How does metoprolol work in the body. What are the common side effects of metoprolol. When should metoprolol be avoided. How to identify metoprolol pills by appearance. What are the major drug interactions with metoprolol. How does metoprolol affect certain medical conditions. Can metoprolol be taken with alcohol or certain foods.

What is Metoprolol and How Does It Work?

Metoprolol is a beta-blocker medication commonly prescribed to treat various cardiovascular conditions. It works by blocking the effects of epinephrine (adrenaline) on beta receptors in the heart and blood vessels. This action helps to:

• Lower blood pressure
• Slow heart rate
• Reduce the workload on the heart
• Improve blood flow

By these mechanisms, metoprolol can effectively manage hypertension, angina, heart failure, and other cardiac issues. It’s also used to prevent migraines and treat certain tremors.

Forms and Dosages of Metoprolol

Metoprolol comes in two salt forms: metoprolol tartrate and metoprolol succinate. The tartrate form is typically taken twice daily, while the succinate form is extended-release and taken once daily. Dosages range from 25 mg to 200 mg, depending on the condition being treated and individual patient factors.

Identifying Metoprolol Pills: A Visual Guide

Metoprolol pills come in various shapes, colors, and sizes depending on the manufacturer and dosage. Here’s a general guide to help identify common metoprolol tablets:

• 25 mg: Often white or pale pink, round or oval
• 50 mg: Typically pink, orange, or white, round or rectangular
• 100 mg: Usually blue, yellow, or white, round or oval

Specific imprints on the pills can include:

1. M 32 (50 mg, pink, round)
2. M 47 (100 mg, blue, round)
3. GG 414 (50 mg, white, capsule-shaped)
4. GG 415 (100 mg, white, capsule-shaped)
5. MP 184 (50 mg, orange, rectangular)
6. MP 185 (100 mg, yellow, rectangular)

Remember that pill appearance can vary between manufacturers, so always verify your medication with a healthcare professional or pharmacist if you’re unsure.

Common Side Effects and Precautions

While metoprolol is generally well-tolerated, it can cause side effects in some individuals. Common side effects include:

• Fatigue or drowsiness
• Dizziness
• Slow heartbeat
• Cold hands and feet
• Nausea or stomach discomfort
• Sleep disturbances

Is metoprolol safe for everyone? No, certain individuals should use caution or avoid metoprolol altogether. These include people with:

• Severe bradycardia (slow heart rate)
• Heart block
• Uncontrolled heart failure
• Severe peripheral artery disease
• Asthma or other reactive airway diseases
• Pheochromocytoma (a rare adrenal gland tumor)

Always inform your healthcare provider about your complete medical history before starting metoprolol.

Drug Interactions: What to Watch Out For

Metoprolol can interact with numerous medications, potentially altering its effectiveness or increasing the risk of side effects. According to the provided information, there are 503 known drug interactions with metoprolol, categorized as follows:

• 26 major interactions
• 440 moderate interactions
• 37 minor interactions

Which drugs have significant interactions with metoprolol? Some of the most important interactions to be aware of include:

1. Other beta-blockers or calcium channel blockers
2. Antiarrhythmic medications
3. Certain antidepressants (e.g., fluoxetine, paroxetine)
4. MAO inhibitors
5. Dipyridamole
6. Ergot alkaloids
7. Clonidine
8. Hydralazine

These interactions can lead to additive effects on heart rate and blood pressure, potentially causing dangerous bradycardia or hypotension. Always inform your healthcare provider about all medications you’re taking, including over-the-counter drugs and supplements.

Metoprolol and Medical Conditions: Special Considerations

Certain medical conditions can affect how metoprolol works in the body or increase the risk of side effects. The drug information provided lists 19 disease interactions with metoprolol. Some of the most significant include:

• Bradyarrhythmia/AV block
• Cardiogenic shock/hypotension
• Congestive heart failure (CHF)
• Diabetes
• Hemodialysis
• Hypersensitivity
• Ischemic heart disease

How does metoprolol affect these conditions? In bradyarrhythmias or AV block, metoprolol can further slow the heart rate, potentially exacerbating the condition. For patients with diabetes, metoprolol may mask the symptoms of hypoglycemia, making it harder to recognize low blood sugar. In heart failure, careful dosing and monitoring are necessary to avoid worsening the condition.

Metoprolol and Pregnancy

Is metoprolol safe during pregnancy? Metoprolol is classified as a Category C drug for pregnancy, meaning that risk cannot be ruled out. It should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus. Women who are pregnant or planning to become pregnant should discuss the risks and benefits with their healthcare provider.

