- Nervous system: headache, weakness, increased fatigue, slowing down the speed of motor and mental reactions; rarely – paresthesia in the extremities (in patients with Raynaud’s syndrome and with intermittent claudication), muscle weakness, decreased attention, depression, anxiety, insomnia, nightmares, drowsiness, confusion, or short-term memory impairment;
- Cardiovascular system: palpitations, sinus bradycardia, orthostatic hypotension, decreased blood pressure, dizziness (with cases of loss of consciousness); seldom – arrhythmias, decreased myocardial contractility, cardialgia, impaired myocardial conduction, manifestation of angiospasm (Raynaud’s syndrome, cooling of the lower extremities, increased peripheral circulation disturbance), transient symptoms of chronic heart failure – swelling of the feet and / or lower legs, swelling, shortness of breath;
- Sensory organs: soreness and dryness of the eyes, decreased secretion of lacrimal fluid, tinnitus, conjunctivitis, visual impairment;
- Integuments: rash, skin itching, urticaria, psoriasis-like skin reactions, exacerbation of psoriasis, flushing of the skin, photodermatosis, exanthema, reversible alopecia, increased sweating;
- Digestive system: taste disturbance, abdominal pain, nausea, dry mouth, vomiting, constipation, diarrhea, impaired liver function;
- Endocrine system: hypothyroidism, hypoglycemia; rarely – hyperglycemia (in patients with diabetes mellitus);
- Respiratory system: nasal congestion, difficulty breathing out, bronchospasm (at high doses in predisposed patients);
- Laboratory indicators: leukopenia, agranulocytosis, increased activity of liver enzymes, thrombocytopenia; very rarely – hyperbilirubinemia;
- Other: pain in the back or joints; in isolated cases, it can lead (like all beta-blockers) to a slight increase in body weight, a decrease in libido and / or potency.
The listed adverse reactions depend on the individual sensitivity of the patient, in most cases they are weakly expressed and disappear after drug withdrawal.
Symptoms of an overdose, the manifestation of which can be observed in the range from 20 minutes to 2 hours after taking the drug, include: a marked decrease in blood pressure, ventricular extrasystole, arrhythmia, severe sinus bradycardia, vomiting, nausea, cyanosis, dizziness, fainting, bronchospasm, with acute overdose – loss of consciousness, cardiogenic shock, coma, cardialgia, atrioventricular block (up to cardiac arrest).
Treatment: gastric lavage and the use of adsorbing agents, with a marked decrease in blood pressure, heart failure, bradycardia – intravenous administration of beta-adrenostimulants (until the desired effect is achieved) or atropine sulfate in a dose of 2-5 mg is prescribed with an interval of 0,5-2 minutes .
In the absence of improvement, norepinephrine (norepinephrine), dobutamine or dopamine are used, in the future, glucagon can be used – 1-10 mg; with bronchospasm, beta 2-adrenoreceptor stimulants are administered intravenously.
It should be borne in mind that with simultaneous use with metoprolol:
- Means for inhalation anesthesia (hydrocarbon derivatives) – increase the risk of developing arterial hypotension and inhibition of myocardial function;
- Theophylline, beta-adrenostimulants, estrogens, cocaine, indomethacin and other non-steroidal anti-inflammatory drugs (NSAIDs) – reduce the hypotensive effect;
- Nifedipine – significantly reduces blood pressure;
- Hypnotics and sedatives, tri- and tetracyclic antidepressants, antipsychotics, ethanol – aggravate central nervous system depression;
- Ergot alkaloids – increase the threat of peripheral circulation disorders, and anesthetic drugs – lead to the summation of the cardiodepressive effect;
- Antiarrhythmic drugs (amiodarone), reserpine, diltiazem, clonidine, alpha-methyldopa, guanfacine, cardiac glycosides, general anesthesia drugs – increase inhibition of AV conduction and severity of decreased heart rate;
- Diuretics, antihypertensives, nitroglycerin, slow calcium channel blockers – lead to a sharp decrease in blood pressure;
- Phenothiazines, oral contraceptives, cimetidine – increase the concentration of metoprolol in plasma, and inducers of microsomal liver enzymes (barbiturates, rifampicin) – reduce;
- Iodine-containing radiopaque substances for intravenous administration increase the risk of anaphylactic reactions;
- Allergens used for immunotherapy or allergen extracts for skin tests increase the likelihood of anaphylaxis or systemic allergic reactions.
The effect of metoprolol on simultaneously taken substances / preparations:
- Lidocaine and xanthine (except diphillin) – reduces their clearance, especially with increased initial clearance of theophylline under the influence of smoking;
- Antidepolarizing muscle relaxants – lengthens and enhances their effect;
- Oral hypoglycemic agents, when combined with insulin – reduces effectiveness, increases the risk of hypoglycemia and aggravates its severity, can mask some symptoms of hypoglycemia (tachycardia, increased blood pressure, sweating);
- Coumarins – prolongs the anticoagulant effect.
It should be remembered that the interval between taking Metoprolol and monoamine oxidase inhibitors should be at least 14 days.
Due to the threat of withdrawal syndrome, when combined with clonidine, it is recommended to cancel it a few days after the cessation of Metoprolol.
