"Metoprolol": reviews, indications for use, instructions and analogues. Metoprolol: instructions for use Metoprolol instructions for use appearance

“Metoprolol”, what does this beta blocker help with? The medicine has antihypertensive properties. The instructions for use of the drug "Metoprolol" suggest using it for ischemia, high blood pressure, arrhythmias.

Composition and release form

Sold in the form of tablets and solution. One of the manufacturers is the German company Ratiopharm, which produces Metoprolol Ratiopharm tablets.

What does the medicine help with heart problems and blood pressure? The therapeutic effect is due to the inclusion of the active element metoprolol tartrate in the composition of the drug, the volume of which is 50 or 100 mg. The solution for administration into a vein is released in ampoules of 5 ml, containing 5 mg of metoprolol.

Auxiliary components are magnesium stearate, sodium carboxymethyl starch, cellulose, silicon dioxide, etc.

Pharmacological properties

The active component of the drug "Metoprolol", which creates antiarrhythmic, antianginal and hypotensive effects, reduces the frequency of myocardial oscillations, inhibits AV conduction, and reduces the heart's need for oxygen. The blood pressure returns to normal after 14 days of using the medication.

The instructions confirm the reviews of doctors that the drug Metoprolol reduces the frequency and likelihood of angina attacks. During atrial fibrillation and tachycardia, the drug stabilizes the heart rhythm. A more effective type of drug is Metoprolol Succinate.

This medication remains active for a longer period of time and provides a therapeutic effect throughout the day. In addition, Metoprolol Succinate reduces the risk of weakness and bradycardia and has a positive effect on smooth muscle bronchi.

Metoprolol tablets: what does the medicine help with?

Indications for use include the following conditions and pathologies:

• myocardial infarction;
• arterial hypertension;
• unstable, tense angina;
• ischemia;
• hypertension.

What else do Metoprolol tablets help with? The drug is prescribed for:

• ventricular extrasystole;
• supraventricular, atrial fibrillation, ventricular arrhythmia;
• atrial, sinus tachycardia;
• atrial flutter;
• thyrotoxicosis (together with other medications);
• withdrawal symptoms;
• tremor;
• migraine;
• akathisia.

The indications for the use of Metoprolol Ratiopharm, for which the tablets are effectively used, are similar.

Contraindications

The instructions for use prohibit the use of the drug "Metoprolol" for:

• Prinzmetal's angina;
• cardiogenic shock;
• arterial hypotension;
• sinoatrial, atrioventricular block of 1-2 degrees;
• hypersensitivity to the composition of the drug "Metoprolol", which can cause an allergy;
• decompensatory heart failure;
• hypersensitivity to beta-blockers;
• severe bradycardia;
• weakness of the sinus node.

The medicine is not prescribed together with monoamine oxidase inhibitors and verapamil, children under adulthood, nursing breast milk women.

Caution when taking tablets should be observed in patients suffering from pheochromocytoma, diabetes mellitus, pulmonary emphysema, metabolic acidosis, 1st degree AV block, obstructive bronchitis, myasthenia gravis, psoriasis, kidney and liver failure, bronchial asthma, as well as pregnant women and the elderly.

Medicine "Metoprolol": instructions for use

Oral form

The tablets are taken orally with water. The standard dosage is 100 mg per day. The medicine is used in several approaches. If necessary, the volume of the drug is doubled. The highest daily amount of medication is 400 mg.

Instructions for using injections

Metoprolol solution is injected into a vein at a dosage of 2-5 mg. The maximum single dose reaches 20 mg. If there is no therapeutic effect, the injections are performed again after 5 minutes. The withdrawal of medication is carried out gradually under medical supervision.

Dosage of the drug "Metoprolol Succinate" in the treatment of diseases

For the treatment of supraventricular tachycardia, angina pectoris, hypertension, extrasystole on initial stages Prescribe 50-100 mg of the drug per day. For myocardial infarction, 200 mg per day should be taken as maintenance treatment. In case of heart failure occurring in chronic form, the dosage is set separately for each patient. The duration of taking Metoprolol Succinate takes about 3 months.

Side effects

The drug "Metoprolol", the instructions and reviews of patients confirm this, causes negative reactions from the nervous, cardiac, digestive, vascular, endocrine, respiratory and other systems. TO side effects the drug refers to:

• weakness, eye pain, orthostatic hypotension;
• changes in taste, photodermatosis, bronchospasm;
• exacerbation of psoriasis, nasal congestion, hypoglycemia;
• decreased potency, headaches, decreased vision, exanthema;
• loss of consciousness, liver dysfunction, shortness of breath;
• increased fatigue, conjunctivitis, dizziness;
• alopecia, drowsiness, drop in blood pressure;
• hypoglycemia, confusion, dry eyes;
• sinus bradycardia, increased sweating;
• weight gain, cramps, swelling;
• hypothyroid condition, attention disorders, thrombocytopenia;
• tremor, cardialgia, joint pain;
• insomnia, itching, allergies;
• agranulocytosis, hallucinations, asthenia.

If you abruptly stop taking the medication, a “withdrawal syndrome” is observed.

Analogues - synonyms

Medicines with similar composition and indications:

1. "Metoprolol - Zentiva."
2. - Akri, -Teva, - Akrikhin.
3. "Metoprolol-Ratiopharm".
4. - Organic.
5. -OBL.

Doctors, if necessary, prescribe the following analogues of Metoprolol:

1. "Corvitol".
2. "Anepro."
3. "Metocore."
4. "Betalok."
5. "Emzok."
6. "Vasocardin".
7. "Metoprol."
8. "Egilok".

Price

In Moscow and other regions of Russia, you can buy Metoprolol tablets for 27-55 rubles. In Kyiv, the medicine costs 10 hryvnia. In Minsk, its cost varies from 0.9 to 8.5 Bel. rubles In Kazakhstan, pharmacies offer an analogue of Egilok 25 mg containing metoprolol as active substance, priced at 1170 tenge (60 tablets, EGIS Pharmaceuticals, Ltd. (Hungary)).

Opinions of patients and doctors

On forums about the drug Metoprolol, patient reviews vary. The positive aspects include the speed of action, low cost, and bioavailability of the drug. Negative reviews are associated with multiple negative effects, contraindications, and symptoms of withdrawal syndrome.

INN: Metoprolol

Manufacturer: Kievmedpreparat OJSC

Anatomical-therapeutic-chemical classification: Metoprolol

Registration number in the Republic of Kazakhstan: No. RK-LS-5 No. 019424

Registration period: 21.11.2012 - 21.11.2017

ALO (Included in the List of free outpatient drug provision)

Instructions

Tradename

Metoprolol

International nonproprietary name

Metoprolol

Dosage form

Tablets 25 mg, 50 mg, 100 mg

Compound

One tablet contains

active substance: metoprolol tartrate, calculated as 100% substance - 25 mg or 50 mg, or 100 mg;

Excipients: microcrystalline cellulose, lactose monohydrate, crospovidone, povidone, talc, calcium stearate.

