Treatment with Metoprolol, also known as Selo-Zok

The medication 

Metoprolol was developed to treat heart and circulatory conditions, but it can also be effective against migraines. When you are prescribed this medication, it is therefore not to lower your blood pressure, but to treat your migraines. 

Effect 

Metoprolol may work to prevent migraines by stabilizing blood vessels, but the exact mechanism of action is not known. 

The effect of metoprolol usually begins after 1-3 weeks. On average, metoprolol halves the number of migraine attacks. However, there is a great deal of individual variation in how well the medication works. 

Side effects 

The most common side effects are fatigue, dizziness, a drop in blood pressure when changing position, nausea, abdominal pain, diarrhea, constipation, cold hands and feet, slow pulse, heart palpitations, and difficulty breathing. 

Precautions 

Metoprolol should not be used for certain types of heart conditions, such as conduction disorders, and should be used with caution or not at all if you suffer from diabetes, asthma, or certain heart conditions. It should also be used with caution if you are taking certain other types of medication, especially other heart medications. 

Before starting treatment 

Before you start treatment, an electrocardiogram (ECG) must be performed, and your pulse and blood pressure must be measured. 

What is the recommended dosage? 

Usually, you start by taking 50 mg once a day for one week. After that, the dose is increased to 100 mg daily. If there is insufficient effect and no bothersome side effects after one month, you should increase to 150 mg once daily for one week and then further to 200 mg once daily (the dose can optionally be split into 100 mg twice daily). Stay at the dose where you experience the best balance between effect and side effects (usually between 100-200 mg daily). If there is no effect after one month at 200 mg per day, it can be concluded that the medication is not working. You should then taper off by 50 mg per week until you have stopped taking the medication completely. 

Once the correct final dose has been found, it should be taken daily for 6-12 months, after which the dose can often be slowly tapered off in consultation with your doctor. However, some patients need to use metoprolol for several years.