The secondary flow is called Stará řeka ("Old river") and was once the main bed of the Metuje.

The streams then join a few hundred metres before the confluence of the Metuje with the Elbe.

The longest tributaries of the Metuje are:[5] The most notable settlement on the river is the town of Náchod.

The river flows through the municipal territories of Jívka, Adršpach, Teplice nad Metují, Česká Metuje, Velké Petrovice, Bezděkov nad Metují, Hronov, Velké Poříčí, Náchod, Přibyslav, Jestřebí, Nové Město nad Metují, Nahořany, Šestajovice, Rychnovek and Jaroměř.

In addition, the area is home to many species of protected birds, amphibians and insects, such as green snaketail, which is critically endangered in the Czech Republic.