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It is important to discuss how to properly discontinue metoprolol with your doctor. Guidelines for the 'Diagnosis and Management of Patients with Stable Ischemic Heart Disease' suggests tapering beta-blockers over a 3 week time period in those who have experienced a prior heart attack and have nitroglycerin available for symptoms of chest pain. If withdrawal symptoms do occur, even with a gradual taper, it can be beneficial to reinstate therapy at your previously well-tolerated dose and decreased more slowly. Most sources, and prescribing information inserts for all beta-blockers recommended tapering gradually over a 1-2 week period to reduce the risk of adverse effects.
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Sudden discontinuation of beta-blockers is particularly dangerous if treating coronary artery disease. The recommendation to gradually discontinue metoprolol is generally true for all beta-blocker medications. When discontinuing chronically administered Lopressor, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1-2 weeks and the patient should be carefully monitored." Lopressor Package Insert Per the prescribing information for Lopressor (metoprolol tartrate): "Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. Stopping metoprolol abruptly, or 'cold-turkey' can exacerbate chest pains and could potentially increase the risk of heart attack and other symptoms. Metoprolol, a beta-adrenergic antagonist (also known as a 'beta-blocker'), is generally recommended to be tapered (step-wise dose decreases) if you have been taking it chronically. Abrupt discontinuation can increase the risk of adverse events. Beta-blockers are generally recommended to be slowly tapered as opposed to stopping abruptly.