About all

Prescription metoprolol: Drug Database | Medication Decision Support

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 (628)
  • Drug images
  • Side effects
  • Dosage information
  • Patient tips
  • During pregnancy
  • Support group
  • Drug class: cardioselective beta blockers
  • Breastfeeding
  • En español

Related treatment guides

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

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.
MajorHighly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
ModerateModerately clinically significant. Usually avoid combinations; use it only under special circumstances.
MinorMinimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
UnknownNo 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 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” (

118 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

What helps, analogs, prescription, dosage, mechanism of action

THERE ARE CONTRAINDICATIONS. POSSIBLE SIDE EFFECTS. A SPECIALIST’S CONSULTATION IS REQUIRED.

Podoinitsyna Alena Andreevna,

Diploma in Pharmaceutical Education: 105924 3510722 reg. number 31917

All authors

Content of the article

  • Metoprolol: mechanism of action
  • Metoprolol: from what
  • Metoprolol: prescription
  • Metoprolol: dosage
  • Metoprolol: analogues
  • Metoprolol or Egilok: which is better
  • Anaprilin or Metoprolol: which is better
  • Summary
  • Ask an expert on the topic of the article

Hypertension is a chronic disease, the main manifestation of which is an increase in blood pressure. High blood pressure is responsible for 10 million deaths and 200 million disabilities worldwide. Symptoms of hypertension are either absent or nonspecific: headache, dizziness, palpitations.

Hypertension can and should be treated and controlled with medicines. We asked the pharmacist Alena Podoinitsyna to tell us about the drug Metoprolol: what it is prescribed for, in what dosages it is produced and what is the mechanism of action of the drug. They gave several examples of analogues of Metoprolol, and also compared it with Egilok and Anaprilin.

All products Metoprolol

20 reviews

Metoprolol: mechanism of action

Metoprolol is a medicine that is taken for high blood pressure. The drug blocks beta-adrenergic receptors. Blockade of beta-adrenergic receptors leads to a decrease in the number of heart contractions, contractility and speed of contraction of the heart muscle, while reducing myocardial oxygen demand.

Metoprolol: from what

We understand what Metoprolol tablets are from. The drug has antihypertensive, antianginal and antiarrhythmic effects. Metoprolol is a beta-blocker. It helps to reduce pressure at rest, during stress and physical exertion.

Antianginal effect is manifested in a decrease in heart rate and a decrease in the heart’s need for oxygen. The antiarrhythmic effect is expressed in the elimination of tachycardia, a decrease in the excitability of the heart and the conduction of nerve impulses in its tissues.

Metoprolol: indications for use

  • high blood pressure
  • angina pectoris
  • complex therapy after a heart attack
  • arrhythmia, tachycardia
  • migraine prophylaxis
  • hyperthyroidism

Prescription metoprolol

Metoprolol is a prescription drug. When buying it, a pharmacy employee will ask you to provide a prescription from a doctor. The drug is available by prescription, as when used in recommended doses, the patient can harm himself.

Metoprolol has side effects and contraindications. Only a doctor can evaluate the benefit-risk ratio of the drug. Therefore, the decision on the need for his appointment is also made by the doctor.

Metoprolol: contraindications for use

  • hypersensitivity to any component of the preparation
  • atrioventricular block II and III degree
  • heart failure in the stage of decompensation
  • patient therapy with nootropics acting on beta-adrenergic receptors
  • decrease in heart rate below 60 beats per minute
  • cardiogenic shock
  • circulatory disorders in the organs, or the threat of gangrene
  • low blood pressure
  • acute myocardial infarction
  • lactose intolerance, glucose-galactose malabsorption
  • children under 18 years of age
  • severe form of bronchial asthma and chronic obstructive pulmonary disease.
  • concomitant use of certain groups of drugs
  • lactation

Metoprolol: dosage

Metoprolol contains the active ingredient: metoprolol tartrate, at a dosage of 100 mg per 1 tablet. But we note that Metoprolol is produced on the basis of 2 active ingredients, or rather, salts. Each of them carries an action peculiar only to it.