Description

Tablets are round in shape with a flat surface, white or white with a creamy tint, with two perpendicularly intersecting lines and a chamfer. Marbling is allowed on the surface.

Pharmacotherapeutic group

Drugs for the treatment of diseases of the cardiovascular system.

Beta-blockers are selective.

Code ATX C07A B02

Pharmacological properties

Pharmacokinetics

Absorption of Metoprolol when administered orally is almost complete and does not depend on food intake, however, bioavailability is about 50% due to intensive metabolism during the first pass through the liver. With prolonged use, bioavailability increases due to decreased blood circulation in the liver and saturation of liver enzymes.

After oral administration, the maximum concentration of the drug in the blood plasma is observed after 1-2 hours. In blood plasma, Metoprolol is 5-25% protein bound. The half-life is 3-7 hours. During the first passage through the liver, about 65-80% of the drug is metabolized. Excreted by the kidneys in the form of metabolites. Metoprolol is a lipophilic β-blocker. About 90% is absorbed into digestive tract, penetrates well through the blood-brain barrier.

Pharmacodynamics

A cardioselective β-blocker, without its own sympathomimetic and membrane-stabilizing activity, acts predominantly on β1 receptors of the heart, and to a lesser extent on β2 receptors in peripheral vessels and bronchi. It has antihypertensive, antianginal and antiarrhythmic effects. The drug is characterized by negative inotropic effect, reduces myocardial contraction, cardiac output, sinus node automaticity, heart rate, slows down atrioventricular conduction. Suppresses the stimulating effect of catecholamines on the heart during physical and psycho-emotional stress. In patients coronary disease heart has anti-ischemic and antianginal effects. For angina pectoris, Metoprolol reduces the number and severity of attacks, increases tolerance to physical activity; contributes to normalization heart rate. In case of myocardial infarction, it helps to limit the area of ​​necrosis of the heart muscle; reduces the risk of fatal arrhythmias and recurrent myocardial infarction. It has an antihypertensive effect, which stabilizes by the end of the 2nd week of regular use. In contrast to non-selective β-blockers, Metoprolol, when used in average therapeutic doses, has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries, insulin release, carbohydrate and lipid metabolism.

Indications for use

Arterial hypertension

Angina (including post-infarction)

Arrhythmias (including supraventricular tachyarrhythmia)

Maintenance treatment after myocardial infarction

As part of complex therapy for thyrotoxicosis

Preventing migraine attacks

Directions for use and doses

The dose of Metoprolol is set individually, however daily dose should not exceed 400 mg. The tablets are taken orally with a small amount of liquid, without chewing, after meals.

Arterial hypertension: The initial daily dose of Metoprolol is 100 mg once or divided into 2 doses. Depending on the body’s reaction, the daily dose can be gradually increased weekly to 200 mg. To enhance the antihypertensive effect, it is possible to use Metoprolol with other antihypertensive drugs.

Angina: 50-100 mg 2-3 times a day.

Arrhythmias: 50 mg 2-3 times a day. If necessary, the daily dose can be increased to 300 mg, divided into 2-3 doses.

Hyperthyroidism (thyrotoxicosis): 50 mg 4 times a day. When the expected effect is achieved, the dose should be gradually reduced.

Myocardial infarction.

Early treatment pain syndrome after myocardial infarction: 50 mg every 6 hours for 48 hours. It is advisable to start treatment within the first 12 hours after the onset of chest pain.

Migraine prevention: daily dose - 100-200 mg, divided into 2 doses in the morning and evening.

Age-related physiological changes only slightly affect the pharmacokinetics of Metoprolol, and there is no need to adjust the dosage regimen in elderly people. However, it is recommended to be careful when prescribing Metoprolol to geriatric patients.

Correction of the dosage regimen is necessary in patients with impaired liver function.

No dose adjustment is required in patients with renal failure.

Side effects

Sometimes

Bradycardia, arterial hypotension, orthostatic hypotension (sometimes with loss of consciousness)

Shortness of breath on exertion

Dizziness, headache

Nausea, vomiting, abdominal pain

Rarely

Appearance/intensification of signs of heart failure (especially with increasing dosage of the drug), arrhythmia, rapid heartbeat, edema, Raynaud's syndrome

Bronchospasm

Poor concentration, depression, nightmares, insomnia or drowsiness, paresthesia

Decreased vision, decreased secretion of tear fluid, dryness and irritation of the mucous membrane of the eyes, conjunctivitis, tinnitus, hearing loss

Diarrhea, constipation

Thrombocytopenia, leukopenia

Skin rash (including urticaria, psoriasis-like, degeneration of subcutaneous fatty tissue), itching, urticaria

Very rarely

Impaired AV conduction, pain in the heart, gangrene (in patients with severe peripheral circulatory disorders);

Hallucinations, personality changes, increased agitation, confusion

Dry mouth; in some cases - retroperitoneal fibrosis (however, a clear cause-and-effect relationship between this reaction and the use of Metoprolol has not been established)

Photosensitivity, increased sweating, reversible alopecia, exacerbation of psoriasis

- laboratory parameters: increased activity of liver enzymes, hyperbilirubinemia, increased levels of triglycerides in the blood, decreased levels of high-density lipoprotein (HDL)

- other: weakness, fatigue (usually at the beginning of treatment), hepatitis, nonspecific pain in muscles, joints, cramps

Arthritis, weight gain, libido disorders, impotence

in some cases - Peyronie's disease (however, a clear cause-and-effect relationship between this reaction and the use of Metoprolol has not been established).

Contraindications

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

History of bronchial asthma or bronchospasm

Atrioventricular block II-III degree

acute or chronic (IV functional class according to NYHA) heart failure

Clinically significant sinus bradycardia

Sick sinus syndrome

Severe peripheral circulatory disorders

Cardiogenic shock

Arterial hypotension

pheochromocytoma

metabolic acidosis

severe liver failure

Children under 18 years of age (efficacy and safety have not been established).

Carefully: first degree atrioventricular block, Prinzmetal angina, bronchial asthma, chronic obstructive pulmonary disease, diabetes, heavy renal failure, severe liver failure, metabolic acidosis, co-administration with cardiac glycosides.

Metoprolol should not be prescribed to patients with suspected acute heart attack myocardium at heart rate less than 45 beats/min., P-Q interval>0.24 s or systolic blood pressure <100 мм рт.ст.

