What is metoprolol used for. How does metoprolol work in the body. What are the potential side effects of metoprolol. How should metoprolol be taken correctly. What are the major drug interactions with metoprolol. Can metoprolol be used during pregnancy or breastfeeding. What precautions should be taken when using metoprolol.

Understanding Metoprolol: A Beta-Blocker Medication

Metoprolol is a widely prescribed medication belonging to the class of drugs known as beta-blockers. It is primarily used to treat various cardiovascular conditions, including high blood pressure, angina, and heart rhythm disorders. To fully comprehend the significance of this medication, it’s essential to delve into its mechanisms, uses, and potential effects on the body.

What is Metoprolol?

Metoprolol is a selective beta-1 receptor blocker that works by slowing down the heart rate and reducing the workload on the heart. This action helps to lower blood pressure and improve blood flow throughout the body. Available in both immediate-release and extended-release formulations, metoprolol is marketed under various brand names, including Lopressor and Toprol-XL.

How Does Metoprolol Work?

Metoprolol functions by blocking the effects of epinephrine (adrenaline) on beta-1 receptors in the heart. This blockade results in:

• Decreased heart rate
• Reduced force of heart contractions
• Lowered blood pressure
• Decreased oxygen demand by the heart muscle

By modulating these cardiovascular parameters, metoprolol helps alleviate symptoms associated with various heart conditions and hypertension.

Indications and Uses of Metoprolol

Metoprolol is prescribed for several cardiovascular conditions. Understanding its primary uses can help patients and healthcare providers make informed decisions about treatment options.

Hypertension Management

As a first-line treatment for high blood pressure, metoprolol effectively reduces both systolic and diastolic blood pressure. It can be used alone or in combination with other antihypertensive medications for optimal blood pressure control.

Angina Pectoris Treatment

For patients suffering from angina (chest pain due to reduced blood flow to the heart), metoprolol can provide relief by decreasing the heart’s workload and oxygen demand. This action helps prevent or reduce the frequency and severity of angina attacks.

Heart Attack Prevention and Recovery

Metoprolol is often prescribed to patients who have experienced a heart attack. It can help reduce the risk of a subsequent heart attack and improve long-term survival rates when administered early in the treatment process.

Heart Rhythm Disorders

In cases of certain arrhythmias, such as atrial fibrillation or supraventricular tachycardia, metoprolol can help regulate heart rhythm by slowing the heart rate and stabilizing electrical conduction within the heart.

Metoprolol Dosage Forms and Strengths

Metoprolol is available in various formulations and strengths to accommodate different patient needs and treatment regimens. Understanding these options can help healthcare providers tailor the medication to individual patient requirements.

Immediate-Release Tablets

Metoprolol tartrate, the immediate-release formulation, is typically available in the following strengths:

• 25 mg
• 50 mg
• 100 mg

These tablets are usually taken two to three times daily, with or without food.

Extended-Release Tablets

Metoprolol succinate, the extended-release formulation, is available in the following strengths:

• 25 mg
• 50 mg
• 100 mg
• 200 mg

Extended-release tablets are typically taken once daily and should be swallowed whole without crushing or chewing.

Injectable Form

In hospital settings, metoprolol may be administered intravenously for acute situations such as myocardial infarction or arrhythmias.

Potential Side Effects and Adverse Reactions

While metoprolol is generally well-tolerated, it’s crucial for patients and healthcare providers to be aware of potential side effects. Recognizing and addressing these effects promptly can help ensure safe and effective treatment.

Common Side Effects

Some of the more frequently reported side effects of metoprolol include:

• Fatigue or tiredness
• Dizziness or lightheadedness
• Slow heart rate (bradycardia)
• Cold hands and feet
• Mild nausea or stomach discomfort
• Sleep disturbances or vivid dreams

These side effects are often mild and may diminish as the body adjusts to the medication.

Serious Adverse Reactions

While less common, some patients may experience more severe side effects that require immediate medical attention:

• Severe dizziness or fainting
• Shortness of breath or wheezing
• Swelling of the hands, feet, or ankles
• Unusual weight gain
• Depression or mood changes
• Severe allergic reactions (rash, itching, swelling)

Patients experiencing any of these symptoms should seek medical help promptly.

Drug Interactions and Precautions

Metoprolol can interact with various medications and substances, potentially altering its effectiveness or increasing the risk of side effects. Understanding these interactions is crucial for safe and effective treatment.

Major Drug Interactions

Some medications that may have significant interactions with metoprolol include:

• Other beta-blockers or calcium channel blockers
• Certain antiarrhythmic drugs (e.g., amiodarone, propafenone)
• MAO inhibitors
• Some antidepressants (e.g., fluoxetine, paroxetine)
• Certain antifungal medications (e.g., terbinafine)

These interactions may lead to increased blood levels of metoprolol or enhanced beta-blocking effects, potentially causing bradycardia or hypotension.

