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class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK501156_"><span class="title" itemprop="name">Metoprolol</span></h1><p class="fm-aai"><a href="#_NBK501156_pubdet_">Publication Details</a></p><p><em>Estimated reading time: 3 minutes</em></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><p>CASRN: 37350-58-6</p><a href="https://pubchem.ncbi.nlm.nih.gov/substance/403393902" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=403393902" alt="image 403393902 in the ncbi pubchem database" /></a><div id="LM296.Drug_Levels_and_Effects"><h2 id="_LM296_Drug_Levels_and_Effects_">Drug Levels and Effects</h2><div id="LM296.Summary_of_Use_during_Lactation"><h3>Summary of Use during Lactation</h3><p>Because of the low levels of metoprolol in breastmilk, amounts ingested by the infant are small and would not be expected to cause any adverse effects in breastfed infants. Studies on the use of metoprolol during breastfeeding have found no adverse reactions in breastfed infants. Monitor breastfed infants for symptoms of beta blockade such as bradycardia and listlessness due to hypoglycemia.</p></div><div id="LM296.Drug_Levels"><h3>Drug Levels</h3><p>The excretion of beta-adrenergic blocking drugs into breastmilk is largely determined by their protein binding. Those with low binding are more extensively excreted into breastmilk.[<a class="bibr" href="#LM296.REF.1" rid="LM296.REF.1">1</a>] Accumulation of the drugs in the infant is related to the fraction excreted in urine. With 10% protein binding, 40% renal excretion and a moderate half-life, metoprolol presents moderately low risk for accumulation in infants.</p><p><i>Maternal Levels.</i> With metoprolol doses of 50 mg orally twice daily, milk levels are usually less than 420 mcg/L.[<a class="bibr" href="#LM296.REF.2" rid="LM296.REF.2">2</a>-<a class="bibr" href="#LM296.REF.4" rid="LM296.REF.4">4</a>] Five women taking oral metoprolol 100 to 200 mg daily had average milk metoprolol levels of 316 mcg/L.[<a class="bibr" href="#LM296.REF.5" rid="LM296.REF.5">5</a>] It is estimated that a breastfed infant would receive a dose of about 0.07 mg/kg daily in breastmilk with a maternal dose of 200 mg daily.[<a class="bibr" href="#LM296.REF.4" rid="LM296.REF.4">4</a>]</p><p>Peak milk levels of 106 to 689 mcg/L have been reported following doses of 100 mg orally twice daily.[<a class="bibr" href="#LM296.REF.4" rid="LM296.REF.4">4</a>,<a class="bibr" href="#LM296.REF.6" rid="LM296.REF.6">6</a>] Peak milk levels occurred about 30 minutes after peak serum levels, at 1.5 hours after the dose in two patients, and 6 hours after the dose in a third.[<a class="bibr" href="#LM296.REF.6" rid="LM296.REF.6">6</a>]</p><p>Two women who were taking metoprolol (dosage not specified). Milk samples were obtained over one dosage interval. The dosage of metoprolol and alpha-hydroxymetoprolol in breastmilk was less than 2% of the mother's weight-adjusted dose.[<a class="bibr" href="#LM296.REF.7" rid="LM296.REF.7">7</a>]</p><p>Three mothers who took metoprolol in unspecified dosages during breastfeeding had breastmilk samples collected every 2 to 3 hours over one dosage interval. The average amount of metoprolol excreted in breast milk was 71.5 mcg daily (range 17.0 to 158.7 mcg daily). The average relative infant dosage was 0.5% of the mother's weight-adjusted dosage. Renal clearance of metoprolol was increased during lactation at 3 to 4 months postpartum, possibly related to increased maternal prolactin.[<a class="bibr" href="#LM296.REF.8" rid="LM296.REF.8">8</a>]</p><p><i>Infant Levels.</i> Metoprolol was undetectable (<2.7 mcg/L) in the plasma of 3 infants aged 4, 10 and 60 days after maternal oral doses of 100 mg daily.[<a class="bibr" href="#LM296.REF.2" rid="LM296.REF.2">2</a>]</p><p>Metoprolol serum levels in 3- to 5-day-old breastfed infants ranged from 0.5 to 2.9 mcg/L after maternal doses of 50 or 100 mg twice daily.