Drug interactions

When taking Metoprolol simultaneously with insulin or oral hypoglycemic agents, their effect may be enhanced or prolonged. In this case, the symptoms of hypoglycemia (especially tachycardia and tremor) may be masked or disappear. In such cases, it is necessary to regularly monitor blood glucose levels.

With the simultaneous use of Metoprolol and barbiturates, phenothiazines, nitroglycerin, diuretics, vasodilators and other antihypertensive drugs (for example, prazosin), oral contraceptives, the hypotensive effect may be enhanced.

When taking Metoprolol simultaneously with drugs that inhibit the CYP2D6 enzyme, the metabolism of Metoprolol may be inhibited, its concentration in the blood plasma may increase and the risk of developing toxic effects may increase. These drugs include: antidepressants (fluoxetine, paroxetine, bupropion), antipsychotics (thioridazine), antiretrovirals (ritonavir), antihistamines (diphenhydramine), antimalarials (hydroxychloroquine, guinidine), antifungals (terbinafine), ranitidine, cimetidine.

Cardiac glycosides, methyldopa, reserpine and guanfacine, slow calcium channel blockers (verapamil, diltiazem), amiodarone, propafenone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV block, cardiac arrest and heart failure. When using Metoprolol, intravenous administration of drugs of the verapamil class is contraindicated (threat of cardiac arrest); When using Metoprolol and oral forms of drugs of the verapamil class, you need to be especially careful.

When combined with clonidine and metoprolol, treatment with the latter should be discontinued several days before discontinuation of clonidine to prevent a hypertensive crisis.

Careful monitoring of patients is required when taking Metoprolol concomitantly with ganglion blockers, other β-blockers (for example, eye drops) or MAO inhibitors.

When used simultaneously with norepinephrine, epinephrine, other adrenergic and sympathomimetics (including in the form of eye drops or as part of antitussives), a slight increase in blood pressure is possible.

When used simultaneously with indomethacin and rifampicin, the concentration of Metoprolol in the blood plasma decreases.

With the simultaneous use of Metoprolol with lidocaine, the elimination of the latter may be impaired.

When used simultaneously with ergotamine, peripheral circulatory disorders may increase.

With simultaneous use of Metoprolol and peripheral muscle relaxants (for example, suxamethonium, tubocurarine), neuromuscular blockade may be enhanced.

Narcotics enhance the hypotensive effect of Metoprolol. At the same time, the negative inotropic effect of these drugs is potentiated. Therefore, before surgery under general anesthesia, the anesthesiologist must be informed that the patient is taking Metoprolol. When used simultaneously with opioid analgesics, the cardiodepressive effect is mutually enhanced.

Metoprolol may cause a slight decrease in the clearance of theophylline in patients who smoke.

With simultaneous use, Metoprolol increases the concentration of ethanol in the blood and prolongs its elimination.

special instructions

Metoprolol is used with extreme caution in patients with diabetes mellitus. In patients taking insulin and oral hypoglycemic tablets, Metoprolol may mask the symptoms of hypoglycemia. Metoprolol may affect glucose levels and liver enzymes.

When conducting a course of treatment for pheochromocytoma, it is possible to prescribe Metoprolol only in combination with an alpha-blocker.

Before performing surgical interventions, it is necessary to inform the anesthesiologist about taking Metoprolol (it is necessary to select a drug for general anesthesia with minimal negative inotropic effect); discontinuation of the drug is not recommended. Reciprocal activation of the n.vagus can be eliminated by intravenous atropine.

It is recommended to discontinue therapy if skin rashes appear and depression develops. Patients should be under close medical supervision during drug withdrawal. The drug is discontinued gradually, reducing the dose over 10 days to 25 mg. If treatment is abruptly stopped, withdrawal syndrome may occur (increased angina attacks, increased blood pressure). When discontinuing the drug, special attention should be paid to patients with angina pectoris.

Patients who use contact lenses should consider the possibility of decreased tear production during treatment with Metoprolol.

If it is necessary to prescribe Metoprolol to patients with bronchial asthma, β2-agonists are used as concomitant therapy.

Metoprolol is used with caution in patients with allergic diseases, myasthenia gravis, depression, vasospastic angina, chronic diseases of the bronchopulmonary system, psoriasis, prolonged fasting, and Raynaud's disease.

Elderly patients may experience increased sensitivity even with normal dosing.

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

Metoprolol may increase symptoms of peripheral arterial circulatory disorders and worsen bradycardia. If the heart rate is less than 50-55 beats/min, it is necessary to reduce the dose of the drug or gradually discontinue the drug.

It is possible that the severity of allergic reactions may increase (against the background of a burdened allergic history) and there will be no effect from the administration of usual doses of adrenaline.

Metoprolol should be prescribed with extreme caution to patients with Prinzmetal's angina.

Monitoring of patients taking β-blockers, incl. and Metoprolol, includes monitoring heart rate and blood pressure (at the beginning of treatment - daily, then once every 3-4 months), blood glucose concentration in patients with diabetes (once every 4-5 months). The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min. In elderly patients, it is recommended to monitor kidney function (once every 4-5 months).

Use during pregnancy and lactation

The use of the drug during pregnancy is possible only if there are vital indications and provided that the expected benefit to the woman outweighs the potential risk to the fetus (due to the possible development of bradycardia, hypotension, hypoglycemia in the fetus/newborn). This fact must be taken into account when prescribing the drug during the last trimester. Use of the drug should be discontinued at least 2-3 days before birth.

Metoprolol is excreted into breast milk. However, when used by women who are breastfeeding in therapeutic doses, a negative effect on the baby is unlikely.

When prescribing Metoprolol to pregnant and breastfeeding women, it is necessary to select the minimum effective dose.

Features of the effect of the drug on the ability to drive a vehicle or potentially dangerous mechanisms

During the treatment period, you must be careful when driving vehicles or working with other potentially dangerous mechanisms, which requires increased concentration and speed of psychomotor reactions.

Overdose

Symptoms: severe hypotension, bradycardia, atrioventricular block, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, impaired consciousness or coma, convulsions, nausea, vomiting, cyanosis, hypoglycemia, hyperkalemia.

Treatment. In case of overdose, rinse the stomach or induce vomiting and take activated charcoal. You should consult a doctor. If severe hypotension, bradycardia or the threat of heart failure develops, it is necessary to prescribe an adrenergic agonist and administer 1-2 mg of atropine sulfate intravenously. If after this there is no necessary improvement, it is possible to prescribe pressor agents. In cases of severe hypotension, bradycardia, or impending heart failure, a β1-agonist (eg, prenalterol) should be administered. In the absence of a selective β1-agonist, sympathomimetic agents can be administered intravenously (eg, norepinephrine, dopamine, dobutamine). Glucagon can be administered. It may be necessary to use a pacemaker. To relieve bronchospasm, a β2-agonist should be administered intravenously.