Alcohol and Food Interactions with Metoprolol

The provided information mentions 4 alcohol/food interactions with metoprolol. While specific details aren’t given, it’s important to be aware of potential interactions:

• Alcohol: Can enhance the blood pressure-lowering effect of metoprolol, potentially leading to dizziness or fainting.
• High-fat meals: May increase the absorption of metoprolol, potentially intensifying its effects.
• Grapefruit juice: Can increase metoprolol levels in the blood, potentially leading to side effects.
• Salt substitutes: Those containing potassium should be used with caution, as metoprolol can affect potassium levels.

Should you avoid alcohol completely while taking metoprolol? While moderate alcohol consumption may be acceptable for some patients, it’s best to consult with your healthcare provider about your specific situation.

Proper Use and Administration of Metoprolol

To ensure the safe and effective use of metoprolol, follow these guidelines:

1. Take the medication exactly as prescribed by your doctor.
2. Do not stop taking metoprolol suddenly, as this can lead to rebound hypertension or worsening of heart conditions.
3. If you miss a dose, take it as soon as you remember. However, if it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule.
4. Monitor your blood pressure and heart rate regularly, and report any significant changes to your healthcare provider.
5. Be aware of potential side effects and report any concerning symptoms to your doctor promptly.

How long does it take for metoprolol to start working? The blood pressure-lowering effects of metoprolol can be seen within a few hours of taking the first dose. However, it may take several weeks to achieve the full therapeutic effect, especially in treating conditions like angina or heart failure.

Monitoring and Follow-up

Regular follow-up appointments with your healthcare provider are essential when taking metoprolol. These visits may include:

• Blood pressure and heart rate checks
• Blood tests to monitor electrolyte levels and kidney function
• Electrocardiogram (ECG) to assess heart rhythm
• Adjustment of dosage if needed
• Evaluation of side effects and overall treatment efficacy

Alternatives to Metoprolol: Other Beta-Blockers and Treatment Options

While metoprolol is a widely used and effective medication, it may not be suitable for everyone. There are several alternative beta-blockers and other treatment options available for various cardiovascular conditions:

Other Beta-Blockers

• Atenolol
• Propranolol
• Bisoprolol
• Carvedilol
• Nebivolol

Other Classes of Medications

• ACE inhibitors (e.g., lisinopril, enalapril)
• Angiotensin receptor blockers (e.g., losartan, valsartan)
• Calcium channel blockers (e.g., amlodipine, diltiazem)
• Diuretics (e.g., hydrochlorothiazide, furosemide)

How do these alternatives compare to metoprolol? Each medication has its own set of benefits, side effects, and appropriate uses. The choice of medication depends on the specific condition being treated, individual patient factors, and potential drug interactions. Always consult with your healthcare provider to determine the most appropriate treatment option for your situation.

Long-term Effects and Considerations of Metoprolol Use

For many patients, metoprolol is a long-term medication that may be taken for years. Understanding the potential long-term effects and considerations is crucial for optimal management:

Potential Long-term Benefits

• Reduced risk of cardiovascular events in patients with hypertension or heart disease
• Improved survival rates in patients with heart failure
• Decreased frequency and severity of migraines in some patients
• Potential neuroprotective effects in certain neurological conditions

Long-term Considerations

• Metabolic effects: Metoprolol may affect lipid and glucose metabolism over time
• Tolerance: Some patients may develop tolerance to the blood pressure-lowering effects
• Drug interactions: Long-term use increases the likelihood of encountering drug interactions
• Withdrawal syndrome: Abrupt discontinuation after long-term use can lead to rebound hypertension or worsening of underlying conditions

Is it safe to take metoprolol indefinitely? For many patients, long-term use of metoprolol is safe and beneficial when properly monitored. However, regular follow-ups with your healthcare provider are essential to assess ongoing efficacy and manage any potential long-term effects.

Lifestyle Modifications to Complement Metoprolol Therapy

While metoprolol can effectively manage various cardiovascular conditions, combining medication with lifestyle changes can enhance its benefits:

1. Maintain a heart-healthy diet low in saturated fats and sodium
2. Engage in regular physical activity as recommended by your healthcare provider
3. Manage stress through relaxation techniques or counseling
4. Quit smoking and limit alcohol consumption
5. Monitor your blood pressure at home and keep a log for your doctor
6. Maintain a healthy weight
7. Get adequate sleep and practice good sleep hygiene

How do these lifestyle changes work with metoprolol? These modifications can help reduce the overall cardiovascular risk, potentially allowing for lower medication doses and improved outcomes. Always consult with your healthcare provider before making significant changes to your diet or exercise routine.

