Fast, Irregular Heartbeat (Atrial Fibrillation)"; n 120; "Proportion of Participants Achieving Target Heart Rate Control Within 30 Minutes"; 2027-08-01
NCT07750587
"Predicting Response and Exposure Changes in Cirrhosis for Effectiveness"; n 45; "Unbound clearance (CL) of each parent drug"; 2028-12-01
NCT07755904
"BHB-1893 Versus Metoprolol for Symptomatic Obstructive Hypertrophic Cardiomyopathy"; n 210; "Change from Baseline in Peak Oxygen Uptake (pVO2) by Cardiopulmonary Exercise Testing (CPET)"; 2028-11
recorded 2026-09-01 · last checked 2026-09-04
Q9
Which running trial of Metoprolol could settle vo2max?
NCT07755904 measures Change from Baseline in Peak Oxygen Uptake (pVO2) by Cardiopulmonary Exercise Testing (CPET), reading out 2028-11.
3 open trials; n 210; "BHB-1893 Versus Metoprolol for Symptomatic Obstructive Hypertrophic Cardiomyopathy"
Show the evidence
Trial
NCT07755904
"BHB-1893 Versus Metoprolol for Symptomatic Obstructive Hypertrophic Cardiomyopathy"; n 210; "Change from Baseline in Peak Oxygen Uptake (pVO2) by Cardiopulmonary Exercise Testing (CPET)"; 2028-11
NCT04996550
"Are Carvedilol and Metoprolol Succinate Comparable Treatments in Heart Failure Patients With Reduced Ejection Fraction"; n 5600; "A combined endpoint of all-cause mortality or first hospitalization for worsening heart failure."; 2028-12-18
NCT03778554
"Danish Trial of Beta Blocker Treatment After Myocardial Infarction Without Reduced Ejection Fraction"; n 2760; "A composite of all-cause mortality, recurrent MI, revascularisation with PCI or CABG, ischemic stroke, incident heart failure, or malignant ventricular arrhythmia including resuscitated cardiac arrest of cardiac origin."; 2035-12-10
Q10
Which 62 trials of Metoprolol posted no result?
Posted no result
62 of 62 completed trials
Registrations
NCT00000499, NCT01478490, NCT00648271, NCT00649116, NCT00038077 and NCT00475462, and 56 more
Completion dates
oldest 1983-05; newest 2024-03-20
Show the evidence
Trial
NCT00000499
1983-05
NCT01478490
2002-11
NCT00648271
2003-01
NCT00649116
2003-01
NCT00038077
2003-09
NCT00475462
2003-12
14 further recorded trials
NCT00060918
2004-04
NCT00060931
2004-04
NCT00642096
2004-07
NCT04364139
2007-06-30
NCT00166400
2007-07
NCT00226096
2007-09
NCT03370835
2008-06
NCT01248338
2009-12
NCT01587638
2009-12
NCT00313157
2010-09
NCT01211821
2010-11
NCT01673997
2011-01
NCT01694797
2011-01
NCT01655303
2011-12
Q11
At the median, Metoprolol's trials enrolled 53 people — anything larger?
Median enrolment
53
Largest enrolment
22213
Registered trials counted
213
Q12
What do 8020 spontaneous reports say about Metoprolol — and not say?
These are reports people sent to a regulator. They do not show the medicine caused the reaction. Nobody counted how many people took the medicine and reported nothing. The same event can be reported more than once, and many reports are incomplete. News coverage, lawsuits and new warnings change how often people report. A count is not a rate and not a risk.
Metoprolol appears in spontaneous reports to regulators. Across the 10 most-reported reaction terms, 8020 reaction mentions were counted: bradycardia 1541; hypotension 1505; dizziness 1124; dyspnoea 857. open-targets-adr · CHEMBL13 · 2026-06-24
Show the evidence
bradycardia
1541
hypotension
1505
dizziness
1124
dyspnoea
857
syncope
769
fall
629
4 more recorded rows
drug interaction
447
atrial fibrillation
408
toxicity to various agents
397
general physical health deterioration
343
recorded 2026-06-24 · last checked 2026-09-04
Q13
Metoprolol and CYP2D6: shared by which compounds?
CYP2D6 appear in Metoprolol's recorded interaction sentences, 4 in all. openfda-label+europepmc · 2026-08-30
Interpretation pharmacokinetics
Show the evidence
CYP2D6
pharmacokinetics
Metoprolol is a racemic mixture of R- and S- enantiomers, and is primarily metabolized by CYP2D6.
pharmacokinetics
Metoprolol is metabolized predominantly by CYP2D6, an enzyme that is absent in about 8% of Caucasians (poor metabolizers) and about 2% of most other populations.
pharmacokinetics
Poor metabolizers and extensive metabolizers who concomitantly use CYP2D6 inhibiting drugs will have increased (several-fold) metoprolol blood levels, decreasing metoprolol's cardioselectivity [see Drug Interactions (7.2) ] .
pharmacokinetics
CYP2D6 can be inhibited by a number of drugs.
recorded 2026-08-30 · last checked 2026-09-04
Q14
Was Metoprolol studied with fasting and exercise?
fasting and exercise are named in Metoprolol's label sentences: "In a randomized, controlled, crossover trial, 12 healthy subjects received a single administration of a cytochrome P450 (CYP) probe cocktail, consisting of caffeine (CYP1A2), metoprolol (CYP2D6), midazolam (CYP3A4), omeprazole (CYP2C19) and warfarin (CYP2C9), on four occasions: an oral (1) and…" openfda-label+europepmc · 2026-08-30
2 recorded statements; fasting, exercise
Show the evidence
fasting
In a randomized, controlled, crossover trial, 12 healthy subjects received a single administration of a cytochrome P450 (CYP) probe cocktail, consisting of caffeine (CYP1A2), metoprolol (CYP2D6), midazolam (CYP3A4), omeprazole (CYP2C19) and warfarin (CYP2C9), on four occasions: an oral (1) and intravenous (2) administration after an overnight fast (control) and an oral (3) and intravenous (4)…
exercise
The Metoprolol vs Aficamten in Patients with Left Ventricular Outflow Tract Obstruction on Exercise Capacity in HCM (MAPLE-HCM) trial characterizes comprehensive exercise response to aficamten monotherapy vs β-blockade (metoprolol).
recorded 2026-08-30 · last checked 2026-09-04
Q15
What is recorded about Metoprolol and sirtuin?