Release form and packaging

Why is the medication Metoprolol needed? Patient reviews of this drug, its release form, composition and side effects will be presented below. We will also tell you about what contraindications and indications this medicine has, in what dose it should be taken, whether there are analogues, etc.

Composition of the drug and its release form

In what form is the drug Metoprolol sold? Reviews from patients say that you can find three types of this drug in the pharmacy. Let's look at the release forms and composition in more detail.

• Pills. They contain the active ingredient metoprolol tartrate (100, 50 and 25 milligrams). In addition, the medication also includes auxiliary components in the form of colloidal anhydrous silicon dioxide, microcrystalline cellulose, sodium carboxymethyl starch (type A) and magnesium stearate. The medicine is sold in 50, 10, 30, 20 or 40 tablets per package.
• Tablets with sustained release properties ("Metoprolol succinate"), coated. They contain similar active and excipients. In pharmacies this medicine can be found in 30, 20 or 10 tablets per package.
• Solution for intravenous injection in ampoules of 5 milliliters. The medicine goes on sale in cardboard packaging of 10 ampoules.

Pharmacological properties of the drug

What is the drug Metoprolol intended for? Indications for the use of this remedy will be presented below. Now I would like to tell you about what pharmacological properties this drug has.

The medicine mentioned is a cardioselective beta-adrenergic receptor blocker. It does not exhibit membrane stabilizing properties and does not have sympathomimetic intrinsic activity. However, this drug is antihypertensive, antiarrhythmic and

The medication is able to reduce the patient’s heart rate, reduce myocardial excitability and contractility, slow down AV conduction, and also reduce myocardial oxygen demand.

As a rule, the hypotensive effect is observed in patients only after fourteen days after taking the drug. The drug reduces the frequency of attacks during supraventricular tachycardia, angina pectoris and atrial fibrillation. As a result, the patient's heart rate normalizes.

Slow-release tablets (Metoprolol succinate) have a significant advantage over regular ones. They allow you to maintain a constant concentration of the active element in the blood, which ensures a good therapeutic effect throughout the day. It should also be noted that the effect of Metoprolol succinate helps reduce the risk of bradycardia and weakness, and has a lesser effect on the smooth muscles of the bronchi.

Pharmacokinetics (absorption, metabolism and excretion of the drug)

We will talk about the indications for use of the drug and the analogs available for the drug “Metoprolol” below, and now let’s talk about the pharmacokinetic features.

This product is absorbed very quickly and almost completely (about 95%). Maximum plasma concentrations are usually achieved 50-110 minutes after oral administration.

When first used, the bioavailability of the drug is 50%. When repeated, it increases to 70%. By the way, eating food increases the bioavailability of the drug by 20-40%. It also increases if the patient has cirrhosis of the liver. The average binding to proteins is 10%.

The mentioned drug penetrates well through the placenta and is also excreted in small quantities into breast milk.

The drug is metabolized in the liver. Moreover, the metabolites do not have pharmacological activity. About 5% of the drug is excreted unchanged by the kidneys. Therapy for a patient with reduced renal function does not require a reduction or other dose adjustment of the drug. However, abnormal liver function may slow down the metabolism of the drug. In this case, the dosage should be reduced.

Medication "Metoprolol": indications for use

There is a fairly large list of pathological conditions for which this drug is prescribed. Let's look at them.

• akathisia, which was caused by antipsychotics;
• arterial hypertension of the 1st and 2nd degree, arterial hypertension (monotherapy is possible, and in severe cases - together with diuretics and other antihypertensive medications);
• thyrotoxicosis (only as part of complex treatment);
• prevention of angina and exertional angina;
• prevention of migraine attacks;
• violation (for example, with extrasystole, paroxysmal and;
• to reduce the risk of death and morbidity due to cardiovascular failure and coronary disease;
• secondary prevention after myocardial infarction and acute myocardial infarction;
• mitral valve prolapse;
• dilated idiopathic cardiomyopathy;
• Essential cardiovascular hyperkinesis, hyperkinetic cardiac syndrome, cardiac dysfunction.

Reviews about the medication

According to reviews from those who have ever taken the drug mentioned, it effectively copes with the task and has a positive effect on the functioning of the heart. However, it should be noted that some patients do not respond very well to the medication. As a rule, this is due to the fact that it has many contraindications and side effects. We will talk about what patients complain about when taking the drug in question below.

Contraindications to the use of the medication

So, now you know what the drug Metoprolol is intended for (indications for use were described just above). However, this medication has a number of contraindications. These include:

Restrictions on the use of the drug (take with extreme caution)

In what cases should you limit your intake of Metoprolol? Reviews from experts say that the dose of this medication should be reduced in case of hyperthyroidism, emphysema, a history of allergies, bronchial asthma, non-allergic bronchitis, psoriasis, pheochromocytoma, liver and kidney disorders (sometimes), depression, myasthenia gravis and general anesthesia.

Is it possible to give children Metoprolol? The use of this medicine by persons under 18 years of age is prohibited. The ban on taking the drug also applies to pregnant women and nursing mothers. If these recommendations are not followed, there is a huge risk of developing bradycardia, hypoglycemia and arterial hypotension in a newborn baby.

If it is necessary to take medication during breastfeeding, then lactation should be interrupted at this time.

Preparations "Metoprolol" and "Metoprolol succinate": instructions for use

As a rule, the drug Metoprolol is taken in an amount of 100 mg per day. In this case, the specified volume is divided into several doses. To achieve a better therapeutic effect, the dose can be doubled. However, the maximum dose of the drug should not be higher than 400 mg.

For intravenous injection, a single dose of 2 to 5 mg of the drug is administered. In this case, the maximum dosage is 15-20 mg. If the desired effect is not achieved, it is allowed to re-administer the drug (after 5 minutes).

This medication should be discontinued gradually. This is usually done for ten days under the special supervision of a doctor.

The initial dosage of the drug "Metoprolol succinate" for supraventricular tachycardia, angina pectoris, arterial hypertension and extrasystole is about 50-100 mg once a day. For maintenance therapy of myocardial infarction, the medication is taken in a dose of 200 mg.

The minimum duration of treatment with Metoprolol succinate is 3 months. If the patient is diagnosed with chronic heart failure, the dosage is selected individually. First, the drug is taken in an amount of 12.5 mg once a day for 2 weeks, and then every 14 days the dose is doubled.