Future Developments and Research in Beta-Blocker Therapy

As medical science advances, ongoing research continues to explore new applications and improvements in beta-blocker therapy, including metoprolol:

Emerging Research Areas

• Personalized medicine approaches to optimize beta-blocker selection and dosing
• Investigating the potential neuroprotective effects of beta-blockers in conditions like Alzheimer’s disease
• Exploring new formulations or delivery methods to improve efficacy and reduce side effects
• Studying the role of beta-blockers in cancer treatment and prevention
• Investigating potential benefits in non-cardiovascular conditions such as osteoporosis

What potential advancements might we see in beta-blocker therapy? Future developments could include more targeted beta-blockers with fewer systemic side effects, improved long-acting formulations for better adherence, or combination therapies that enhance efficacy while minimizing adverse effects.

The Importance of Ongoing Research

Continued research into beta-blockers like metoprolol is crucial for several reasons:

1. Improving patient outcomes and quality of life
2. Identifying new therapeutic applications
3. Enhancing our understanding of cardiovascular physiology and pharmacology
4. Developing strategies to mitigate side effects and drug interactions
5. Optimizing treatment protocols for various conditions

As research progresses, patients and healthcare providers can look forward to more refined and effective use of metoprolol and other beta-blockers in the management of cardiovascular and related conditions.

Metoprolol Pill Images – What does metoprolol look like?

Print

Save

What does Metoprolol tartrate look like?

Note: Multiple pictures are displayed for those medicines available in different strengths, marketed under different brand names and for medicines manufactured by different pharmaceutical companies. Multi ingredient medications may also be listed when applicable.
Return to Pill Identifier…

Results for “Metoprolol tartrate” (

1 – 18 of 102)

1 / 6

Metoprolol Tartrate

Strength

50 mg

Imprint

M 32

Color

Pink

Shape

Round

View details

1 / 6

Metoprolol Tartrate

Strength

100 mg

Imprint

M 47

Color

Blue

Shape

Round

View details

1 / 2

Metoprolol Tartrate

Strength

100 mg

Imprint

GG 415

Color

White

Shape

Round

View details

1 / 4

Metoprolol Tartrate

Strength

100 mg

Imprint

167

Color

White

Shape

Oval

View details

Metoprolol Tartrate

Strength

50 mg

Imprint

GG 414

Color

White

Shape

Capsule-shape

View details

Metoprolol Tartrate

Strength

100 mg

Imprint

GG 415

Color

White

Shape

Capsule-shape

View details

1 / 2

Metoprolol Tartrate

Strength

50 mg

Imprint

MP 184

Color

Orange

Shape

Rectangle

View details

1 / 2

Metoprolol Tartrate

Strength

100 mg

Imprint

MP 185

Color

Yellow

Shape

Rectangle

View details

1 / 3

Metoprolol Tartrate

Strength

50 mg

Imprint

93 733

Color

Pink

Shape

Round

View details

1 / 2

Metoprolol Tartrate

Strength

100 mg

Imprint

93 734

Color

Blue

Shape

Round

View details

Metoprolol Tartrate

Strength

50 mg

Imprint

50 N 727

View details

1 / 4

Metoprolol Tartrate

Strength

50 mg

Imprint

WATSON 462

Color

Pink

Shape

Round

View details

1 / 2

Metoprolol Tartrate

Strength

100 mg

Imprint

WATSON 463

Color

Blue

Shape

Round

View details

1 / 5

Metoprolol Tartrate

Strength

25 mg

Imprint

M 18

Color

White

Shape

Round

View details

Metoprolol Tartrate

Strength

50 mg

Imprint

554 R

Shape

Round

View details

1 / 2

Metoprolol Tartrate

Strength

50 mg

Imprint

166

Color

White

Shape

Oval

View details

1 / 4

Metoprolol Tartrate

Strength

25 mg

Imprint

1

Color

White

Shape

Round

View details

Metoprolol Tartrate

Strength

100 mg

Imprint

100 N 734

Color

White

Shape

Oval

View details

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Metoprolol Interactions Checker – Drugs.com

Print

Save

There are 503 drugs known to interact with
metoprolol, along with
19 disease interactions, and 4 alcohol/food interactions.

Of the total drug interactions,
26 are major, 440 are moderate, and 37 are minor.