Nervous system: slowing down the speed of motor, mental reactions, weakness, headaches, increased fatigue, paresthesias in the extremities, cramps, tremors, drowsiness, impaired attention, anxiety, insomnia, myasthenia gravis, hallucinations, memory disorders, confusion, “nightmare” dreams, asthenia.
Sensory organs: sore eyes, decreased vision, conjunctivitis, dry eyes, decreased production of lacrimal fluid.
Cardiovascular system: orthostatic hypotension, loss of consciousness, dizziness, drop in blood pressure, sinus bradycardia, swelling, decreased myocardial contractility, cardialgia, impaired myocardial conduction, manifestation of angiospasm, heart failure, worsening of atrioventricular conduction is rarely observed.
Digestive tract: changes in taste, impaired liver function (cholestasis, darkening of urine, yellowing of the skin and sclera).
Integuments: photodermatosis, psoriasis-like skin reactions, exacerbation of psoriasis, skin rash, exanthema, reversible form of alopecia, increased sweating.
Respiratory system: bronchospasm, nasal congestion, shortness of breath.
Endocrine system: hypoglycemia (with insulin-demanding diabetes mellitus), hyperglycemia (in individuals with non-insulin-dependent diabetes mellitus), hypothyroid state. Perhaps the development of rash, itching, allergies, thrombocytopenia, hyperbilirubinemia, agranulocytosis.
The effect of Metoprolol on the fetus: hypoglycemia, intrauterine growth retardation, bradycardia.
The drug can cause a decrease in potency, libido, weight gain, joint pain. A sharp cessation of the drug causes the development of “withdrawal syndrome.”
Allergen extracts used for skin tests, allergens themselves significantly increase the likelihood of developing anaphylaxis, severe systemic allergic reactions in patients who use Metoprolol.
The risk of developing anaphylactic reactions increases with the intravenous administration of iodine-based radiopaque drugs. Medications for general inhalation anesthesia, phenytoin when administered intravenously increase the likelihood of a drop in blood pressure, increase the severity of the cardiodepressive effect.
Metoprolol can mask the symptoms of hypoglycemia (high blood pressure, tachycardia), change the effectiveness of oral forms of hypoglycemic agents, insulin.
The drug reduces the clearance of xanthines, lidocaine, increasing their concentration in blood plasma, especially in patients with increased clearance of theophylline with concomitant smoking.
Estrogens, glucocorticosteroids, NSAIDs weaken the hypotensive effect of the drug.
Methyldopa, reserpine, BMKK, cardiac glycosides, antiarrhythmic drugs, amiodarone, diltiazem, Verapamil, guanfacin aggravate the course of bradycardia, heart failure, atrioventricular block.
When taking nifedipine, a significant drop in blood pressure is noted. Hydralazine, sympatholytics, clonidine, diuretics, other antihypertensive drugs can provoke a sharp and excessive drop in blood pressure.
Metoprolol prolongs the period of anticoagulant exposure to coumarins, increases the period of action of non-depolarizing muscle relaxants. Antipsychotic drugs, tetracyclic antidepressants, antipsychotics, tricyclic antidepressants, hypnotics and sedatives, ethanol enhance the inhibitory effect of metoprolol on the central nervous system.
The simultaneous appointment of MAO inhibitors is unacceptable due to the risk of a sharp drop in blood pressure.
Disturbance of peripheral circulation is noted with the appointment of unhydrogenated ergot alkaloids.
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Metoprolol is a cardioselective beta1-blocker. It has antiarrhythmic, antianginal, antihypertensive and minor membrane-stabilizing effects.
By blocking beta1-adrenergic receptors of the heart, the formation of cAMP (cyclic adenosine monophosphate) from ATP (adenosine triphosphate) stimulated by catecholamines is reduced, intracellular calcium flow is reduced, heart rate is reduced, myocardial contractility is reduced, excitability and conductivity are inhibited.
In the first 24 hours after taking beta-blockers, the total peripheral vascular resistance increases, after 1-3 days it returns to its original value, and with prolonged use of the drug it decreases.
The antihypertensive effect of metoprolol is due to the following effects:
- decrease in minute volume of blood;
- decreased renin synthesis;
- inhibition of the activity of the renin-angiotensin-aldosterone system;
- suppression of activity of the central nervous system;
- restoration of sensitivity of aortic arch baroreceptors;
- reduction of peripheral sympathetic effects.