If the medication is relatively well tolerated, its maximum daily intake can reach 200 mg.

Side effects. Patient reviews

Can the drug Metoprolol harm the body? Reviews about this drug contain a lot of information that negative consequences occur after taking it. What exactly are the phenomena we are talking about?

Among other things, after taking this drug, some patients report pain in the joints or back. It is extremely rare for people to report a slight increase in body weight or a decrease in libido or potency.

Special instructions for the use of the drug

Currently, you can purchase the drug Metoprolol at any pharmacy. No recipe is required. However, the patient taking the medication should be regularly monitored by the attending physician. This is especially true for those patients who have been diagnosed with diabetes or angina.

You should be aware that with increasing dosage (more than 200 mg per day), cardioselectivity decreases. In the presence of heart failure, therapy is started only after the compensation stage has been reached.

People who use contact lenses should take into account that during treatment with Metoprolol, the production of tear fluid decreases.

Sometimes this medication masks some manifestations of thyrotoxicosis. At the same time, abrupt withdrawal of the drug in patients with the mentioned disease is contraindicated, as this increases the symptoms.

If it is necessary to undergo surgery, the patient should be sure to notify the anesthesiologist about drug therapy.

During treatment with Metoprolol, you must wear appropriate clothing. This is due to the fact that the drug can cause allergic reactions on the skin due to exposure to sunlight.

It should also be said that the drug “Metoprolol” (including analogues of this drug) in elderly people can cause the appearance of increasing bradycardia, a pronounced decrease in blood pressure, and atrioventricular block. That is why such patients require special monitoring.

In addition, during treatment with this drug, you should refrain from driving vehicles and stop engaging in hazardous activities that require increased concentration and speed of psychomotor reactions. It is also recommended to avoid ethanol intake.

Existing analogues of the drug

What to do if the patient was unable to purchase the medication Metoprolol prescribed by the doctor? Its analogues are available in any pharmacy. Most of them contain a similar active ingredient, due to which they have the same properties as the mentioned drug. Among such medicines the following can be noted: “Metoprolol-Acri”, “Metolol”, “Metocor Adifarm” and others.

After purchasing these products, the patient is recommended to read the attached instructions and also consult a doctor. This is due to the fact that the methods of administration may differ from the dosages of the above-mentioned drug.

What other analogues does this drug have? You can replace the medication prescribed by your doctor with the following medications: Bisoprolol, Metoprolol-ratiopharm, Metocard, Corvitol, Metozok, Lidalok, Serdol, Egilok, Emzok and others.

How and for how long should the drug be stored?

Now you know what Metoprolol is intended for, how and in what dosage it is taken. It should be stored in a cool place (for example, in a refrigerator) or in a room where the air temperature does not exceed 25 degrees. In this case, the drug must be protected from direct sunlight.

The shelf life of the mentioned medicinal product and most of its analogues is five years from the date of production. After this period, the use of the medication for therapeutic and prophylactic purposes is prohibited. It should be thrown away.

The drug "Metoprolol" has been successfully used since the 1980s. It has two dosage forms: succinate and tartrate (long-acting and fast-acting, respectively). According to the classification, the drug is considered a beta-blocker. Let's take a closer look at why Metoprolol tablets are prescribed, instructions for their use, and at what pressure the medicine should be taken.

Available in film-coated tablets. Their shade varies from white to yellow-white. The shape is round, biconvex. There is a risk on one side. The active ingredient is metoprolol tartrate. The composition also contains the following components:

The medicine is found in dosages of 25, 50 and 100 mg. If the dosage is 50 mg, the blister contains 14 pieces, and the cardboard packaging contains 2 or 4 blisters. With a dosage of 100 mg, there are 10 pieces in one blister, 3 blisters in a cardboard package. Tablets of 25 mg come in 60 pieces per package.

pharmachologic effect

Metoprolol is considered a cardioselective beta-1 adrenergic receptor blocker that does not have membrane stabilizing properties and internal sympathomimetic activity. The effect of the drug is antiarrhythmic, hypotensive and antianginal.

There is a blockade of beta-adrenergic receptors of the heart in small doses, resulting in a decrease in the production of AMP from ATP, which stimulate catecholamines. The contractility of the heart muscle, excitability and output decrease, and the heart rate becomes less frequent.

On the first day after oral administration, total peripheral resistance increases. The reason is a reciprocal increase in the activity of alpha-adrenergic receptors and blockade of beta-adrenergic receptors. After 1-3 days there is a return to the original state. With prolonged use, resistance decreases.

The acute antihypertensive effect occurs due to a decrease in cardiac output, the development of a stable hypotensive effect occurs after 2-3 weeks. It is associated with a decrease in renin synthesis and accumulation of plasma renin. The activity of the renin-angiotensin system and the central nervous system is also inhibited, and the sensitivity of the baroreceptors of the aortic arch is restored. Ultimately, peripheral sympathetic influences are reduced. Blood pressure decreases at rest, stress and during exercise.

The antianginal effect is caused by a decrease in the need of the heart muscle for oxygen due to a decrease in heart rate, contractility and a decrease in the sensitivity of the heart muscle to the influence of sympathetic innervation.

The number and severity of angina attacks decreases and tolerance to physical stress increases. Pressure readings decrease after a quarter of an hour, maximum - a couple of hours, duration is 6 hours. The change in lower pressure occurs at a slower pace. Stability becomes noticeable after several weeks of constant use of the drug.

The antiarrhythmic effect is expressed in getting rid of arrhythmogenic factors, such as tachycardia, excessive activity of the sympathetic nervous system, hypertension, and increased cAMP levels. The rate of spontaneous excitation of the ectopic and sinus pacemaker decreases, atrioventricular conduction becomes slower (mainly in the antegrade direction, less in the retrograde direction through the atrioventricular node) and along additional pathways. Heart rate becomes lower, sinus rhythm can even be restored in case of sinus and supraventricular tachycardia, hyperthyroidism and functional heart disease. The development of diseases such as migraine is prevented.

When consumed in medium dosages, it affects organs that have beta-adrenergic receptors to a lesser extent. These are the smooth muscles of the bronchi, uterus, peripheral arteries, skeletal muscles and the pancreas. There is also no noticeable effect on carbohydrate metabolism, compared to non-selective ones. When consumed in high dosages (more than 100 mg), a blocking effect occurs on two subtypes of beta-adrenergic receptors.

Pharmacokinetics

The drug "Metoprolol" reaches the gastrointestinal tract at high speed and almost all (95 percent). It is maximally concentrated in plasma 1-2 hours after internal use. The average half-life is 3.5 hours (can vary from 1 to 9 hours).