Does metoprolol interact with my other drugs?

Enter other medications to view a detailed report.

• View all 503 medications that may interact with metoprolol
• View metoprolol alcohol/food interactions (4)
• View metoprolol disease interactions (19)

Most frequently checked interactions

View interaction reports for metoprolol and the medicines listed below.

• Major
• Moderate
• Minor
• Unknown

• Advair Diskus (fluticasone / salmeterol)
• Aspir 81 (aspirin)
• Aspirin Low Strength (aspirin)
• Benadryl (diphenhydramine)
• CoQ10 (ubiquinone)
• Coumadin (warfarin)
• Crestor (rosuvastatin)
• Cymbalta (duloxetine)
• Eliquis (apixaban)
• Fish Oil (omega-3 polyunsaturated fatty acids)
• Lantus (insulin glargine)
• Lasix (furosemide)
• Lexapro (escitalopram)
• Lipitor (atorvastatin)
• Lyrica (pregabalin)
• Nexium (esomeprazole)
• Norco (acetaminophen / hydrocodone)
• Plavix (clopidogrel)
• Protonix (pantoprazole)
• Singulair (montelukast)
• Synthroid (levothyroxine)
• Tylenol (acetaminophen)
• Vitamin B12 (cyanocobalamin)
• Vitamin C (ascorbic acid)
• Vitamin D2 (ergocalciferol)
• Vitamin D3 (cholecalciferol)
• Xanax (alprazolam)
• Xarelto (rivaroxaban)
• Zoloft (sertraline)
• Zyrtec (cetirizine)

Metoprolol alcohol/food interactions

There are 4 alcohol/food interactions with metoprolol.

Metoprolol disease interactions

There are 19 disease interactions with metoprolol which include:

• bradyarrhythmia/AV block
• cardiogenic shock/hypotension
• CHF
• diabetes
• hemodialysis
• hypersensitivity
• ischemic heart disease
• PVD
• liver disease
• cerebrovascular insufficiency
• glaucoma
• hyperlipidemia
• hyperthyroidism
• hyperthyroidism PKs
• myasthenia gravis
• pheochromocytoma
• psoriasis
• tachycardia
• asthma/COPD

Report options

Loading…

QR code containing a link to this page

More about metoprolol

• metoprolol consumer information
• Compare alternatives
• Reviews (627)
• Drug images
• Side effects
• Dosage information
• Patient tips
• During pregnancy
• Support group
• Drug class: cardioselective beta blockers
• Breastfeeding
• En español

Related treatment guides

• Angina
• Angina Pectoris Prophylaxis
• Aortic Aneurysm
• Atrial Fibrillation

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.

Major	Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate	Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor	Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown	No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Metoprolol tablets 50mg №50

Composition

One tablet contains:

active substance: metoprolol tartrate – 50 mg,

excipients: 9000 8 lactose monohydrate (milk sugar), colloidal silicon dioxide (aerosil), starch potato, povidone (polyvinylpyrrolidone low molecular weight medical), crospovidone, magnesium stearate.

Dosage form

tablets

Description

Tablets white with a grayish or white with a yellowish tint, flat-cylindrical shape, with a bevel. Marbling is allowed.

Action

Selective beta1-blocker

Pharmacodynamics

Cardioselective beta ₁ is an adrenoblocker. Metoprolol has a slight membrane-stabilizing effect and does not have intrinsic sympathomimetic activity. It has antihypertensive, antianginal and antiarrhythmic effects.

By blocking beta ₁ -adrenergic receptors of the heart, it reduces the formation of cyclic adenosine monophosphate (cAMP) from adenosine triphosphoric acid (ATP) stimulated by catecholamines, reduces the intracellular current of calcium ions, has a negative chrono-, dromo-, batmo- and inotropic effect (reduces heart rate). contractions (HR), inhibits conduction and excitability, reduces myocardial contractility).

Total peripheral vascular resistance (TPVR) at the beginning of the use of beta-blockers (in the first 24 hours after ingestion) increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta-adrenergic ₂ receptors), which after 1-3 day returns to the original, and with a long-term appointment decreases.

The hypotensive effect is due to a reflex decrease in the minute volume of blood and renin synthesis, inhibition of the activity of the renin-angiotensin-aldosterone system (RAAS) (it is more important in patients with initial renin hypersecretion) and the central nervous system (CNS), restoration of the sensitivity of baroreceptors of the aortic arch ( there is no increase in their activity in response to a decrease in blood pressure (BP)) and, as a result, a decrease in peripheral sympathetic influences. Reduces high blood pressure at rest, during physical exertion and stress. The hypotensive effect develops quickly (systolic blood pressure decreases after 15 minutes, maximum – after 2 hours) and lasts for 6 hours, diastolic blood pressure changes more slowly: a stable decrease is observed after several weeks of regular intake.