- Cardiovascular system: palpitations, sinus bradycardia, decreased blood pressure, orthostatic hypotension (dizziness, loss of consciousness); rarely – a decrease in myocardial contractility, arrhythmias, a temporary increase in the symptoms of chronic heart failure (shortness of breath, swelling, including feet and / or lower legs), the manifestation of angiospasm (cooling of the lower extremities, increased peripheral circulation, Raynaud’s syndrome), cardialgia, violation myocardial conduction;
- Nervous system: weakness, increased fatigue, slowing down the speed of psychomotor reactions, headache; rarely – anxiety, muscle weakness, paresthesia in the extremities (against the background of intermittent claudication and Raynaud’s syndrome), drowsiness, depression, insomnia, decreased attention, confusion, nightmares, short-term memory impairment;
- Digestive system: dry mouth, nausea, vomiting, taste change, abdominal pain, diarrhea or constipation, functional liver disorder;
- Sensory organs: rarely – tinnitus, decreased secretion of lacrimal fluid, decreased vision, conjunctivitis, dryness and soreness of the eyes;
- Skin: itching, rash, urticaria, increased sweating, exacerbation of psoriasis, psoriasis-like reactions, exanthema, hyperemia, photodermatosis, reversible alopecia;
- Endocrine system: hypoglycemia (with insulin-dependent diabetes mellitus); rarely – hypothyroidism, hyperglycemia (with diabetes mellitus);
- Respiratory system: nasal congestion, shortness of breath, difficulty breathing out (bronchospasm at high doses);
- Laboratory indicators: rarely – agranulocytosis, thrombocytopenia (unusual hemorrhages and bleeding), leukopenia, increased activity of hepatic transaminases; very rarely – hyperbilirubinemia;
- Effect on the fetus: intrauterine bradycardia, growth retardation, hypoglycemia;
- Other: pain in the back or joints; in isolated cases – a slight increase in body weight, decreased potency and libido.
- Coronary heart disease: myocardial infarction (as part of complex therapy of secondary prevention), prevention of angina attacks;
- Monotherapy or as part of a combination treatment (with other antihypertensive agents) of arterial hypertension, including hyperkinetic type, tachycardia;
- Hyperthyroidism (as part of complex therapy);
- Heart rhythm disturbances, including ventricular extrasystole, supraventricular tachycardia;
- Prevention of migraine attacks.
- Cardiogenic shock;
- Sinoatrial (SA) blockade;
- Atrioventricular (AV) block II-III degree;
- Severe bradycardia;
- Sick sinus syndrome;
- Prinzmetal angina pectoris;
- Decompensated heart failure;
- Arterial hypotension (for the secondary prevention of myocardial infarction – with systolic blood pressure (BP) below 100 mmHg and a heart rate (heart rate) of less than 45 beats per minute);
- Concomitant therapy with monoamine oxidase inhibitors (MAOs) or verapamil;
- Age up to 18 years;
- Period of breastfeeding;
- Hypersensitivity to the components of the drug or other beta-blockers.
It is recommended that metoprolol be prescribed with caution to patients with degree I AV blockade, metabolic acidosis, diabetes mellitus, chronic obstructive pulmonary disease (chronic obstructive bronchitis, pulmonary emphysema), bronchial asthma, peripheral vascular disease obliterans (Raynaud’s syndrome, intermittent claudication), myasthenia gravis, chronic renal and / or liver failure, pheochromocytoma, thyrotoxicosis, psoriasis, depression (including history), in old age and during pregnancy.
The tablets are taken whole inside, during or immediately after a meal, with a sufficient amount of liquid.
The dosage regimen is prescribed by the doctor based on clinical indications.
Recommended daily dosing:
- Secondary prevention of myocardial infarction: 200 mg in 2 divided doses (morning and evening);
- Arterial hypertension: initial dose of 50-100 mg in 1 or 2 doses. To achieve a therapeutic effect, a gradual increase in the dose to 100-200 mg and / or the simultaneous administration of other antihypertensive drugs is indicated. The daily dose should not exceed 200 mg;
- Tachycardia amid functional disturbances in cardiac activity: 100 mg in 2 divided doses;
- Angina pectoris, arrhythmias, prevention of migraine attacks: 100-200 mg in 2 divided doses.
Dose adjustment is not required for impaired renal function, the need for hemodialysis, and treatment of elderly patients.
The appointment of Metoprolol in patients with functional liver disorders must be made in accordance with their clinical condition.
In case of an overdose, the following symptoms occur: dizziness, cyanosis, vomiting, nausea, bronchospasm, severe severe sinus bradycardia, arrhythmia, fainting, a marked decrease in blood pressure, ventricular extrasystole. In acute overdose, atrioventricular block, cardiogenic shock, cardialgia, coma, and loss of consciousness may occur.
The first signs of an overdose occur after 20 minutes – 2 hours after taking the drug.
The patient should rinse the stomach and prescribe absorbent agents. Symptomatic therapy is carried out: with a decrease in blood pressure, the patient is laid in a supine position with a slightly raised pelvis and legs; with an excessive decrease in blood pressure, heart failure and bradycardia, beta-adrenostimulants are administered intravenously at intervals of 2–5 minutes (until the desired effect is achieved) or atropine sulfate is administered intravenously at a dose of 0,5–2 mg.
If there is no positive effect, dopamine, norepinephrine or dobutamine is administered.
In the future, it is possible to prescribe glucagon in a dose of 1-10 mg and staging an electric stimulator. In case of bronchospasm, beta2-adrenoreceptor stimulants are administered intravenously. Hemodialysis is ineffective.
On the Internet resources you can find numerous reviews about Metoprolol. In most cases, patients respond positively to the drug, noting its availability and high effectiveness in various cardiovascular pathologies. Metoprolol helps with attacks of angina pectoris, high blood pressure, tachycardia, severe headaches and migraines.
Some patients complain of side effects (weakness, shortness of breath), addiction to the drug and the presence of a large number of contraindications, which requires a particularly careful approach when prescribing Metoprolol.
Quite rarely there are reviews in which it is said that the drug was not effective or less effective than similar drugs.
