How Long Does It Take Metoprolol to Work? Pharmacists Answer 5 FAQs

Metoprolol is part of a group of medications called beta blockers. More specifically, it’s a “cardioselective” beta blocker, meaning it mainly affects the heart. It comes in two forms: metoprolol tartrate (Lopressor), which is the immediate-release (IR) form, and metoprolol succinate (Toprol XL), which is the extended-release (ER) form.

Metoprolol can slow your heart rate and lower your blood pressure. This is why it’s used to treat several heart-related conditions, such as high blood pressure (hypertension) and chest pain (angina). Metoprolol IR is also approved to lower the risk of death after a heart attack, and metoprolol ER is approved to treat heart failure.

How long metoprolol takes to work, and how long you’ll need to take it, depend on what you’re treating. Here, pharmacists answer these frequently asked questions and more.

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1. How long does it take metoprolol to work?

In general, both forms of metoprolol start working about an hour after you take them. This means you may experience a decrease in your blood pressure or heart rate around this time. But depending on what you’re treating, it may take longer to see the full effects of metoprolol.

For example, if you’re taking metoprolol for hypertension, it can take 1 to 2 weeks to see the full blood pressure-lowering effects.

Being on the right dose of metoprolol IR or metoprolol ER is critical to its effectiveness. Usually, your prescriber will start you at a lower dosage and then increase it after about a week or more. This approach helps lower your risk of side effects. It also helps you avoid taking a dose that’s higher than needed to treat your condition.

2. How do you know if metoprolol is working?

Depending on what you’re treating, you may not be able to tell whether metoprolol is working. This is because it often works by preventing future heart problems, rather than providing immediate relief.

For example, you’ll typically start taking metoprolol within 24 hours after a heart attack. It can help reduce stress on your heart and lower your risk of death, although you may not be able to physically feel these beneficial effects. Still, even if you don’t feel different, taking metoprolol consistently over time is crucial to receiving its full benefits. 

On the other hand, you may notice your symptoms improving in some cases. For example, if you’re using metoprolol to treat angina, your chest pain should improve after starting it. And you may feel less tired when you exercise. But it needs to be taken daily for it to work. If you still have chest pain after you start taking it, let your prescriber know. You may need a higher dose of metoprolol.

Additionally, your home blood pressure readings can help you determine whether metoprolol is working for your hypertension. If your blood pressure is too high or too low, you may need a dosage change. Watch for signs of high blood pressure (such as headache or shortness of breath) or low blood pressure (such as dizziness). If you experience any of these symptoms, contact your prescriber.

3. How long do I have to take metoprolol?

Metoprolol is usually taken long term. Many people take metoprolol for several years or even indefinitely.

But in some cases, metoprolol treatment may not last this long. For example, if you’re taking metoprolol after a heart attack, treatment is recommended for at least 3 months — or possibly longer if you have certain heart problems.

Talk with your prescriber about how long they expect you'll need to take metoprolol. And if you’re experiencing metoprolol side effects, let your prescriber know. 

Don’t stop taking metoprolol on your own. Stopping it abruptly can put extra stress on your heart and rapidly increase your heart rate and blood pressure. If your prescriber recommends stopping metoprolol, they’ll likely lower your dose over time.

4. Does metoprolol cause weight gain?

It’s possible, but it doesn’t happen to everyone. For those who do experience weight gain from metoprolol, it usually occurs during the first few months of treatment. If you do experience weight gain, it may be between 2.5 lbs and 5 lbs.

Some research shows metoprolol causes weight gain by slowing your metabolism. But weight gain might also occur because metoprolol can make you tired and fatigued, making it difficult for some people to maintain their usual level of physical activity. 

To prevent weight gain from metoprolol, practice healthy eating and movement habits. Consider small, simple changes, such as:

• Include fiber-rich foods and a protein source with each meal to feel full longer.

• Move your body throughout the day. Take the stairs, go for a quick walk, or get up and dance. For adults, at least 150 minutes of moderate-intensity cardio, or at least 75 minutes of vigorous or high-intensity exercise, is recommended weekly.

• Don’t drink your calories. Water is the best way to stay hydrated.

Let your prescriber know if you’re struggling to stay active or you gain weight after starting metoprolol. They may recommend a dosage change or switch you to a different medication entirely. For example, carvedilol (Coreg) is a beta blocker that’s less likely to cause weight gain.

However, sudden weight gain can be a symptom of worsening heart failure, especially if you also experience shortness of breath. So, make sure your prescriber is aware if you’re experiencing these symptoms.

5. Is metoprolol safe?

Metoprolol has been used for decades and is considered safe for most people to take. But like all medications, metoprolol can cause side effects, too. For example, you may feel sluggish, light-headed, or dizzy when you start taking it. Typically, these symptoms improve as your body adjusts to the medication. Still, avoid tasks that require alertness (such as driving) until you know how metoprolol affects you. And move slowly when going from a seated or lying-down position to standing.

Other possible metoprolol side effects include diarrhea or rash. Some people also notice changes in their sex life or sleeping habits. A heart rate that’s too slow and other problems can also occur. But these risks are usually rare.

Additionally, people with chronic lung conditions, such as asthma and chronic obstructive pulmonary disease (COPD), should let their healthcare professional know before taking metoprolol, since it can make these conditions worse in rare cases. People with diabetes may also need to check their blood sugars more frequently, since metoprolol can cause high blood glucose (sugar). It can also mask the signs of low blood glucose. Metoprolol can also make a condition called Raynaud's phenomenon (blood vessel spasm in the fingers and toes) worse.

Who shouldn’t take metoprolol?

Metoprolol isn’t safe for everyone. You’ll likely need to avoid metoprolol if you have any of the following health conditions:

• Severe heart failure

• Severely low heart rate and/or blood pressure, which can occur in certain kinds of heart block and cardiac shock

• Sick sinus syndrome (a heart rhythm disorder)

Why trust our experts?

Written by:

Daphne Berryhill, RPh

Daphne Berryhill, RPh, has two decades of experience as a clinical pharmacist. She spent most of her career in the Chicago area practicing in-home infusion.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

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