Bioavailability upon first use is 50%, the second time it increases to 70%. Eating food increases it by 20-40%. It also increases with liver cirrhosis. The average binding rate to plasma proteins is 10%.

The medicine passes through the placental and blood-brain barrier. It passes into milk in small quantities during lactation.

Metabolization occurs in the liver. The metabolites lack pharmacological activity. Approximately 5% of the drug is excreted unchanged through the kidneys. When treating patients suffering from reduced renal function, there is no need to change the dosage of the drug. If the liver function is pathological, the metabolism of the drug becomes slower, therefore, if the function of this organ is insufficient, the dosage of the drug is reduced.

Indications

Indications for the use of Metoprolol are:

• hypertension - monotherapy or together with other medications to lower blood pressure;
• angina pectoris - monotherapy or together with other antianginal drugs;
• myocardial infarction - part of the treatment and for preventive purposes after a heart attack;
• heart rhythm pathologies, such as ventricular extrasystole, sinus tachycardia, supraventricular arrhythmias;
• hyperthyroidism is part of treatment to reduce heart rate;
• functional heart disorders such as hyperkinetic and tachycardic syndrome;
• migraine – preventive purposes against the occurrence of attacks;
• heart failure - with persistent tachycardia at rest, also with dilated cardiomyopathy.

Contraindications

Contraindications to the use of Metoprolol are as follows:

• weakness of the sinus node;
• heart failure during decompensation;
• breast-feeding;
• sinoatrial block;
• cardiogenic shock;
• hypotension (when used for prophylactic purposes against myocardial infarction - upper pressure readings are less than 100 mm Hg, heart rate is less than 45 beats/min);
• atrioventricular block 2 and 3 degrees;
• bradycardia;
• use or administration of monoamine oxidase inhibitors;
• excessive sensitivity to the components of the drug and other beta-blockers;
• age period up to 18 years due to lack of information on safety and effectiveness;
• Prinzmetal's angina.

The drug should be prescribed with caution for the following pathologies:

• first degree atrioventricular block;
• peripheral vascular occlusive diseases such as Raynaud's syndrome and intermittent claudication;
• diabetes;
• depressive states, including a history of depression;
• pregnancy period;
• obstructive pulmonary diseases of a chronic nature, such as chronic obstructive bronchitis and pulmonary enphysema;
• chronic renal or liver failure;
• old age;
• pheochromocytoma;
• bronchial asthma;
• myasthenia gravis;
• psoriasis;
• thyrotoxicosis.

Instructions for use

The drug is intended for internal use with food or immediately after consumption. Do not take the tablets with liquid or chew them. Take Metoprolol for elevated blood pressure.

For arterial hypertension, the primary dosage is 50-100 mg per day once or twice. If the therapeutic effect is not sufficiently pronounced, the dose can be gradually increased to 100-200 mg or you can start taking similar drugs to lower blood pressure as a supplement. The maximum dosage per day is 200 mg.

The instructions for Metoprolol indicate that for arrhythmia, angina pectoris and for prophylactic purposes against migraine attacks, the dose is 100-200 mg per day in 2 doses. For secondary prevention of heart attack, apply 200 mg twice. In case of pathologies of the liver, the dosage of the medication is reduced depending on the patient’s condition.

Important: The dosage does not change in elderly people with pathologies of kidney function and hemodialysis procedures.

Side effects

Negative manifestations are expressed depending on the individual condition of the patient. Mostly they are not significant and disappear after the drug is discontinued.

Nervous system:

• depressive states;
• muscle weakness;
• nightmares;
• decreased attention;
• confusion or brief lapses of memory;
• excessive fatigue;
• drowsiness;
• headache;
• restless state;
• paresthesia in the arms and legs (in patients with Raynaud's syndrome and intermittent claudication).

Sense organs:

• dryness and pain in the eyes;
• noise in ears;
• decreased secretion of tear fluid;
• conjunctivitis;
• decreased vision.

The cardiovascular system:

• decrease in pressure indicators;
• cardialgia;
• symptoms of vasospasm (coldness of the legs, increased pathology of peripheral circulation, Raynaud's syndrome);
• worsening of temporary manifestations of CHF (swelling in the legs, shortness of breath, edema);
• orthostatic hypotension;
• loss of consciousness;
• disruption of cardiac muscle conduction;
• decreased contractility of the heart muscle;
• dizziness;
• heartbeat.

Digestive system:

Skin:

• reversible baldness;
• psoriasis (exacerbation);
• excessive sweating;
• rashes;
• exanthema;
• hives;
• psoriasis-like reactions;
• photodermatosis;
• hyperemia of the skin.

Respiratory system:

• dyspnea;
• nasal congestion;
• difficulty in exhaling (bronchospasm when used in large dosages).

Endocrine system:

• hypothyroidism;
• hyperglycemia (with diabetes);
• hypoglycemia (if the patient takes insulin).

Changes in laboratory tests:

• hyperbilirubinemia;
• agranulocytosis;
• thrombocytopenia (abnormal hemorrhages and bleeding);
• increased activity of liver enzymes;
• leukopenia.

Impact on the child during pregnancy:

• bradycardia;
• hypoglycemia;
• growth retardation.

Other side effects:

• slight weight gain;
• pain in the joints or back;
• decreased potency or libido.

Overdose

Overdose symptoms:

• noticeable decrease in blood pressure;
• cardialgia;
• fainting;
• loss of consciousness;
• severe sinus bradycardia;
• cardiogenic shock;
• cyanosis;
• atrioventricular block (complete transverse block may develop and the heart may stop);
• vomit;
• dizziness;
• coma;
• nausea;
• ventricular ecstasystole.

The first symptoms begin to appear 20-120 minutes after taking the medicine.

For treatment, you will need to rinse the stomach and take adsorbent drugs. With a pronounced decrease in pressure, the patient should lie on his back at an angle of 45 degrees, the pelvis is elevated in relation to the head (Trendelenburg position), with a strong decrease in pressure, heart failure and bradycardia, beta-adrenergic stimulants should be used until the desired result is obtained or atropine sulfate at a dosage of 0. 5-2 mg.

If no improvement is observed, you will need to take medications such as Norepinephrine, Dobutamine and Dopamine.

Afterwards, the doctor may prescribe 1-10 mg of glucagon or install a transvenous intracardial pacemaker. For bronchospasm, beta-2-adrenergic receptor stimulants are administered. With the help of hemodialysis, Metoprolol is not removed enough.

Interaction with other drugs

Do not take together with MAO inhibitors due to a significant increase in the hypotensive effect. The pause between the use of MAO inhibitors and the drug Metoprolol should be at least 2 weeks.