The drug is produced by various pharmaceutical companies, despite this, the price of Metoprolol varies slightly:
- 25 mg tablets (60 pcs. per pack) – from 35 rubles;
- 50 mg tablets (30 pcs. per pack) – from 20 rubles;
- 50 mg tablets (50 pcs. per pack) – from 29 rubles;
- 100 mg tablets (30 pcs. per pack) – from 25 rubles;
- 100 mg tablets (50 pcs per pack) – from 77 rubles.
Since Metoprolol was created in order to reduce the effect of adrenaline on the heart muscle, its administration is indicated in cases where the disease is associated with an excess effect of adrenaline. Most often it is:
- Angina pectoris associated with increased stress on the heart muscle.
- Arterial hypertension.
- Some types of arrhythmias.
- In the prophylactic therapy of myocardial infarction, as well as in acute myocardial infarction.
The medication is used in complex therapy to prevent re-infarction, but in this case it is most often used the “slow”, prolonged form of the tablets – retard and metoprolol succinate as the main substance.
But most often, nevertheless, Metoprolol is prescribed for pressure, due to the fact that the medicine acts on the root cause.
Metoprolol is a fairly powerful drug, and therefore it has an impressive list of contraindications for use. You can not prescribe and take the drug in the following cases:
- Bradycardia, especially severe forms.
- Cardiogenic shock.
- AV block (atrioventricular) 2 and 3 degrees.
- Arterial hypotension;
- Children’s age and pregnancy (not used due to the fact that there is no clinical data on the safety of the drug, and therefore there is a high risk of developing complications in the patient).
There are also conditions that in themselves are not strict contraindications, however, if they exist, Metoprolol is administered with extreme caution:
- Renal and hepatic insufficiency (chronic, in acute condition, the drug is contraindicated).
- Diabetes mellitus, as well as thyrotoxicosis.
- Chronic obstructive bronchitis.
- Bronchial asthma.
Since the drug is available in two different implementations of the tablet form, the methods of administration will also vary. Instructions for use Metoprolol Teva or Metoprolol Ratiopharm states that the drug is taken orally during or after a meal, washed down with water. The frequency of administration will depend on the disease and the condition of the patient. A day, as a rule, prolonged medication is taken once or twice, usually in the mornings and also in the evening.
With a retard form, everything is somewhat simpler. Due to the slower release, metoprolol retard can be taken 1 time per day and not depend on food intake. As a rule, the drug is completely released in the body in 12 hours, and a decrease in its concentration in the blood occurs much later.
Most often, side effects when taking will be:
- Excessive fatigue, shortness of breath, dizziness.
- Bradycardia and low blood pressure (sometimes fainting), headaches, dizziness.
- From the gastrointestinal tract, various minor disorders in the form of feelings of nausea, constipation or, conversely, diarrhea, as well as pain.
In addition, the medicine can also cause other disorders on the part of different organs and systems, however, any disorders not on the list can appear much less frequently than those listed.
The main scope of the tool is the treatment of diseases of the cardiovascular system. In some cases, metoprolol is sufficiently effective to be used as the only drug (monotherapy). However, as a rule, with severe cardiovascular pathologies, metoprolol is part of complex therapy.
So, under what ailments metoprolol will be effective:
- prevention of secondary heart attack,
- coronary artery disease and angina pectoris,
- compensated chronic heart failure,
- hypertonic disease.
Also, the drug is indicated for various types of arrhythmias:
- supraventricular arrhythmia,
- ventricular arrhythmia,
- atrial tachycardia,
- sinus tachycardia,
- atrial fibrillation,
- ventricular extrasystole,
- hyperkinetic cardiac syndrome.
Metoprolol can be used for certain diseases associated not with the cardiovascular, but with the endocrine or nervous systems. For example, the drug is used for thyrotoxicosis, tremor, withdrawal symptoms, anxiety, for the prevention of migraine.
The dosage of the drug largely depends on the disease. Usually start with 100 mg per day. If necessary, this value is gradually increased to 200 mg. In old age, it is recommended to start with 50 mg per day.
With hypertension, 100-150 mg per day is prescribed, the drug is taken 1-2 times a day.
With angina pectoris, the dosage is the same – 100-150 mg per day. However, this dose is divided into 2-3 doses.
With tachycardia or thyrotoxicosis, take 50 mg 1-2 times a day.
With the prevention of heart attack per day, 200 mg should be taken.
In the prevention of migraine should be 100-200 mg per day, for 2-4 doses.
When using the drug, you should also remember the effect of withdrawal. This means that the drug should not be withdrawn immediately, but gradually (within 10 days) reducing the dose, in order to avoid the appearance of negative effects, such as tachycardia, arrhythmia, increased blood pressure, increased angina attacks.
When administered, the maximum daily dose cannot exceed 400 mg. With insufficient effectiveness of the drug in the treatment of hypertension, additional antihypertensive drugs should be taken. In addition, it should be remembered that the selectivity of the drug is reduced when used in high doses.
- Arterial hypertension, including hyperkinetic type, tachycardia (in combination with other antihypertensive drugs or with monotherapy);
- Heart rhythm disturbances (ventricular extrasystole, supraventricular tachycardia);
- Coronary heart disease, myocardial infarction (secondary prevention / complex therapy);
- Hyperthyroidism (as part of complex therapy).