Alcohol and Food Interactions

While moderate alcohol consumption is generally considered safe for most patients taking metoprolol, excessive alcohol intake should be avoided as it may increase the risk of side effects such as dizziness and drowsiness.

Certain foods, particularly those high in potassium, should be consumed in moderation, as metoprolol can affect potassium levels in the body.

Disease Interactions

Metoprolol may need to be used with caution or avoided in patients with certain medical conditions, including:

• Severe bradycardia or heart block
• Cardiogenic shock
• Severe peripheral artery disease
• Uncontrolled heart failure
• Severe liver disease
• Pheochromocytoma (unless adequately treated)

Healthcare providers should carefully evaluate a patient’s medical history before prescribing metoprolol.

Proper Administration and Dosing Guidelines

Adhering to proper administration and dosing guidelines is essential for maximizing the benefits of metoprolol while minimizing potential risks. Patients should follow their healthcare provider’s instructions carefully.

General Dosing Guidelines

Dosing for metoprolol varies depending on the specific condition being treated and the individual patient’s response. Some general guidelines include:

• For hypertension: Starting dose is typically 25-100 mg daily, divided into one or two doses
• For angina: Initial dose is usually 100 mg daily, divided into two doses
• For heart attack prevention: Treatment often begins with 25-50 mg twice daily

Dosages may be adjusted based on the patient’s response and tolerability.

Administration Tips

To ensure optimal effectiveness and minimize side effects, patients should follow these administration guidelines:

• Take metoprolol at the same time(s) each day
• Do not crush or chew extended-release tablets
• If a dose is missed, take it as soon as remembered, unless it’s close to the next scheduled dose
• Do not double up on doses to make up for a missed one
• Avoid abrupt discontinuation of metoprolol without consulting a healthcare provider

Patients should inform their healthcare provider of any difficulties in adhering to the prescribed regimen.

Special Considerations for Specific Patient Populations

Certain patient groups may require special consideration when using metoprolol. Healthcare providers should be aware of these populations and adjust treatment accordingly.

Elderly Patients

Older adults may be more sensitive to the effects of metoprolol and may require lower initial doses. Close monitoring for side effects, particularly bradycardia and hypotension, is essential in this population.

Pregnant and Breastfeeding Women

Metoprolol is generally considered safe during pregnancy, but potential risks should be weighed against benefits. It is classified as FDA Pregnancy Category C. Women who are breastfeeding should consult their healthcare provider, as metoprolol can pass into breast milk.

Patients with Diabetes

Metoprolol may mask some symptoms of hypoglycemia, such as rapid heartbeat. Diabetic patients should monitor their blood sugar levels closely and be aware of other signs of low blood sugar.

Patients with Liver or Kidney Disease

Dose adjustments may be necessary for patients with impaired liver or kidney function. Regular monitoring of liver and kidney function is recommended for these individuals.

By considering these special populations and adjusting treatment plans accordingly, healthcare providers can help ensure the safe and effective use of metoprolol across diverse patient groups.

Monitoring and Follow-up During Metoprolol Therapy

Regular monitoring and follow-up are crucial components of successful metoprolol therapy. These practices help healthcare providers assess the medication’s effectiveness, identify potential side effects, and make necessary adjustments to the treatment plan.

Blood Pressure and Heart Rate Monitoring

Patients taking metoprolol should have their blood pressure and heart rate checked regularly. This monitoring helps ensure that the medication is effectively controlling blood pressure and that the heart rate remains within an appropriate range. Home blood pressure monitoring may be recommended for some patients to provide more frequent data points.

Laboratory Tests

Periodic laboratory tests may be necessary during metoprolol therapy, including:

• Liver function tests
• Kidney function tests
• Electrolyte levels (particularly potassium)
• Blood glucose levels (especially in diabetic patients)

These tests help detect any potential adverse effects on organ function or metabolic parameters.

Symptom Assessment

Regular follow-up appointments allow healthcare providers to assess the patient’s symptoms and overall response to the medication. Patients should report any new or worsening symptoms, such as:

• Increased fatigue or weakness
• Persistent dizziness
• Shortness of breath
• Swelling in the extremities
• Changes in mood or cognitive function

Prompt reporting of these symptoms can lead to timely interventions and adjustments in the treatment plan.

Medication Review

Periodic review of all medications, including over-the-counter drugs and supplements, is essential to identify any potential new drug interactions or changes in the patient’s overall medication regimen that may affect metoprolol therapy.

By implementing comprehensive monitoring and follow-up strategies, healthcare providers can optimize metoprolol therapy, minimize risks, and improve patient outcomes.

Metoprolol Pill Images – What does metoprolol look like?

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Further information

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Metoprolol Interactions Checker – Drugs.com

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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

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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.

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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.