Metoprolol kinetics

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Overview of Metoprolol

Metoprolol is a commonly used medication in the class of beta-blockers. It is primarily prescribed for the management of high blood pressure, angina, and heart failure. Metoprolol works by blocking the effects of adrenaline on the heart, reducing the heart rate, and decreasing the workload on the heart. This helps to lower blood pressure and improve the efficiency of the heart’s pumping action.

Mechanism of Action

Metoprolol is a selective β1-adrenergic receptor blocker that works by blocking the action of adrenaline and noradrenaline on these receptors. By doing so, metoprolol reduces the heart rate and the force of heart contractions, which results in lower blood pressure and decreased oxygen demand by the heart. This helps in managing conditions such as hypertension, angina, and heart failure.


Pharmacokinetics refers to how Metoprolol is absorbed, distributed, metabolized, and excreted in the body. Understanding the pharmacokinetics of Metoprolol helps healthcare professionals optimize dosing regimens and monitor patient response.

Absorption Rate

Metoprolol is well-absorbed after oral administration, with a bioavailability of approximately 50%. The absorption rate can be affected by food intake, so it is recommended to take Metoprolol with or immediately following a meal to ensure consistent absorption.

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Absorption Rate

The absorption rate of Metoprolol refers to how quickly and how much of the medication is absorbed into the bloodstream after administration. Metoprolol is well absorbed from the gastrointestinal tract, with peak plasma concentrations typically reached within 1 to 2 hours after oral administration.

Factors such as food intake or the presence of other medications can affect the absorption rate of Metoprolol. Taking Metoprolol with a meal may delay the absorption rate, while taking it on an empty stomach may result in faster absorption.

It is important to follow the dosing instructions provided by your healthcare provider to ensure optimal absorption and efficacy of Metoprolol in managing your condition.

Distribution in the Body

Metoprolol distribution in the body is primarily in plasma where it binds extensively to plasma proteins, with approximately 5-10% of the drug binding to red blood cells. The drug has a moderate volume of distribution of about 3.2 L/kg, indicating that it distributes well throughout the body tissues.

Metoprolol is known to cross the blood-brain barrier to a certain extent, allowing it to exert its effects on the central nervous system. It also readily crosses the placental barrier and is found in breast milk, so caution is advised when administering it to pregnant or breastfeeding individuals.

Metoprolol is extensively distributed in tissues such as the heart, liver, lungs, and kidneys, where it exerts its pharmacological effects. The drug’s distribution profile plays a crucial role in its clinical pharmacology and therapeutic efficacy.


Metoprolol metabolism primarily occurs in the liver through the cytochrome P450 enzyme system. The main enzyme responsible for the metabolism of metoprolol is CYP2D6. This enzyme oxidizes metoprolol to its active metabolite, alpha-hydroxymetoprolol, which also exhibits beta-blocking activity.

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Enzyme Metabolite Activity
CYP2D6 Alpha-hydroxymetoprolol Beta-blocking

Additionally, another minor pathway involves CYP3A4, which contributes to the metabolism of metoprolol to a lesser extent. The metabolites formed are further eliminated from the body through renal excretion.

Cytochrome P450 Involvement

Cytochrome P450 enzymes play a crucial role in the metabolism of metoprolol. Metoprolol is primarily metabolized by the CYP2D6 enzyme, with minor contributions from CYP3A4. CYP2D6 is a member of the cytochrome P450 superfamily of enzymes and is responsible for the conversion of metoprolol into its active metabolite, alpha-hydroxymetoprolol.

The activity of CYP2D6 can vary between individuals due to genetic polymorphisms, leading to differences in metoprolol metabolism. Some individuals are poor metabolizers of metoprolol, resulting in higher plasma levels of the drug and potentially increased risk of adverse effects. On the other hand, ultra-rapid metabolizers may clear metoprolol more quickly, requiring higher doses to achieve therapeutic levels.



Metoprolol undergoes extensive metabolism in the liver. The main metabolite is alpha-hydroxymetoprolol, which is formed through the action of the cytochrome P450 enzyme CYP2D6.

This metabolite has approximately 13% of the beta-blocking activity of metoprolol. Other minor metabolites include O-demethylated metoprolol, deaminated metoprolol, and glucuronide conjugates.

Role of Metabolites

Role of Metabolites

The metabolites of metoprolol contribute to its overall pharmacological effects and elimination from the body. Understanding the metabolism of metoprolol and its metabolites is crucial for optimizing its clinical use and minimizing potential drug interactions.