  • Metoprolol tartrate – the substance is contained in tablets of immediate action, these tablets must be taken several times a day.
  • Metoprolol succinate – the substance is contained in tablets with a delayed release, respectively, such tablets are drunk 1 time per day.

Metoprolol: analogues

In order to choose metoprolol analogues and substitutes, a specialist consultation is necessary. Egilok, Serdol, Metocard, Betalok, Betalok ZOK contain metoprolol as an active substance. Metoprolol can be replaced with them without consulting a doctor. We recommend that you consult with a pharmacy employee or a pharmacist in the chat on our service. The specialist will help you choose the right dosage and dosage form.

The need to change to drugs with a different active substance is determined by the doctor. Metoprolol is part of the combined preparations. For example, Logimax, Implicor, Hypotef. They, in addition to metoprolol, contain other active ingredients. You can not replace them with a simple Metoprolol.

Do you want to understand the analogues of drugs in order to skillfully select drugs for your budget? Our manual from expert pharmacists “Analogues of popular drugs” will help you with this! Getting a training manual is easy: subscribe to our social networks and write “analogues” in the messages.

Megapharmacy in social networks: VKontakte, Telegram, OK, Viber

Metoprolol or Egilok: which is better

When choosing the best drug, you should first consult with your doctor. There are practically no differences between Metoprolol and Egilok. Preparations differ by manufacturers:

  • Metoprolol is produced in Russia, Slovenia, Israel, Slovakia and Germany
  • Egilok is produced only in Hungary.

Other characteristics, such as: mechanism of action, indications for use, contraindications, side effects and other special indications, are the same for both drugs. All characteristics depend on the active substance. In both preparations, it is metoprolol tartrate. Therefore, Egilok is a substitute for Metoprolol.

Anaprilin or Metoprolol: which is better

Both drugs belong to the same group of drugs – beta-blockers. But the active ingredients are different. Anaprilin contains propranolol hydrochloride.

The difference between active substances lies in the mechanism of their action.

  • Metoprolol is a non-selective adrenoblocker and acts on beta1-adrenergic receptors
  • Anaprilin is selective and acts on beta1- and beta2-adrenergic receptors.

Thus, Anaprilin has more side effects and contraindications than Metoprolol. For example: both drugs should be taken with caution in diabetes mellitus. Metoprolol is also with caution in: chronic obstructive pulmonary disease and bronchial asthma, and Anaprilin is completely contraindicated.

Preparations and manufacturers differ.

  • Anaprilin is produced by Russia and Ukraine
  • Metoprolol is produced by Russia and 4 other countries.

Follow your doctor’s advice to select the best drug.

All products Egilok

20 reviews

All products Anaprilin

21 reviews

Summary

  • Metoprolol is an antihypertensive drug that is often prescribed for the treatment of hypertension, coronary heart disease and arrhythmias.
  • Metoprolol is a prescription drug and is available only on prescription.
  • The active substance of metoprolol is the salt of metoprolol succinate or tartrate.
  • Metoprolol lowers blood pressure by reducing the heart’s need for oxygen and reducing the heart rate.
  • Metoprolol has 4 analogues with which it can be substituted.
  • When comparing Metoprolol with Egilok, differences were found only in manufacturers.
  • Anaprilin differs from Metoprolol not only in producing companies, but also in the active substance.

Ask an expert about the topic of the article

Still have questions? Ask them in the comments below and our experts will answer you. There you can also share your experience with other readers of Megasovets.

Managing editor

Zotina Natalya Igorevna,

Expert pharmacist

Tell mom, dad, grandma and aunt Galya from the third entrance

Copy link

Concor tablets 5 mg x 28 br

hypertension) . Concor contains the active ingredient bisoprolol. Concor is a medicine, some of which are dispensed in a pharmacy according to a medicinal prescription.