Pharmacodynamics and pharmacokinetics
The drug has antiarrhythmic, antianginal and hypotensive effects. The drug does not have internal SMA, does not have a membrane stabilizing effect.
The antihypertensive effect is due to a decrease in the synthesis of renin, monooxygenase, and inhibition of the activity of the renin-angiotensin system, the central nervous system. The drug is able to lower blood pressure during stress, physical exertion at rest.
The antianginal effect is provided by a decrease in heart rate, as well as a decrease in the need for myocardial tissue in oxygen. Long-term use of the drug increases the tolerance of physical exertion, reduces the severity of angina attacks and their frequency. As a result of elimination of arrhythmogenic factors (arterial hypertension, increased content of cAMP, tachycardia, increased activity of the sympathetic nervous system), an antiarrhythmic effect is achieved.
With thyrotoxicosis, heart diseases of functional origin, sinus tachycardia, atrial fibrillation, supraventricular form of tachycardia, Metoprolol allows you to restore the sinus rhythm, reduce heart rate. The drug prevents the formation of migraines.
The average therapeutic doses of metoprolol, unlike other beta-blockers, have a less pronounced effect on the organs in which beta2-blockers (uterus, bronchi, smooth muscle tissue of peripherally located arteries, skeletal muscle, pancreas) are located, on carbohydrate metabolism.
Long-term use of the drug leads to a decrease in blood cholesterol.
- atrioventricular block 2 and 3 degrees,
- severe bradycardia (less than 50 beats per minute),
- arterial hypotension,
- Prinzmetal angina,
- sinoatrial block
- insufficient functionality of the sinus node,
- decompensated chronic heart failure,
- acute stage of myocardial infarction (with pulse less than 45 beats / min, pq interval less than 240 ms, systolic pressure below 100 mm),
- children’s age (up to 18 years),
- severe disturbances in peripheral circulation.
Can I take the drug during pregnancy and lactation? First of all, it must be remembered that the active component in its composition penetrates the body of the developing fetus and into breast milk. Therefore, when breastfeeding, the drug is clearly contraindicated.
During pregnancy, the doctor must weigh the pros and cons, and if you can not do without a remedy, then he can prescribe it. However, in any case, therapy should be discontinued 2 days before the expected birth. If the expectant mother took the drug before childbirth, then her newborn baby should be under special supervision for the next five days, since the intake of the active substance in the bloodstream can cause phenomena such as bradycardia, hypotension, hypoglycemia, and respiratory depression in the baby.
With caution, the drug is used for:
- renal and liver failure,
- bronchial asthma,
- chronic obstructive pulmonary disease,
- adrenal tumors,
as well as in old age.
- Atrioventricular block (AV block) II-III degree;
- Cardiogenic shock;
- Sinoatrial (SA) blockade;
- Severe bradycardia;
- Sick sinus syndrome;
- Prinzmetal angina pectoris;
- Decompensated heart failure;
- Arterial hypotension (systolic blood pressure (BP) less than 100 mmHg, heart rate of 45 beats per minute – if used in the secondary prevention of myocardial infarction);
- Age up to 18 years (safety and effectiveness of the drug are not confirmed);
- Lactation period;
- The simultaneous use of monoamine oxidase inhibitors (possibly a significant increase in the hypotensive effect) or the simultaneous intravenous administration of verapamil (can lead to cardiac arrest);
- Hypersensitivity to the drug or other beta-blockers.
Relative (must be used with extreme caution, since there is a likelihood of complications):
- Metabolic acidosis;
- Chronic obstructive pulmonary disease, bronchial asthma (chronic obstructive bronchitis, pulmonary emphysema);
- Obliterating peripheral vascular disease (Raynaud’s syndrome, intermittent claudication);
- Chronic hepatic and / or renal failure;
- AV block of I degree;
- Myasthenia gravis;
- Depression (including history);
- Elderly age.
During pregnancy, admission is permissible only according to strict indications with a careful balance of the benefits of treatment with the drug and the risk of developing its adverse reactions (possible occurrence of bradycardia, hypoglycemia, arterial hypotension in the fetus). After birth, the newborn should be under strict control for 2-3 days.
Since the effect of the drug on the newborn during breastfeeding has not been studied, it is necessary to refuse breastfeeding during administration.
With metabolic acidosis, myasthenia gravis, diabetes mellitus, liver failure, pheochromocytoma, chronic renal failure, COPD (chronic obstructive bronchitis, pulmonary emphysema), with bronchial asthma, obliterating disease of peripheral vessels, during pregnancy, thyrotoxicosis, psoriasis, depression, pediatric patients for the elderly, the medicine is prescribed with caution.
Indicated gastric lavage, intake of enterosorbents, the introduction of norepinephrine and dopamine, beta-receptor agonists. With persistent bradycardia, the installation of a pacemaker is possible. Hemodialysis is ineffective.
The first symptoms are noted 20 minutes after taking high doses of the drug.
Requires the appointment of enterosorbents, timely gastric lavage. With a pronounced drop in blood pressure, the patient is given the position of Trendelenburg, norepinephrine, dobutamine, dopamine are administered. Later, glucagon is prescribed, an intracardial electrostimulator is installed as needed by the transvenous method.