The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (lengthening of diastole and improvement in myocardial perfusion) and contractility, as well as a decrease in myocardial sensitivity to the effects of sympathetic innervation. Reduces the number and severity of angina attacks and increases exercise tolerance. By increasing the end diastolic pressure in the left ventricle and increasing the stretching of the muscle fibers of the ventricles, it can increase the need for oxygen, especially in patients with chronic heart failure (CHF).

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown in atrioventricular (AV) conduction (mainly in antegrade and to a lesser extent in retrograde directions through the AV node) and along additional pathways.

With supraventricular tachycardia, atrial fibrillation, sinus tachycardia in functional heart disease and thyrotoxicosis, it slows down the heart rate or may even lead to the restoration of the heart rhythm.

Prevents the development of migraine.

When used in average therapeutic doses, unlike non-selective beta-blockers, it has a less pronounced effect on organs containing beta-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate exchange.

When used in high doses (more than 100 mg / day), it has a blocking effect on both subtypes of beta-adrenergic receptors.

Pharmacokinetics

Complete oral absorption (95%). The maximum plasma concentration is reached 1-2 hours after ingestion. The elimination half-life averages 3.5 hours (ranging from 1 hour to 9 hours). Exposed to intensive first pass metabolism, bioavailability is 50% at the first intake and increases to 70% with repeated use. Food intake increases bioavailability by 20-40%. The bioavailability of metoprolol increases with cirrhosis of the liver. Communication with blood plasma proteins – 10%. Penetrates through the blood-brain and placental barrier. Penetrates into breast milk in small quantities. Metabolized in the liver, 2 metabolites have beta-blocking activity. The CYP2D6 isoenzyme takes part in the metabolism of the drug. About 5% of the drug is excreted unchanged by the kidneys.

Treatment of patients with reduced renal function does not require dose adjustment.

Impaired liver function slows down the metabolism of the drug, and in cases of insufficiency of liver function, the dose of the drug should be reduced.

Not removed by hemodialysis.

Indications for use

– Arterial hypertension (in monotherapy or in combination with other antihypertensive drugs),

– functional disorders of cardiac activity accompanied by tachycardia, ischemic heart disease: myocardial infarction (secondary prevention – complex therapy), prevention of angina attacks ,

– heart rhythm disorders (supraventricular tachycardia, ventricular extrasystole),

– hyperthyroidism (complex therapy),

– prevention of migraine attacks.

Contraindications

– Hypersensitivity to metoprolol or other components of the drug, other beta-blockers,

– cardiogenic shock,

– II-III degree AV blockade (without artificial pacemaker),

– syno atrial blockade,

– sick sinus syndrome,

– severe bradycardia,

– chronic heart failure in the stage of decompensation,

– Prinzmetal’s angina pectoris,

– acute myocardial infarction (heart rate less than 45 bpm, PQ interval more than 0 .24 sec, systolic blood pressure less than 100 mmHg),

– lactose intolerance, lactase deficiency and glucose-galactose malabsorption syndrome,

– lactation (see section Pregnancy and lactation),

– simultaneous intravenous administration of slow calcium channel blockers (CCBs) of the verapamil type (see section Interaction with other drugs),

– age up to 18 years (efficacy and safety not established),

– pheochromocytoma (without simultaneous use of alpha -blockers),

– to patients receiving long-term or intermittent therapy with inotropic agents and acting on beta-adrenergic receptors.

Use in pregnancy and lactation

During pregnancy Metoprolol is prescribed only under strict indications if the expected benefit to the mother outweighs the potential risk to the fetus (due to the possible development of bradycardia, arterial hypotension, hypoglycemia in the fetus). At the same time, careful monitoring is carried out, especially for the development of the fetus. Strict monitoring of newborns within 48-72 hours after delivery is necessary.

If Metoprolol is needed during lactation , breastfeeding must be stopped.

Side effects

From the side of the central nervous system: increased fatigue, weakness, headache, slowing of the rate of mental and motor reactions, paresthesia in the extremities (in patients with intermittent claudication and Raynaud’s syndrome), depression, anxiety, decreased concentration of attention , drowsiness, insomnia, nightmares, confusion or short-term memory impairment, myasthenia gravis, hallucinations, asthenia.