CONCOR® 5 mg

CONCOR 5 mg isoprolol fumarate (2:1)

Soprolol 5 mg: 1 filmiran tablet containing medicinal substance: 5 mg bisoprolol fumarate (2:1)

Help:

Conson 10 mg: Coloidal silicone dioxide, magnesium (stearate), crospovidone, microcrystalline cellulose, tsarevich nicheste, calcium hydrogen phosphate, iron (III) oxide (E172), iron hydroxide (172), dimethicone, macrogol 400, titanium dioxide (E171), hypromelose

Pack of

Conson 5 mg: Filmirani tablets, light yellow, with heart shape, with dividing line Pack of 30, 50 and 100 tablets

Pharmacological group 9 0005

Cardioselective beta-receptor blocker

Indications

– High blood pressure (hypertension)

– Ischemic pain in the neck (throat toad)

Contraindications

5/10 mg? Sopsog 5/10 mg not available for use at:

– acute myocardial insufficiency (cardiac insufficiency) or in time on the insufficiency (decompensation) for cardiac insufficiency, from the need for intravenous therapy with means, increasing the contractility (ability for intercourse) on sirceto.

– shock, predicted from impaired cardiac function (cardiogenic shock)

– signs of impaired conduction to the atrial chamber impulse (second or third degree AV) without pacemaker

– sinus pain syndrome

– the conduction on the impulse between the sinus vein and the predsardieto (sinoatrial block) is disturbed

– it is underlined to amuse the heartbeat (slowly on the pulse from 50 beats / min) in advance of the ground for therapy

– it is underlined to decrease the blood pressure on lyagane (systolic bloody lyagane In a face from 90 mm hg)

– Bronchialna Astma or Tezhko chronically obstructively whitewash

– stages at the perihno arterialo velvezilo or spasms on a prostite on Krakat and Ratseta (Raynaud Syndrome)

– Non-swelling of tumors on the epigastric medulla (pheochromcytoma)

– Metabolic acidosis (depending on the acidic substance)

– Proved hypersensitivity to bisoprolol or any of the help substances

9 0002

COG 10 mg self-trace consultation with your doctor?

Follow the situations described when you can take Concord 5/10 mg on your own under certain conditions and take special attention. Pray, nourish your doctor for Comrade. Tova se otnasya and aco ste were beaten zasegnati from some trace of the situation in Minaloto.

Patients in similar circumstances should be observed especially carefully.

– bronchospasm (bronchial asthma, obstructive respiratory diseases)

– treatment with inhalation anesthesia symptomatic on markedly malena blood sugar (hypoglycemia) may be masquerade

– strict post-wall

– continuing desensitization therapy

– moderate disturbances in conduction to the precardiac chamber impulse (AV block from the first degree)

– impaired blood flow, caused elastic cording on the coronary artery (Angina on Prinzmetal)

9 0002 – peripheral arterial occlusive disease (can be

In patients with personal or family history of psoriasis β-receptor blocker (kato Conson 5/10 mg) . In a patient with a tumor on the adnexal medulla (pheochromcytoma), Concur 5/10 mg may be accompanied by a preexisting blockade on the alpha receptor.

Why do you need to pay attention to your wife and buy T-shirts?

According to the time of pregnancy Conson tried and all of itself, after which the doctors carefully assessed the risk/reward ratio.

By the principle of beta-receptor blockers, they paint the blood flow on the placenta and may affect the development of the unborn child. The blood flow on the placenta and uterus, as well as the development of a non-born baby, try to observe the trace of a child, and as a result of this, and to calculate alternative therapeutic measures. Symptoms are lowered blood pressure and amusing chestity on the pulse according to the principle of se appearing for three days after the birth of a citizen. It is not known that they gave Sopsog a preminava in karmata. Zatova is not prejudicial to treatment with Concord 5/10 mg on a regular basis. On what tryabva and all obrne special attention in children and older patients? Nyama special zabelezhki during treatment for the age of the choir.

