Ischemic Heart Disease: Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered metoprolol, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, metoprolol administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician’s advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue metoprolol therapy abruptly even in patients treated only for hypertension. Metoprolol tartrate, USP is a selective beta1-adrenoreceptor blocking agent, available as 25, 50 and 100 mg tablets for oral administration. Metoprolol tartrate is (±)-1-(isopropylamino)-3-[p-(2-methoxyethyl) phenoxy]-2-propanol (2:1) dextro-tartrate salt, and its structural formula is: Metoprolol tartare, USP is a white, practically odorless, crystalline powder with a molecular weight of 684.82. Summary Description and Clinical Pharmacology Indications and Dosage Warnings and Precautions Side Effects and Adverse Reactions Drug Interactions, Overdosage, Contraindications, Other Rx Info Active Ingredients User Ratings / Reviews Side Effect Reports ’s (mg/kg): mice, 1158 to 2460; rats, 3090 to 4670. Potential signs and symptoms associated with overdosage with metoprolol are bradycardia, hypotension, bronchospasm, myocardial infarction, cardiac failure and death. In general, patients with acute or recent myocardial infarction may be more hemodynamically unstable than other patients and should be treated accordingly (see WARNINGS, Myocardial Infarction). On the basis of the pharmacologic actions of metoprolol, the following general measures should be employed: Elimination of the Drug: Gastric lavage should be performed. Other clinical manifestations of overdose should be managed symptomatically based on modern methods of intensive care. Hypotension: A vasopressor should be administered, e.g., levarterenol or dopamine. Bronchospasm: A beta -stimulating agent and/or a theophylline derivative should be administered. Cardiac Failure: A digitalis glycoside and diuretic should be administered.
Absorption: Well absorbed after oral administration. Distribution: Crosses the blood-brain barrier, crosses the placenta; small amounts enter breast milk. Metabolism and Excretion: Mostly metabolized by the liver (primarily by CYP2D6; the CYP2D6 enzyme system exhibits genetic polymorphism); ~7% of population may be poor metabolizers and may have significantly ↑ metoprolol concentrations and an ↑ risk of adverse effects. TIME/ACTION PROFILE (cardiovascular effects)When switching from immediate-release to extended-release product, the same total daily dose can be used PO: (Adults) Antihypertensive/antianginal– 25–100 mg/day as a single dose initially or 2 divided doses; may be ↑ q 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). MI– 25–50 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mg twice daily. Heart failure– 12.5–25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day. https://nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/51497/all/metoprolol. Migraine prevention– 50–100 mg 2–4 times daily (unlabeled). IV: (Adults) MI– 5 mg q 2 min for 3 doses, followed by oral dosing. Tablets (tartrate): 25 mg, 50 mg, 100 mg Cost: Generic: All strengths $7.18/100Extended-release tablets (succinate; Toprol XL): 25 mg, 50 mg, 100 mg, 200 mg Cost: Generic: 25 mg $35.68/100, 50 mg $41.93/100, 100 mg $53.95/100, 200 mg $84.54/100Solution for injection: 1 mg/m LIn Combination with:hydrochlorothiazide (Dutoprol, Lopressor HCT). See combination drugs.metoprolol is a sample topic from the Davis's Drug Guide. Do not stop taking this medication without consulting your doctor. Some conditions may become worse when you suddenly stop this drug. Some people who have suddenly stopped taking similar drugs have had chest pain, heart attack, and irregular heartbeat. If your doctor decides you should no longer use this drug, he or she may direct you to gradually decrease your dose over 1 to 2 weeks. When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease strain on the heart. Get medical help right away if you develop chest pain/tightness/pressure, chest pain spreading to the jaw/neck/arm, unusual sweating, trouble breathing, or fast/irregular heartbeat. Show More Metoprolol is used with or without other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems.
Jul 1, 2010. Peak drug levels are highest when oral metoprolol is taken with meals;. Fluids are often ineffective or contraindicated due to heart failure. CONTRAINDICATIONS / PRECAUTIONS. Abrupt discontinuation. Abrupt discontinuation of any beta-adrenergic-blocking agent, including metoprolol, can result.