From the senses : decreased vision, decreased secretion of lacrimal fluid, dryness and soreness of the eyes, conjunctivitis, ringing in the ears, impaired taste sensations.

From the side of the cardiovascular system : sinus bradycardia, orthostatic hypotension (dizziness, sometimes loss of consciousness), palpitations, pronounced decrease in blood pressure, decrease in myocardial contractility, temporary aggravation of symptoms of chronic heart failure (swelling of the feet and / or lower part shins, shortness of breath), arrhythmias, manifestation of angiospasm (increased peripheral circulatory disorders, coldness of the lower extremities, Raynaud’s syndrome), cardialgia, aggravation of pre-existing AV conduction disorders.

From the digestive system : nausea, vomiting, abdominal pain, dryness of the oral mucosa, diarrhea, constipation, change in taste, hepatitis, impaired liver function.

On the part of the skin : urticaria, pruritus, rash, exacerbation of psoriasis, psoriasis-like skin reactions, skin flushing, exanthema, photosensitivity, increased sweating, reversible alopecia.

From the endocrine system : hypoglycemia (in patients receiving insulin), hyperglycemia (in patients with diabetes mellitus), hypothyroidism.

From the respiratory system : rhinitis, bronchospasm in patients with bronchial asthma, shortness of breath with physical effort.

Other : back or joint pain, arthralgia, like all beta-blockers, in rare cases, may cause a slight increase in body weight, a decrease in libido and / or potency.

Interactions

Simultaneous use with monoamine oxidase (MAO) inhibitors is not recommended due to a significant increase in the hypotensive effect. A break in treatment between taking MAO inhibitors and metoprolol should be at least 14 days.

Simultaneous intravenous administration of verapamil may cause cardiac arrest.

The simultaneous use of nifedipine leads to a significant decrease in blood pressure.

Medications for inhalation anesthesia (halogenated hydrocarbons) increase the risk of myocardial depression and the development of arterial hypotension, there is a summation of the cardiodepressive effect – with agents for general anesthesia, an increase in the severity of slowing heart rate and inhibition of AV conduction – when using metoprolol with verapamil, diltiazem, antiarrhythmic drugs (amiodarone), reserpine, methyldopa, clonidine, guanfacine, general anesthetics and cardiac glycosides.

Beta-agonists, theophylline, cocaine, estrogens (sodium ion retention), indomethacin and other non-steroidal anti-inflammatory drugs (sodium retention and blocking the synthesis of prostaglandins by the kidneys) weaken the hypotensive effect.

Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), sedatives and hypnotics increase CNS depression.

There is an increase in the inhibitory effect on the central nervous system – with ethanol, an increase in the risk of peripheral circulatory disorders – with ergot alkaloids.

When taken together with hypoglycemic agents for oral administration, their effect may be reduced, with insulin – an increased risk of developing hypoglycemia, increasing its severity and lengthening, masking some symptoms of hypoglycemia (tachycardia, sweating, increased blood pressure).

When combined with antihypertensives, diuretics, nitroglycerin or slow calcium channel blockers, a sharp decrease in blood pressure may develop, special care is needed when combined with prazosin.

If metoprolol and clonidine are taken simultaneously, then when metoprolol is discontinued, clonidine is discontinued after a few days (due to the risk of withdrawal syndrome).

Inducers of microsomal liver enzymes (rifampicin, barbiturates) lead to an increase in the metabolism of metoprolol, to a decrease in the concentration of metoprolol in the blood plasma and a decrease in the effect. Inhibitors of microsomal liver enzymes (cimetidine, oral contraceptives, phenothiazines) – increase the concentration of metoprolol in the blood plasma.

Allergens used for immunotherapy or allergen extracts for skin tests when used together with metoprolol increase the risk of systemic allergic reactions or anaphylaxis, iodine-containing radiopaque agents for intravenous administration increase the risk of anaphylactic reactions.

Decreases clearance of xanthines (except diprophyllia), especially with initially increased clearance of theophylline under the influence of smoking.

Reduces the clearance of lidocaine, increases the concentration of lidocaine in the blood plasma.

Enhances and prolongs the action of non-depolarizing muscle relaxants, prolongs the anticoagulant effect of coumarin derivatives.

When combined with ethanol, the risk of a pronounced decrease in blood pressure increases.

Medications that reduce catecholamine stores (eg, reserpine) may increase the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure or bradycardia.

Dosage and Administration

Tablets are taken orally at the same time as meals or immediately after meals. Tablets can be divided in half (but not chewed) and washed down with liquid.