"Subsequently, metoprolol disrupted mitochondrial biogenesis machinery through the negative regulation of the SIRT1/PGC-1α/NRF1/TFAM signaling axis, which was followed by apoptotic cell death." — where Metoprolol and sirtuin appear together. Europe PMC · pathway abstract search · 2025-08-24
"Subsequently, metoprolol disrupted mitochondrial biogenesis machinery through the negative regulation of the SIRT1/PGC-1α/NRF1/TFAM signaling axis, which was followed by apoptotic cell death."
NAD+PMID 39335471
"The study drugs were administered intragastrically-new drug Hypertril (1-(β-phenylethyl)-4-amino-1,2,4-triazolium bromide)-3.5 mg/kg, Metoprolol-15 mg/kg, Nebivolol -10 mg/kg, Carvedilol 50 mg/kg, and Bisoprolol, 10 mg/kg. In the myocardium, the main indices of energy metabolism were determined-ATP, ADP, AMP, malate, lactate, pyruvate, succinate dehydrogenase (SDH) activity, and NAD-dependent…"
mTORPMID 35800350
"We constructed a fluorescently labeled adenovirus carrying the wild-type or R302Q mutant of the <i>PRKAG2</i> gene, infected neonatal rat cardiomyocytes (NRCMs) and H9C2 cell lines, and then analyzed changes in AMP-activated protein kinase (AMPK) activity, cell hypertrophy, glycogen storage, and cell proliferation when presence or absence of metoprolol or protein kinase A (PKA) inhibition H89,…"
AMPKPMID 35800350
"We constructed a fluorescently labeled adenovirus carrying the wild-type or R302Q mutant of the <i>PRKAG2</i> gene, infected neonatal rat cardiomyocytes (NRCMs) and H9C2 cell lines, and then analyzed changes in AMP-activated protein kinase (AMPK) activity, cell hypertrophy, glycogen storage, and cell proliferation when presence or absence of metoprolol or protein kinase A (PKA) inhibition H89,…"
mTORPMID 35800350
"Application of either β1-adrenergic receptor (β1-AR) blocker metoprolol or PKA inhibitor H89 to the cardiomyocytes rescued the hypertrophic cardiomyopathy (HCM)-like phenotypes induced by <i>PRKAG2</i> R302Q, including suppression of both AKT-mTOR phosphorylation and AMPK activity."
AMPKPMID 35800350
"Application of either β1-adrenergic receptor (β1-AR) blocker metoprolol or PKA inhibitor H89 to the cardiomyocytes rescued the hypertrophic cardiomyopathy (HCM)-like phenotypes induced by <i>PRKAG2</i> R302Q, including suppression of both AKT-mTOR phosphorylation and AMPK activity."
3 more recorded rows
NAD+
"The study drugs were administered intragastrically – new drug Hypertril (1-(β-phenylethyl)-4-amino-1,2,4-triazolium bromide)-3.5 mg/kg, metoprolol - 15 mg/kg, Nebivolol -10 mg/kg, Carvedilol 50 mg/kg, Bisoprolol, 10 mg/kg. In the myocardium, the main indices of energy metabolism were determined - ATP, ADP, AMP, malate, lactate, pyruvate, succinate dehydrogenase (SDH) activity, NAD-dependent…"
mTOR
"Application of either β1-AR blocker metoprolol or protein kinase A (PKA) inhibitor H89 to the cardiomyocytes rescued the HCM-like phenotypes induced by PRKAG2 R302Q, including suppression of both AKT-mTOR phosphorylation and AMPK activity."
AMPK
"Application of either β1-AR blocker metoprolol or protein kinase A (PKA) inhibitor H89 to the cardiomyocytes rescued the HCM-like phenotypes induced by PRKAG2 R302Q, including suppression of both AKT-mTOR phosphorylation and AMPK activity."
sirtuin
PMID 29097705
"Moreover, metoprolol dramatically inhibited the impairment of atrial energy metabolism by activating the Sirt1-AMPK pathway."
PMID 29097705
"In vitro, metoprolol significantly activated the Sirt1-AMPK pathway in intermittent hypoxic and isoproterenol-treated HL-1 cells, and the effect was abolished by the coadministration of EX-527, an inhibitor of Sirt1 activation."
autophagyPMID 36103993
"Following phenotypic characterization, expanded Hem-ECs, at P2 to P6, were exposed to different concentrations (50 μM to 150 μM) of propranolol, atenolol or metoprolol alone and in combination with the autophagy inhibitor Bafilomycin A1."
NAD+PMID 36677711
"In this study, the photocatalytic activity of V2O5 was investigated through the degradation of nadolol (NAD), pindolol (PIN), metoprolol (MET), and their mixture under ultraviolet (UV) irradiation in water."
recorded 2025-08-24 · last checked 2026-09-04
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