If Verapamil is administered simultaneously, cardiac arrest may occur. In case of simultaneous administration of Nifedipine, blood pressure can decrease significantly. The risk of inhibition of the heart muscle and the development of arterial hypotension increases when taking inhalation anesthesia.

The weakening of the hypotensive effect occurs due to beta-agonists, Indomethacin, Theophylline. The depression of the central nervous system increases when taking antipsychotics, tri- and tetracyclic antidepressants, sleeping pills and sedatives, ethanol. The risk of pathologies of peripheral circulation increases with the use of ergot alkaloids, and the cardiodepressive effect is additive with drugs for general anesthesia.

With internal use of hypoglycemic drugs, a decrease in their effect is sometimes observed; when treated with insulin, the risk of hypoglycemia and its increased severity increases.

When taken together with antihypertensive drugs, diuretics, calcium channel blockers, or nitroglycerin, a sharp decrease in blood pressure may occur. Particular caution should be exercised when consuming Prazonin. The severity of the decrease in heart rate and inhibition of atrioventricular conduction increases when combined with drugs such as Diltiazem, Clonidone, Verapamil, Amiodarone, Clonidine, Reserpine, Guanfacine. Also in interaction with cardiac glycosides and drugs for general anesthesia.

When taken simultaneously with the drug Clonidine, when Metoprolol is discontinued, after a few days it is necessary to discontinue Clonidine. Otherwise, withdrawal syndrome may occur.

Barbiturates and Rifampicin can increase the metabolism of Metoprolol, reduce its concentration in plasma and reduce its effectiveness. Inhibitors increase plasma concentrations.

Allergens used for immunotherapy or their extracts for skin testing increase the risk of allergies or anaphylaxis. Anaphylactic reactions may occur after the administration of radiocontrast agents containing iodine. When taken together with ethanol, the risk of a pronounced decrease in blood pressure increases.

Interaction with alcohol

Drinking alcoholic beverages while taking tablets containing metoprolol tartate may increase side effects. Hypotension often develops with accompanying symptoms: weakness, dizziness, and sometimes even loss of consciousness. If the active ingredient in the medicine is metoprolol succinate, alcohol can be drunk in moderation. However, excessive consumption is dangerous. Drinking alcohol-containing drinks is not recommended in the first 7-14 days from the start of therapy and after increasing the dosage of the drug.

Prescription for children

Use in childhood (before age 18) is contraindicated. The reason is the lack of data on safety and effectiveness.

Use during pregnancy

During pregnancy, the drug is prescribed according to strict indications. Be sure to take into account the risk-benefit ratio, since the fetus may develop hypoglycemia, hypotension and bradycardia. Careful monitoring of the child's development is necessary. After birth, regular monitoring of the child by doctors is required for 2-3 days.

Metoprolol should not be used during lactation. In special cases, it is necessary to stop feeding due to insufficient information about the effect of the drug on the child.

special instructions

If the patient is taking beta blockers, the patient's blood pressure, heart rate, and blood glucose levels should be monitored regularly in diabetics. Sometimes it is necessary to select a special dosage of hypoglycemic drugs and insulin for diabetes mellitus.

The patient needs to be able to use the heart rate calculation method and contact a medical facility if the reading is less than 50 beats/min. When using a dosage above 200 mg per day, a decrease in cardioselectivity occurs.

If you are diagnosed with heart failure, you should take Metoprolol exclusively in the compensation stage. Sometimes the severity of hypersensitivity reactions increases (with a burdened allergy history). There is no effectiveness from taking regular doses of adrenaline.

Sometimes there is an increase in the symptoms of peripheral arterial circulation pathology. The drug Metoprolol should be discontinued gradually, reducing the dosage over 10 days. If therapy is abruptly stopped, withdrawal syndrome may occur - angina attacks will intensify and blood pressure will increase.

It is important to pay special attention when discontinuing medication to patients diagnosed with angina pectoris. Angina pectoris requires a selected dosage that will ensure a resting heart rate of 55 to 60 beats/min; during exercise it should not exceed 110 beats/min. People who use contact lenses should be aware that treatment may reduce tear production.

Analogs

Analogs of the drug "Metoprolol" are as follows:

• "Metoprolol Organica";
• "Emzok";
• "Metoprolol-Ratiopharm";
• "Egilok";
• "Metoprolol Zentiva";
• "Metoblock";
• "Metoprolol-OBL";
• "Corvitol";
• "Metoprolol-Acri";
• "Betalok";
• "Metoprol";

"Betalok ZOK";

• "Metoprolol Retard-Akrikhin";
• "Anepro."

Compound

The composition includes the active substance metoprolol tartrate in the amount of 50 or 100 mg, excipients: silicon dioxide, magnesium stearate, microcrystalline cellulose, sodium carboxymethyl starch, as well as additional elements that make up the tablet shell.

Release form

The drug is available in tablet form.

pharmachologic effect

Cardioselective beta blocker .

Pharmacodynamics and pharmacokinetics

The drug has antiarrhythmic, antianginal and hypotensive effects. The drug does not have internal SMA and does not have a membrane-stabilizing effect.

The hypotensive effect is due to a decrease in the synthesis of renin, monooxygenase, inhibition of the activity of the renin-angiotensin system and the central nervous system. The drug can reduce blood pressure during stress and physical exertion at rest.

Antianginal effect is ensured by a decrease in heart rate, as well as a decrease in the need for oxygen in myocardial tissue. Long-term use of the medication increases exercise tolerance and reduces the severity of angina attacks and their frequency. As a result of eliminating arrhythmogenic factors (arterial hypertension, increased cAMP content, tachycardia, increased activity of the sympathetic nervous system), an antiarrhythmic effect is achieved.

For thyrotoxicosis, heart diseases of functional origin, sinus tachycardia , atrial fibrillation, supraventricular tachycardia Metoprolol allows you to restore sinus rhythm and reduce heart rate. The drug prevents the formation of migraines.

Average therapeutic dosages of metoprolol, unlike other beta-blockers, have a less pronounced effect on the organs in which beta2-blockers are located (uterus, bronchi, smooth muscle tissue of peripheral arteries, skeletal muscles, pancreas), on carbohydrate metabolism .

Long-term use of the medication leads to a decrease in levels cholesterol in blood.

Indications for use of Metoprolol

The medicine is used for myocardial infarction, unstable angina, angina pectoris , with ischemic heart disease, with arterial hypertension, crisis.

The drug is used for rhythm disturbances: supraventricular arrhythmia , ventricular form of arrhythmia, sinus tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, ventricular extrasystole.

The drug is used for thyrotoxicosis (in complex therapy), for (senile, essential forms), for migraine, withdrawal syndrome , akathisia when taking antipsychotics, when.