Arterial hypertension

The initial daily dose is 50-100 mg in 1-2 doses (morning and evening). With insufficient therapeutic effect, the daily dose can be gradually increased to 100-200 mg and / or additional prescription of other antihypertensive agents.

The maximum daily dose is 200 mg.

Secondary prevention of myocardial infarction

200 mg daily in two divided doses (morning and evening).

Angina pectoris arrhythmia prevention of migraine attacks

100-200 mg per day in two divided doses (morning and evening).

Functional disorders of cardiac activity accompanied by tachycardia

100 mg per day in two divided doses (morning and evening).

For hyperthyroidism

150-200 mg per day in 3-4 divided doses.

In elderly patients with impaired renal function (CC less than 40 ml / min) and if necessary, hemodialysis does not change the dose.

In case of severe hepatic impairment, the dose of the drug should be reduced depending on the clinical condition.

Overdose

Symptoms: severe sinus bradycardia, dizziness, nausea, vomiting, cyanosis, pronounced decrease in blood pressure, arrhythmia, ventricular extrasystole, bronchospasm, syncope, in acute overdose – cardiogenic shock, loss of consciousness, coma, AV (up to development of complete transverse blockade and cardiac arrest), convulsions, respiratory arrest.

The first signs of overdose appear 20 minutes – 2 hours after taking the drug.

Treatment: gastric lavage and administration of adsorbents, symptomatic therapy: in case of a pronounced decrease in blood pressure – the patient should be in the Trendelenburg position, in case of an excessive decrease in blood pressure, bradycardia and heart failure – in / in, with an interval of 2-5 minutes , beta-agonists – until the desired effect is achieved or in / in 0.5-2 mg of atropine. In the absence of a positive effect – dopamine, dobutamine or norepinephrine (norepinephrine). As a follow-up, perhaps the introduction of 1-10 mg of glucagon only for hypoglycemia, which may accompany an overdose of metoprolol, the setting of an artificial pacemaker. With bronchospasm, beta 9 should be administered intravenously0029 2 – adrenomimetics. Hemodialysis is ineffective.

Special instructions

Monitoring of patients taking beta-blockers includes regular monitoring of heart rate and blood pressure, blood glucose concentration in diabetes mellitus. If necessary, for patients with diabetes mellitus, the dose of insulin or hypoglycemic agents administered orally should be selected individually. The patient should be taught how to calculate the heart rate and should be instructed to consult a doctor if the heart rate is less than 50 bpm.

May increase the severity of allergic reactions (against a burdened allergic history) and the lack of effect from the introduction of conventional doses of epinephrine (adrenaline).

In elderly patients, it is recommended to monitor kidney function (once every 4-5 months). May exacerbate symptoms of peripheral arterial circulatory disorders.

Withdrawal of the drug is carried out gradually, reducing the dose within 10 days. With arterial hypertension, the effect occurs after 2-5 days, a stable effect is noted after 1-2 months.

In case of exertional angina, the selected dose of the drug should provide heart rate at rest in the range of 55-60 beats / min, with exercise – no more than 110 beats / min.

Beta-blockers are less effective in smokers.

Metoprolol may mask some of the clinical manifestations of thyrotoxicosis (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, as it can exacerbate symptoms.

In diabetes mellitus, may mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal values.

If it is necessary to prescribe to patients with bronchial asthma, beta ₂ -adrenergic agonists are used as concomitant therapy, in case of pheochromocytoma – alpha-blockers.

If surgical intervention is necessary, it is necessary to warn the anesthesiologist about taking Metoprolol (the choice of a general anesthetic with a minimal negative inotropic effect), drug withdrawal is not recommended.

Reciprocal activation of the vagus nerve can be eliminated by intravenous atropine (1-2 mg).

In case of increasing bradycardia (less than 50 bpm), arterial hypotension (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe impairment of liver and kidney function, it is necessary to reduce the dose or stop treatment .

It is recommended to stop therapy in the event of skin rashes and the development of depression caused by taking beta-blockers.

With a sharp cessation of treatment, withdrawal syndrome may occur (increased angina attacks, increased blood pressure). Particular attention should be paid to patients with angina pectoris when discontinuing the drug.

Patients using contact lenses should be aware that during treatment with beta-blockers, a decrease in tear fluid production is possible.

Influence on the ability to drive vehicles and control mechanisms

During the period of treatment, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Form

Tablets, 50 mg.

Packaging

10 tablets in a blister pack.