In the formation of convulsive syndrome, diazepam is slowly administered intravenously. With the development of bronchospasm, beta-2 adrenostimulants are administered intravenously.
Hemodialysis has not been proven effective.
Treatment with beta-blockers must be accompanied by regular monitoring of heart rate and blood pressure, in patients with diabetes mellitus – the level of glucose in the blood (the dose of hypoglycemic agents or insulin is selected individually).
When prescribing the drug, the patient should be taught the method of self-calculating heart rate and instructed on the need to immediately consult a doctor with a heart rate below 50 beats per minute.
Cardioselectivity of Metoprolol at a dose of more than 200 mg per day is reduced.
The use of the drug in the treatment of heart failure should begin only at the stage of compensation.
In patients with a burdened allergic history, an increase in severity and lack of effect from the usual doses of epinephrine (adrenaline) in hypersensitivity reactions is possible.
The drug can enhance the symptoms of pathology of peripheral arterial circulation.
The drug should be discontinued by gradually reducing the dose over 10 days. Abrupt cessation of treatment can cause the patient to withdraw (increase in blood pressure, increased attacks of angina pectoris).
An individual dose of the drug for angina pectoris should provide a heart rate patient at rest 55-60 beats per minute, with a load of not higher than 110.
When using contact lenses, it is necessary to take into account the decrease in the production of tear fluid while taking beta-blockers.
The drug may mask tachycardia and other symptoms of hyperthyroidism.
In patients with diabetes, Metoprolol may obscure tachycardia caused by hypoglycemia. With insulin-induced glycemia, the drug practically does not affect the process of restoring the concentration of glucose in the blood to a normal level.
In bronchial asthma, the use of the drug is indicated with the simultaneous administration of beta2-adrenostimulants, with pheochromocytoma – alpha-adrenergic blockers.
Before surgery, it is necessary to inform the anesthetist about taking Metoprolol so that general anesthesia is performed with minimal negative inotropic effect without drug withdrawal.
It should be borne in mind that with the simultaneous use of reserpine and other drugs that reduce the reserves of catecholamines and enhance the action of beta-blockers, an excessive decrease in blood pressure and the development of bradycardia are possible.
In elderly patients, it is necessary to control liver function, and with a strong decrease in blood pressure, AV blockade, the appearance of bronchospasm, ventricular arrhythmias, increasing bradycardia, severe liver dysfunction, dose adjustment or drug withdrawal is required.
In severe renal failure, regular monitoring of renal function is required.
It is necessary to monitor the condition of patients with depressive disorders, with the appearance of signs of depression, treatment should be discontinued.
At the beginning of the use of the drug, patients should be careful or refuse to drive vehicles and mechanisms, since during this period they may experience fatigue and dizziness. During treatment, the safety of the dose is determined individually.
Taking the medicine may mask some dangerous diseases or symptoms. For example, it can mask tachycardia caused by thyrotoxicosis, as well as tachycardia caused by hypoglycemia.
When preparing a patient for surgery, it is necessary to notify the anesthetist that the patient is taking metoprolol.
In case of liver failure, an adjustment in the dosage regimen is necessary.
The tool can affect the speed of psychomotor reactions, cause drowsiness and dizziness. This should be remembered by people driving vehicles, complex mechanisms or engaged in activities that require concentration. Therefore, if such effects occur, then the tool should not be used, or you need to change the occupation.
Beta-blockers can lead to a decrease in the secretion of tear fluid by the eye glands. This circumstance must be taken into account by people wearing contact lenses.
The interval between taking the medication and MAO inhibitors should be at least 2 weeks.
A medication can increase the severity of anaphylactic shock.
With cramping in the bronchi, beta-adrenostimulants must be prescribed simultaneously with the medication.
The scheme of administration for intravenous administration is prescribed by a doctor. It should not be administered intravenously at a systolic pressure of less than 110 mm.
During therapy, it is required to regularly monitor blood pressure, heart rate, blood glucose concentration (with diabetes).
When using the drug in a dose exceeding 200 mg per day, cardioselectivity decreases.
The patient should be trained in the method of calculating heart rate and informed of the need to consult a specialist at a frequency of less than 50 beats per minute.
With therapy, it is possible to increase the symptoms of a violation of peripheral arterial circulation.
During administration, an aggravation of the severity of hypersensitivity reactions (with a burdened allergic history), and lack of effect from the use of usual doses of epinephrine (adrenaline) can be observed.
Since withdrawal syndrome may develop with a sharp rejection of the drug, in case of discontinuation of treatment, the dose should be reduced gradually over a period of 10 days. Particular caution when discontinuing metoprolol should be shown to patients with exertional angina. In this case, the selected dose of the drug should provide a heart rate at a load of no more than 110 beats per minute, and at rest – within 55-60.
The drug can help mask the clinical signs of hyperthyroidism (tachycardia), and with sudden cancellation, exacerbate its symptoms.
If it is necessary to carry out surgical intervention during treatment with Metoprolol, an agent with minimal negative inotropic effect should be used for general anesthesia.
When wearing contact lenses, you must remember that with beta-adrenergic blocking therapy, tear fluid production may decrease.