Deadlines for use and warnings

In case of impaired function on black shot and bbrecite, tryabva yes, follow the instructions for dosage, (see t. Instructions for dosage) In bronchial asthma or other chronic obstructive diseases, which may be associated with symptoms, bronchodilator therapy is indicated. Of course, there may be an increase in resistance to respiratory distress in asthmatic patients, some of which are based on a higher dose of beta2-sympathomimetic. Some other beta-receptor blockers, such as Conson 5/10 mg, may be more sensitive to allergies and also to anaphylactic reactions, i.e. sharpen common allergic reactions. Adrenaline does not lead to desire and has a therapeutic effect in these cases.

Symptom of thyroid dysfunction (thyrotoxicosis) may be masquerade from Concord 5/10 mg.

Treatment with Concord 5/10 mg does not try and sespira clearly without a categorical indication.

How can you pay attention to which shofirate is a good tool, work from a machine or work without a support?

When trained on patients with ischemic pain, Bisoprolol sirceto does not owe the ability to shofiran. Contrary to this, for the sake of individual variation in the reaction of the drug product, the ability of the shofiran to transport the vehicle, work from a machine or work without a support, you can do it all. Tova tryabva and this ima foresee, especially when motivated by therapy, increased by dose and when taken for treatment, such as in combination with alcohol.

Drug Interactions

Which other drug products affect the effect of Conso 5/10 mg or how does Conso 5/10 mg affect other drug products?

Simultaneous application monitor the drug performance is not detrimental:

Simultaneously application with calcium antagonists, observing an increased decrease in the blood pressure, amusing conduction to the atrial chamber, (AV) impulse, somehow the ability to svyvane on the heart muscles. Especially, intravenous application on calcium and antagonists from verapamil type can lead to hypotension and AV blockade.

The use of Concorde 5/10 mg and clonidine can lead to severe damage to the heart rate and to the effect of conduction on the pulse in the heart. Spiraneto on clonidine can be done so and brought to the extreme on the crooked lyagan. Simultaneous application of inhibitors to monoamine oxidase (with an exception to MAO-B inhibitors) can affect the redness of the drug (painting on the blood of the drug, but it is also extremely high on the blood of the drug).

Watch for medications that may be used daily and with Concord 5/10 mg under specified conditions and with special attention:

Tighten the effects on Concord 5/10 mg and antiarrhythmics in the upper part of the impulse conduction and the ability to intervene on the heart can and se cumulate. eri, dori they and they are put in caps for the eyes, the potentiate of the effect on Concord 5/10 mg.

The use of Concord 5/10 mg and insulin or other drugs that lubricate sugar (oral anti-diabetic agents) may have a potentiator effect on the latter. Warn of signs of low blood pressure (hypoglycemia), especially pulse counts (tachycardia), may or may not masquerade or tighten. Therapy with Concord 5/10 mg and anesthetics can lead to a sharp decline in blood pressure. Protivoregulatory mechanisms and such an increase in heart rate (reflex tachycardia) can and will disrupt. The continuation of this on beta-blockade shows the risk of arrhythmia over time on the basis of anesthesia and intubation. The anesthetist tried and advised to be informed about treatment with Concord 5/10 mg.

Concomitant therapy with Conzog 5/10 mg and cardioselective glycosides (digitalis) can lead to a pronounced reduction in heart rate and pulse conduction in the heart. ata synthesis (e.g. acetylsalicylic Kiselina) may have an antihypertensive effect on Concord 5/10 mg.

The use of ergotamine derivatives (eg ergotamine as an anti-migraine drug) and Concord 5/10 mg may lead to an increase in impaired peripheral circulation.

Use of Concord 5/10 mg and sympathomimetic may have an effect on two hours of the product. Treatment for allergic reactions may require an increase in the dose of adrenaline. Antihypertensive effect on Concord 5/10 mg may be weak. Yes, please semi-abdomen on bisoprolol. Adaptirane to the dose according to the principle of not se iziskva.

Keep food, drinks, etc. shaking and beating?