3 or 5 blister packs, together with instructions for use, are placed in a carton box.

Pharmacy conditions

Prescription

Storage conditions

Store in a dry, dark place at a temperature not exceeding 25 C.

Keep out of the reach of children.

Shelf life

3 years. Do not use after the date indicated on the package.

Manufacturer and organization that accept consumer claims

OJSC Irbita Himfarmzavod

Extrasystole Violation of the heart rhythm – causes and methods of treatment, diagnosis in St. Petersburg

extrasystole – this is an extraordinary premature heart excitation or its departments, which occurs in the ectopic (unusual) focus under the hearth under the influence of a pathological impulse. Usually, extrasystoles are felt by the patient as a strong cardiac impulse with a “failure” or “fading” after it. Some extrasystoles may occur unnoticed by the patient.

Extrasystole is an extraordinary premature excitation of the heart or its departments that occurs in an ectopic (unusual) focus under the influence of a pathological impulse. Usually, extrasystoles are felt by the patient as a strong cardiac impulse with a “failure” or “fading” after it. Some extrasystoles may occur unnoticed by the patient. Extrasystoles can be found in more than 75% of people.

Extrasystole – causes of development

The reasons for the development of extrasystole can be both diseases of the heart itself: cardiosclerosis, myocardial infarction, inflammatory diseases of the heart muscle, heart defects, as well as diseases of other organs and systems. Extrasystoles can occur in diseases of the gastrointestinal tract, osteochondrosis of the spine, endocrine diseases, arterial hypertension. They are often the result of excessive consumption of coffee, alcohol, smoking. The appearance of extrasystoles when taking cardiac glycosides is one of the signs of an overdose of the drug taken. Diseases of the nervous system (neurocirculatory dystonia) can also contribute to the occurrence of these heart rhythm disturbances. Extrasystoles can also appear in a healthy person with excessive physical and mental stress.

Extrasystole symptoms

The patient may complain of “jolts” and strong heart beats due to vigorous extraordinary ventricular systole after a compensatory pause, a feeling of “fading” in the chest, “somersaulting of the heart”, a feeling of a stopped heart. For patients suffering from extrasystole of a functional origin, symptoms of neurosis and dysfunction of the autonomic nervous system are more characteristic: anxiety, pallor, sweating, fear, a feeling of lack of air. With the organic origin of extrasystoles, manifestations are usually absent. Frequent (especially early and group) extrasystoles lead to a decrease in cardiac output, a decrease in cerebral, coronary and renal blood flow by 8-25%. Because of this, with stenotic atherosclerosis of the cerebral and coronary vessels, transient cerebrovascular accidents and angina attacks may occur. The presence of ventricular extrasystoles with concomitant cardiac pathology can lead to ventricular tachycardia and become a threat to the patient’s life.

Diagnosis and types of extrasystoles

• ECG in 12 leads – allows you to identify the morphology and possible localization of the focus of extrasystole.

• Daily Holter monitoring (HM – continuous ECG recording) is the most reliable method for diagnosing transient heart rhythm disturbances per day of observation.

• EchoCG (ultrasound of the heart) – detects myocardial pathology, determines the state of the valvular apparatus of the heart.

When analyzing the ECG, it is possible to talk about single and group extrasystoles. A group of 5 extrasystoles can be regarded as an ectopic tachycardia.

According to the localization of the ectopic focus, they are distinguished:

• atrial,
• atrioventricular,
• ventricular extrasystoles.

Extrasystole – treatment

It is necessary to eliminate provoking factors and treat the underlying disease. Single extrasystoles without clinical manifestations are not treated.

Neurogenic extrasystoles are treated with the establishment of a work and rest regimen, dietary recommendations are given, regular sports are useful, psychotherapy, tranquilizers or sedatives (for example, valerian tincture) are used. Self-administration of drugs, self-medication by various methods is highly undesirable and not safe, since it can be life-threatening if the nature, mechanisms and causes of extrasystoles are not determined.

The choice of a method for treating extrasystole is carried out by a specialist, taking into account the clinical picture of the disease, the data of instrumental diagnostic studies and the current Russian and European recommendations.

By taking antiarrhythmic drugs, extrasystoles can be eliminated, but after discontinuation of the drugs, extrasystole resumes. In addition, the most important thing: in people with organic heart disease, against the background of effective treatment of extrasystole with antiarrhythmic drugs, an increase in mortality by more than 3 times was revealed! Only in the treatment of beta-blockers or amiodarone, there was no increase in the risk of mortality.