[<a class="bibr" href="#LM296.REF.3" rid="LM296.REF.3">3</a>,<a class="bibr" href="#LM296.REF.9" rid="LM296.REF.9">9</a>]</p><p>A woman was taking metoprolol 100 mg daily for hypertension during pregnancy and postpartum. Her breastfed infant's serum concentrations of metoprolol and its active metabolite, alpha-hydroxymetoprolol, were undetectable on days 4 and 182 postpartum.[<a class="bibr" href="#LM296.REF.10" rid="LM296.REF.10">10</a>]</p></div><div id="LM296.Effects_in_Breastfed_Infants"><h3>Effects in Breastfed Infants</h3><p>A study of mothers taking beta-blockers during nursing found a numerically, but not statistically significant increased number of adverse reactions in those taking any beta-blocker. Although the ages of infants were matched to control infants, the ages of the affected infants were not stated. Of 6 mothers taking metoprolol, none reported adverse effects in her breastfed infant.[<a class="bibr" href="#LM296.REF.11" rid="LM296.REF.11">11</a>,<a class="bibr" href="#LM296.REF.12" rid="LM296.REF.12">12</a>]</p><p>A prospective study of pregnant patients taking a beta-blocker asked mothers to complete a questionnaire about postpartum breastfeeding and any side effects in their breastfed infants. Two mothers reported taking metoprolol in unreported dosages while breastfeeding. Neither reported any adverse reactions in their breastfed infants.[<a class="bibr" href="#LM296.REF.13" rid="LM296.REF.13">13</a>]</p></div><div id="LM296.Effects_on_Lactation_and_Breastmil"><h3>Effects on Lactation and Breastmilk</h3><p>Relevant published information on the effects of beta-blockade or metoprolol during normal lactation was not found as of the revision date. A study in 6 patients with hyperprolactinemia and galactorrhea found no changes in serum prolactin levels following beta-adrenergic blockade with propranolol.[<a class="bibr" href="#LM296.REF.14" rid="LM296.REF.14">14</a>]</p></div><div id="LM296.Alternate_Drugs_to_Consider"><h3>Alternate Drugs to Consider</h3><p><a href="/books/n/lactmed/LM301/?report=reader">Propranolol</a>, <a href="/books/n/lactmed/LM291/?report=reader">Labetalol</a></p></div><div id="LM296.References"><h3>References</h3><dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><div class="bk_ref" id="LM296.REF.1">Riant
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[<a href="https://pubmed.ncbi.nlm.nih.gov/556882" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 556882</span></a>]</div></dd></dl></dl></div></div><div id="LM296.Substance_Identification"><h2 id="_LM296_Substance_Identification_">Substance Identification</h2><div id="LM296.Substance_Name"><h3>Substance Name</h3><p>Metoprolol</p></div><div id="LM296.CAS_Registry_Number"><h3>CAS Registry Number</h3><p>37350-58-6</p></div><div id="LM296.Drug_Class"><h3>Drug Class</h3><p>Breast Feeding</p><p>Lactation</p><p>Milk, Human</p><p>Antihypertensive Agents</p><p>Adrenergic Beta-Antagonists</p><p>Antiarrhythmics</p></div></div><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_top_margin"><p><b>Disclaimer: </b>Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.</p></p></div></dd></dl></dl></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK501156_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Revision: <span itemprop="dateModified">November 15, 2024</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a><p class="small"><b>Attribution Statement:</b> LactMed is a registered trademark of the U.S. Department of Health and Human Services.</p></div></div><h3>Publisher</h3><p><a href="https://www.nlm.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Child Health and Human Development</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-. Metoprolol. [Updated 2024 Nov 15].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/lactmed/LM181/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/lactmed/LM440/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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