The indications for use of Metoprolol Ratiopharm are similar, for which the tablets are used effectively.

Contraindications

Metoprolol is not prescribed for atrioventricular block of 2-3 degrees, cardiogenic shock , intolerance to the active substance, acute form of heart failure, arterial hypotension, Prinzmetal's angina , in the acute period, while taking an MAO inhibitor, with intravenous infusion of verapamil.

At metabolic acidosis , diabetes mellitus, liver failure, pheochromocytoma, chronic renal failure, COPD (chronic, pulmonary), obliterating disease of peripheral vessels, depression, in pediatric practice, the drug is prescribed to the elderly with caution.

Side effects

Nervous system: slower speed of motor and mental reactions, weakness, increased fatigue, paresthesia in the limbs , convulsions, attention disorders, anxiety, memory impairment, confusion, “nightmare” dreams, asthenia.

Sense organs: eye pain, decreased vision, conjunctivitis, dry eyes, decreased tear production.

The cardiovascular system: orthostatic hypotension , loss of consciousness, dizziness, drop in blood pressure, sinus bradycardia, swelling, decreased myocardial contractility, myocardial conduction disturbances, manifestation of vasospasm, CHF, rarely worsening of impaired atrioventricular conduction is noted.

Digestive tract: changes in taste, liver dysfunction (cholestasis, darkening of urine, yellowing of the skin and sclera).

Skin: photodermatosis , psoriasis-like skin reactions, exacerbation of psoriasis, skin rashes, exanthema, reversible form of alopecia, increased sweating.

Respiratory system: bronchospasm, nasal congestion, shortness of breath.

Endocrine system: hypoglycemia (in insulin-requiring diabetes mellitus), hyperglycemia (in persons with non-insulin-dependent diabetes mellitus), hypothyroid state. Possible development of rash, itching, allergies, thrombocytopenia, hyperbilirubinemia, agranulocytosis.

The effect of Metoprolol on the fetus: hypoglycemia, intrauterine growth retardation, bradycardia.

The medicine may cause decreased potency , libido, weight gain, joint pain. Abrupt cessation of the drug causes the development "withdrawal syndrome" .

Metoprolol tablets, instructions for use (Method and dosage)

The medicine is taken orally. Tablets should not be divided in half, chewed, or broken. The average dosage for arterial hypertension is 100-150 mg for 1-2 doses per day.

Angina: 2-3 times a day 50 mg.

Thyrotoxicosis, hyperkinetic cardiac syndrome, tachyarrhythmia: 1-2 times a day, 50 mg.

For secondary prevention of myocardial infarction 200 mg of metoprolol is indicated.

For migraine prevention Prescribe 100-200 mg per day for 2-4 doses.

With paroxysmal supraventricular tachycardia in order to relieve an attack, it is administered parenterally under inpatient observation.

In acute myocardial infarction Metoprolol is administered immediately after the patient’s hospitalization; monitoring of blood pressure, pulse, ECG, and atrioventricular conduction levels is mandatory.

For elderly people, therapy begins with 50 mg per day. In case of 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 of Metoprolol Ratiopharm and Metoprolol Acri are similar.

The use of the substance metoprolol succinate can be found in the instructions for the drugs and where it is active.

Overdose

Manifested by dizziness, drop in blood pressure, severe sinus bradycardia severe course, arrhythmias, fainting, ventricular extrasystole , cardiogenic shock, heart failure, cardiac arrest, bronchospasm , nausea, vomiting, coma, loss of consciousness.

The first symptoms are observed 20 minutes after taking increased doses of the drug.

The administration of enterosorbents and timely gastric lavage are required. If there is a significant drop in blood pressure, the patient is placed in the Trendelenburg position, norepinephrine is administered, , . Later, an intracardial pacemaker is prescribed and installed as needed using a transvenous method.

When a convulsive syndrome develops, it is administered slowly intravenously. When bronchospasm develops, beta-2 adrenergic stimulants are administered intravenously.

Hemodialysis has not proven effective.

Interaction

Allergen extracts used for skin testing themselves significantly increase the likelihood of developing severe systemic anaphylaxis in patients using Metoprolol.

The risk of developing anaphylactic reactions increases with intravenous administration of radiocontrast drugs based on. Medicines for general inhalation anesthesia, phenytoin when administered intravenously increase the likelihood of a drop in blood pressure, increase the severity cardiodepressive effect .

Metoprolol may mask symptoms hypoglycemia (high blood pressure, tachycardia ), change the effectiveness of oral forms of hypoglycemic agents, insulin.

The drug reduces the clearance of xanthines, increasing their concentration in the blood plasma, especially in patients with increased clearance of theophylline due to concomitant smoking.

Estrogens, glucocorticosteroids NSAIDs weaken the hypotensive effect of the drug.

BMKK, cardiac glycosides , antiarrhythmic drugs, amiodarone, , guanfacine aggravate the course bradycardia, heart failure, atrioventricular block.

When taking nifedipine, there is a significant drop in blood pressure. Hydralazine, sympatholytics, , diuretics, and other antihypertensive drugs can provoke a sharp and excessive drop in blood pressure.

Metoprolol prolongs the period of anticoagulant action of coumarins, increases the period of action non-depolarizing muscle relaxants . Antipsychotic drugs, tetracyclic antidepressants, neuroleptics, tricyclic antidepressants, hypnotics and sedatives, ethanol enhance the inhibitory effect of metoprolol on the central nervous system.

The simultaneous administration of MAO inhibitors is unacceptable due to the risk of a sharp drop in blood pressure.

Impaired peripheral circulation is observed when non-hydrogenated ergot alkaloids are prescribed.

Terms of sale

Recipe required.

Storage conditions

In a dry, dark place, out of reach of children, at a temperature of no more than 15-25 degrees Celsius.

Best before date

No more than five years.

special instructions

Monitoring of patients who use beta-blockers includes regular monitoring of heart rate and sugar levels. It is important to teach the patient to keep track of the pulse rate, and in case of bradycardia, he needs to seek the help of his attending physician.

Elderly people need to monitor the functioning of the renal system.

Metoprolol can cause peripheral arterial circulatory disorders.

Metoprolol is withdrawn gradually over 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 (tachycardia).

When planning a surgical intervention, it is necessary to notify the anesthesiologist about taking the drug Metoprolol, and do not stop taking the drug.

When registering for elderly people arterial hypotension , increasing bradycardia, ventricular arrhythmia, severe liver and kidney pathology, the dosage of the drug is reduced and it is gradually discontinued.

Treatment is stopped if depression develops or skin rashes appear.

When taking the drug during pregnancy, Emzok .