As a concomitant therapy, patients suffering from bronchial asthma are prescribed beta2-adrenostimulants, and in the presence of pheochromocytoma – alpha-adrenergic blockers.
Elderly people need to control liver function. With the development in this age category of a marked decrease in blood pressure, ventricular arrhythmias, increasing bradycardia, AV blockade, the dosage regimen should be adjusted (in some cases, drug withdrawal may be required).
At the beginning of the course, in connection with the possible occurrence of undesirable side effects (decreased attention, dizziness), it is recommended to refuse to drive vehicles and other complex equipment, with further admission, a safe dose for these types of activities is determined individually.
Monitoring patients who use beta-blockers includes regular monitoring of blood pressure, pulse, sugar level. It is important to teach the patient how to keep track of the pulse rate, and in case of bradycardia, he needs to seek the help of a doctor.
Elderly people need to monitor the work of the renal system.
Metoprolol can cause peripheral arterial circulatory disorders.
Withdrawal of metoprolol is carried out gradually over a period of at least 10 days.
Taking more than 200 mg per day leads to a decrease in cardioselectivity.
When taking the drug, it is possible to mask the clinical picture of thyrotoxicosis (tachycardia).
When planning an surgical intervention, it is necessary to notify the anesthesiologist about taking the drug Metoprolol, while taking the drug does not stop.
When registering in elderly people arterial hypotension, increasing bradycardia, ventricular arrhythmias, atrioventricular block, severe liver disease, kidneys, the dosage of the drug is reduced, it is gradually withdrawn.
Treatment is stopped with the development of depression, the appearance of skin rashes.
When taking the drug during the gestation period, it is canceled 48-72 hours before the expected birth.
Metoprolol affects the management of vehicles, the performance of complex work.
Rp: Metoprololi 0,05 D. td No. 100 in tab. S. 1 tab. 2-3 times a day.
Attention should be paid to controlling the pressure while taking the medicine. However, you also need to control other characteristics, including heart rate, blood sugar, and heart rate. This is done so that in case of rapid development of side effects from the cardiovascular system, it would be possible to consult a doctor more quickly and adjust the dose or frequency of administration.
In addition, the elderly, taking Metoprolol, need to monitor the work of the excretory system, namely the kidneys.
“It is forbidden to abruptly cancel the medication, as this can provoke withdrawal syndrome. In the best way, cancellation is tolerated if the dose of the drug is gradually reduced, and the cessation of therapy is made within 10 days or longer. It should also be remembered that it is impossible to overestimate the dose of the drug. “Metoprolol is a cardioselective drug, but when taking a dose of more than 200 mg, its cardioselectivity decreases, and the drug also begins to act on other adrenoreceptors.”
In preparation for surgery, the medicine should not be canceled. It is necessary to warn the anesthesiologist about taking the medication in advance, while continuing the treatment as usual.
If the patient has any serious side effects (severe bradycardia, ventricular arrhythmias, or serious renal impairment), the drug should not be abruptly discontinued. It is necessary to reduce the dose, daily adjusting it in the direction of decrease and within a few days to cancel the drug. This will prevent possible problems caused by abrupt drug withdrawal.
Remember that the drug has a direct impact on the ability to perform complex work and concentrate on driving. At the time of admission, it will be better to refuse driving.
The clinical picture of thyrotoxicosis can be masked by metoprolol, since in this condition tachycardia is characteristic, which is relieved by taking beta-blockers. Therefore, when passing the diagnosis, you need to inform the doctor about taking the medicine and adjust your further actions in accordance with this.
Application in pregnancy and lactation
For pregnant women, the drug is prescribed only according to strict indications, taking into account the benefit / risk ratio, since under the influence of Metoprolol, the development of bradycardia, hypoglycemia, and arterial hypotension in the fetus is possible. Careful monitoring of fetal development, as well as newborns in the first 48–72 hours after delivery, is required.
If it is necessary to use the drug during breastfeeding, breast-feeding should be discontinued.
The medication is contraindicated in pregnancy.
In particular, non-steroidal anti-inflammatory drugs, estrogens, glucocorticosteroids, barbiturates weaken the effect of the drug.
Iodine-containing radiopaque substances administered by intravenous injection increase the risk of anaphylactic reactions.
Selective serotonin reuptake inhibitors enhance the effect of the drug. Nifedipine, clonidine, some other antihypertensive drugs and diuretics enhance, first of all, its antihypertensive effect. If treatment is carried out together with clonidine and termination of therapy by both means is required, then the abolition of clonidine in the first place may entail a severe hypertensive crisis. Therefore, you should first stop taking metoprolol, and then, after a couple of days, clonidine.
Drugs for anesthesia enhance the cardiodepressive effect of the drug. Antipsychotics, tricyclic and tetracyclic antidepressants, sleeping pills and sedatives increase its inhibitory effect on the central nervous system.
Antiarrhythmic medications such as quinidine increase the risk of hypotension and atrial ventricular block. Cardiac glycosides increase the risk of bradycardia.
The simultaneous intravenous administration of slow calcium channel blockers, such as verapamil, is prohibited due to the risk of cardiac arrest.
This drug is also incompatible with MAO inhibitors.
