The dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may direct you to start this medication at a low dose and gradually increase your dose. Follow your doctor's instructions carefully. May need to increase diuretics and wait until clinically stable to advance dose to target. Use with caution in patients with hepatic impairment.
Use beta-blockers with caution in patients with myasthenia gravis. May precipitate or aggravate symptoms of arterial insufficiency in patients with PVD and Raynaud disease.
Use with caution and monitor for progression of arterial obstruction. Adequate alpha-blockade is required prior to use of any beta-blocker. Beta-blockers without alpha1-adrenergic receptor blocking activity should be avoided in patients with Prinzmetal variant angina because unopposed alpha1-adrenergic receptors mediate coronary vasoconstriction and can worsen anginal symptoms Mayer Beta-blocker use has been associated with induction or exacerbation of psoriasis, but cause and effect have not been firmly established.
Use beta-blockers with caution in patients with a history of psychiatric illness; may cause or exacerbate CNS depression. May mask signs of hyperthyroidism eg, tachycardia. If hyperthyroidism is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm.
Alterations in thyroid function tests may be observed. Concurrent drug therapy issues: Consult drug interactions database for more detailed information. Dosage form specific issues: The conversion ratio for immediate release metoprolol tartrate and extended release metoprolol succinate is 1: However, metoprolol tartrate is typically administered in 2 to 3 divided daily doses and metoprolol succinate is administered once daily.
Severe exacerbation of angina, ventricular arrhythmias, and myocardial infarction MI have been reported following abrupt withdrawal of beta-blocker therapy. Temporary but prompt resumption of beta-blocker therapy may be indicated with worsening of angina or acute coronary insufficiency.
Chronic beta-blocker therapy should not be routinely withdrawn prior to major surgery. Monitoring Parameters Acute cardiac treatment: Monitor ECG, heart rate, and blood pressure with IV administration; heart rate, rhythm, and blood pressure with oral administration.
IV use in a nonemergency situation: Necessary monitoring for surgical patients who are unable to take oral beta-blockers because of prolonged ileus has not been defined. Some institutions require monitoring of baseline and postinfusion heart rate and blood pressure when a patient's response to beta-blockade has not been characterized ie, the patient's initial dose or following a change in dose. Consult individual institutional policies and procedures. Metoprolol and the metabolite alpha-hydroxymetoprolol cross the placenta and can be detected in cord blood Lindeberg ; Ryu Adequate facilities for monitoring infants at birth is generally recommended.
The pharmacokinetics of metoprolol may be changed during pregnancy; the degree of changes may be dependent upon maternal CYP2D6 genotype Ryu Untreated chronic maternal hypertension and preeclampsia are also associated with adverse events in the fetus, infant, and mother ACOG ; Magee Recommendations for the treatment of hypertension in pregnancy vary by guideline, but use of metoprolol may be considered ESC [Regitz-Zagrosek ]; Magee Use of metoprolol may be considered if migraine prophylaxis is needed in a pregnant woman Pringsheim During this hospital stay, were you given any medicine that you had not taken before?
Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?
Have patient report immediately to prescriber depression, severe dizziness, passing out, angina, abnormal heartbeat, bradycardia, shortness of breath, excessive weight gain, or swelling of arms or legs HCAHPS. This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Pheochromocytoma If Lopressor is used in the setting of pheochromocytoma, it should be given in combination with an alpha blocker , and only after the alpha blocker has been initiated. Administration of beta blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. Thyrotoxicosis Lopressor may mask certain clinical signs e.
Avoid abrupt withdrawal of beta blockade, which might precipitate a thyroid storm. Such patients may be unresponsive to the usual doses of epinephrine used to treat allergic reaction. Carcinogenesis, Mutagenesis, Impairment Of Fertility Long-term studies in animals have been conducted to evaluate carcinogenic potential. The only histologic changes that appeared to be drug related were an increased incidence of generally mild focal accumulation of foamy macrophages in pulmonary alveoli and a slight increase in biliary hyperplasia.
There was no increase in malignant or total benign plus malignant lung tumors, or in the overall incidence of tumors or malignant tumors. This month study was repeated in CD-1 mice, and no statistically or biologically significant differences were observed between treated and control mice of either sex for any type of tumor. Reproduction toxicity studies in mice, rats and rabbits did not indicate teratogenic potential for metoprolol tartrate. High doses were associated with some maternal toxicity, and growth delay of the offspring in utero, which was reflected in minimally lower weights at birth.
The oral NOAELs for embryo-fetal development in mice, rats, and rabbits were considered to be 25, , and Archived from the original on 8 April Retrieved 22 April Carlsson, edited by Bo Technological systems and industrial dynamics. In patients with severely damaged hearts, adequate ventricular function may depend on sympathetic drive.
In the presence of AV block, beta-blockade may prevent the necessary facilitating effect of sympathetic activity on conduction. Beta2-adrenergic blockade results in passive bronchial constriction by interfering with endogenous adrenergic bronchodilator activity in patients subject to bronchospasm and may also interfere with exogenous bronchodilators in such patients. Pharmacokinetics Adults In man, absorption of metoprolol is rapid and complete.
Plasma levels achieved are highly variable after oral administration. When administered orally, it exhibits stereoselective metabolism that is dependent on oxidation phenotype. Elimination is mainly by biotransformation in the liver, and the plasma half-life ranges from approximately 3 to 7 hours. The systemic availability and half-life of metoprolol in patients with renal failure do not differ to a clinically significant degree from those in normal subjects.
Consequently, no reduction in metoprolol succinate dosage is usually needed in patients with chronic renal failure. CYP2D6 can be inhibited by a number of drugs. In comparison to conventional metoprolol, the plasma metoprolol levels following administration of TOPROL-XL are characterized by lower peaks, longer time to peak and significantly lower peak to trough variation. The peak plasma levels following once-daily administration of TOPROL-XL average one-fourth to one-half the peak plasma levels obtained following a corresponding dose of conventional metoprolol, administered once daily or in divided doses.
The bioavailability of metoprolol shows a dose-related, although not directly proportional, increase with dose and is not significantly affected by food following TOPROLXL administration. The pharmacokinetics of metoprolol were similar to those described previously in adults.
Age, gender, race, and ideal body weight had no significant effects on metoprolol pharmacokinetics. Clinical Studies In five controlled studies in normal healthy subjects, the same daily doses of TOPROL-XL and immediate-release metoprolol were compared in terms of the extent and duration of beta1 — blockade produced. Both formulations were given in a dose range equivalent to mg of immediaterelease metoprolol per day. The dosage is based on your medical condition and response to treatment.
Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the tablets unless they have a score line and your doctor or pharmacist tells you to do so.
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