Antihypertensive effect on Conzog 5/10 mg may be affected by alcohol. Instructions for dosage, start and duration of use

wrote something else.

Please follow these directions carefully, otherwise Concord 5/10 mg may not have a suitable effect. What is the dose of Sopsog 5/10mg Treatment is according to the principle of tryabva and then gradually from the bottom of the dose, which is more and more povishavat funny. In all cases, the dose of tryabva and this adapter is individual, especially when it comes to pulse and therapeutic success. High blood pressure (hypertension):

If not prescribed otherwise, the correct dose is 1 filmiran tablet Concord 5 mg (5 mg bisoprolol fumarate (2:1)) once a day. For moderate hypertension (diastolic blood pressure up to 105 mmHg), treatment with LA filmiran tablet Conco 5 mg (equivalent to 2. 5 mg bisoprolol fumarate (2:1)) once daily may be adequate.

If the effect is not satisfactory, the dosage may be increased by 2 Filmiran Tablets Conxor 5 mg or 1 Filmiran Tablet Conson 10 mg (equivalent to 10 mg bisoprolol fumarate (2:1)) once a day. An additional increase in dose is justified in exceptional cases.

Ischemic pain on sarceto (angina toad)

If not prescribed otherwise, the correct dose is 1 filmiran tablet Concord 5 mg (5 mg bisoprolol fumarate (2:1)) once daily. , dose can Yes, increase by 1 filmiran tablet Conzog 10 mg (equivalent to 10 mg bisoprololfumarate (2:1)) once a day. An additional increase in dose is justified in exceptional cases.

Dose when breech and/or black-fraction function is impaired

In patients with severe or severe functional impairment, mild to moderate, the same, in principle, is not subject to adaptation to the dose. In patients with advanced malnutrition (creatinine clearance < 20 ml/min) and in patients with the same impairment of chromosomal function, the daily dose of 10 mg bisoprolol fumarate (2:1) is not required.

How do you take Consox 5/10 mg?

Take tryabva and take filmirata tablet sutri, cyala, with low fluidity, ahead of time or after a snack. How long do you try and take Conzog 5/10 mg? The duration of treatment is not limited. That depends on the origin and on the illness.

Dosage for Conson 5/10 mg is not a problem for me, but according to a prescription for a doctor. If this is the case, the treatment of this drug or spiral is premature, even though it is prescribed by the drug.

Treatment with Concord 5/10 mg does not cause tremors – especially in patients with impaired blood flow in the coronary artery (ischemic pain in the heart: angina toad) – yes, the spira is sudden, and the tremor is gradual, and the tremor is gradual (for example, through painting on half per dose at weekly intervals), such a sharp spiral can be brought to an acute effect on the patient. The doctor determines the duration of the treatment.

Sins in taking and overdose case on suspected predosiran with Consog 5/10 mg, praying , inform your doctor in a fun way. Depending on the degree on the predose of your drug, decide what measures to take.

NAY-CHITTITION ON THE SPSOG 5/10 Mg, Obvengen, Glorda Dauren (bradycardia), bronchospazm, elegance of the decline on KRENENOTO NAALYAGAN, MOICODRAL CARODRANA (SAME DIGNITIONS) and Hipoglycemia (reduced KRIVNA ZAKHAR). In the case of predosed therapy with Consox 5/10 mg tryabva and se spray after a consultation with the drug.

What do you pay attention to, did you take a small amount of Conso 5/10 mg or did you take it?

Do not take a double dose of the next dose, but continue your regimen as described in the “Dosage Instructions” or as directed by your doctor.

What do you notice if you stopped treatment with Concord 5/10 mg or stopped it prematurely?

Please do not stop or stop treatment with Coronar 5/10 mg, without consulting your medication. : angina toad) – yes, this spiral is sudden, and the trembling, according to the principle, yes, this spiral is gradual (for example, through painting half the dose at seven intervals), you can sharply spirane and bring it to an acute condition on the patient.