Intravenous (iv) administration of verapamil while taking metoprolol can cause cardiac arrest.
With simultaneous use with metoprolol:
- Nifedipine, ethanol – significantly reduce blood pressure;
- Hydrocarbon derivatives for inhalation anesthesia – increase the likelihood of developing arterial hypotension due to inhibition of myocardial function;
- Theophylline, beta-adrenostimulants, cocaine, estrogens, indomethacin and other non-steroidal anti-inflammatory drugs – weaken the hypotensive effect;
- Antipsychotics, tetra- and tricyclic antidepressants, hypnotics and sedatives, and ethanol – increase depression of the nervous system;
- Ergot alkaloids – increase the risk of peripheral circulation disorder;
- Antihypertensive drugs, diuretics, slow calcium channel blockers or nitroglycerin – potentiate a sharp decrease in blood pressure (especially prazosin);
- Diltiazem, verapamil, antiarrhythmic drugs (amiodarone), methyldopa, reserpine, clonidine, general anesthetics, guanfacine, cardiac glycosides – lead to a strong decrease in heart rate and inhibition of AV conduction;
- Rifampicin, barbiturates (inducers of microsomal liver enzymes) – accelerate the metabolism of metoprolol, reducing its concentration in blood plasma and reducing the clinical effect;
- Hypoglycemic agents for oral administration and insulin – reduce their effectiveness, the risk of hypoglycemia increases;
- Oral contraceptives, cimetidine, phenothiazines (inhibitors) – increase the concentration of metoprolol in blood plasma.
Metoprolol reduces xanthine clearance (except for diphillin), especially in patients with increased theophylline clearance while smoking, increases the concentration of lidocaine in blood plasma, prolongs the anticoagulant effect of coumarins, prolongs and enhances the effect of antidepolarizing muscle relaxants.
The combination with allergen extracts used for skin tests and allergens for immunotherapy increases the likelihood of developing systemic allergic reactions (including anaphylaxis). With simultaneous administration with radiopaque iodine-containing agents for iv administration, the risk of anaphylactic reactions increases.
With the simultaneous use of metoprolol and clonidine, if it is necessary to stop treatment, clonidine should be canceled only a few days after metoprolol.
Terms of sale
Keep out of the reach of children.
The price may depend not only on the pharmacy network in which it is purchased, but also on which manufacturer produced the drug. In general, Metoprolol can be found in almost any pharmacy, its price fluctuates around 150 rubles per pack.
A doctor’s prescription will be needed to dispense the drug.
The table of the current prices for the drug Metoprolol in online pharmacies. Last update of the data was 21.10.2019 00:00.
A recipe is needed.
No more than five years.
Reviews on the network indicate that the drug works well, however, in some cases, side effects may occur, which patients are advised to pay attention to. It is also said that the drug is highly sensitive to the dose, and therefore it is better not to prescribe it yourself.
- Irina, 49 years old. I have been taking metoprolol for quite some time, good effect. I drink constantly. But you need to choose and look for health reasons, and it is better to cancel the appointment under the guidance of a doctor. The drug itself perfectly reduces pressure, the effect lasts a long time, I have about 12 hours.
- Ivan, 51 years old. Care must be taken to take metoprolol at about the same time. I take in the morning. A decrease in pressure occurs somewhere after half an hour or an hour. If you need to urgently bring down, then still drink Clonidine. In general, I am pleased with the pills for constant pressure maintenance.
The analogues of Metoprolol are: Betalok, Metocardum, Metoprolol Retard-Akrikhin, Metoprolol-Akri, Metoprolol-Ratiofarm, Metoprolol-OBL, Metoprolol Organika, Metoprolol Zentiva, Anepro, Vazokardin, Corvitol, Metoblock, Metokorokm, Metokorok, Metokorok, Metokorok, Metokorok Metoprol.
The drug is used for rhythm disturbances: supraventricular arrhythmia, ventricular arrhythmia, sinus tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, ventricular extrasystole.
The drug is used for thyrotoxicosis (in complex therapy), for tremors (senile, essential forms), for migraines, withdrawal symptoms, akathisia when taking antipsychotics, and anxiety.
Indications for use Metoprolol Ratiopharm are similar, from which the tablets are effectively used.
Angina pectoris: 2–3 times daily 50 mg.
Thyrotoxicosis, hyperkinetic cardiac syndrome, tachyarrhythmia: 1-2 mg per day, 50 mg each.
For secondary prevention of myocardial infarction, 200 mg of metoprolol is indicated.
For the prevention of migraine, 100-200 mg per day is prescribed for 2-4 doses.
In case of paroxysmal supraventricular tachycardia with the aim of stopping the attack, it is administered parenterally under stationary observation.
In acute myocardial infarction, Metoprolol is administered immediately after the hospitalization of the patient, it is necessary to monitor the level of blood pressure, pulse, ECG, atriventricular conduction.
Elderly people start therapy with 50 mg per day. With pathology of the hepatic system, dosage adjustment is not carried out (it is preferable to prescribe drugs that are not metabolized in the hepatic system).
Instructions for use Metoprolol Ratiopharm and Metoprolol Acry are similar.
Using the substance metoprolol succinate can be found in the instructions for the preparations Egilok S and Betalok ZOK, where it is active.
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