Metoprolol

Listed in Dosage.

Adult: PO Hypertension Conventional tab: Initially, 100 mg daily as single or in 2 divided doses, may be increased weekly according to response. Maintenance: 200 mg daily in divided doses. Extended release tab: Initially, 25-100 mg daily, may be increased weekly according to response. Max: 400 mg/day. Angina pectoris Conventional tab: 50-100 mg bid or tid. Extended-release: Initially, 100 mg daily, may be increased gradually at weekly intervals until satisfactory response is achieved. Max: 400 mg/day. Heart failure Extended-release tab: 12.5-25 mg once daily, may be increased gradually as tolerated, at intervals of 2 weeks. Max dose: 200 mg once daily. Cardiac arrhythmias Conventional tab: 50 mg bid or tid, may be increased to 300 mg daily in divided doses, as necessary. Adjunct in hyperthyroidism Conventional tab: 50 mg qid, may be reduced once euthyroid state is achieved. Prophylaxis of migraine Conventional tab: 100-200 mg daily in divided doses. IV Adjunct in the early management of acute myocardial infarction Within 12 hours of onset of chest pain: 5 mg at a 2 minute intervals to total of 15 mg, if tolerated. Patients who have received full IV dose: After 15 minutes, initiate oral therapy of 50 mg every 6 hours for 2 days. Patients who did not tolerate the full IV dose: Reduced oral dose should be given as and when their condition permits. Subsequent oral maintenance: 100 mg bid. Patients not given an IV inj: 200 mg in 2 or 4 divided doses started when patient's condition stabilises. Cardiac arrhythmias Initially, 5 mg injected at a rate of 1-2 mg/minute, may be repeated if necessary at a 5-minute interval to a total dose of 10-15 mg. Prophylaxis or control of arrhythmias on induction of anaesthesia 2-4 mg as slow injection, may further give 2 mg injections as necessary. Max dose: 10 mg.

May be taken with or without food.

2nd or 3rd degree atrioventricular block, decompensated cardiac failure, severe bradycardia, sick-sinus syndrome (without pacemaker), untreated phaeochromocytoma, severe peripheral arterial disease, and cardiogenic shock.

Patient with 1st degree atrioventricular block, sinus node dysfunction, or conduction disorders, bronchospastic disease, diabetes mellitus, psoriasis, myasthenia gravis, thyrotoxicosis, peripheral vascular disease. Avoid abrupt withdrawal. Hepatic impairment. Elderly. Pregnancy and lactation. CYP2D6 ultrarapid and poor metabolisers. Patient Counselling This drug may cause dizziness, if affected, do not drive or operate machinery. Monitoring Parameters Monitor blood pressure, heart rate, and ECG.

Significant: Bradycardia, atrioventricular block, hypotension. Cardiac disorders: Dyspnoea, pulmonary oedema, palpitations. Ear and labyrinth disorders: Tinnitus. Eye disorders: Blurred vision, visual disturbances. Gastrointestinal disorders: Nausea, vomiting, abdominal pain, constipation, flatulence, dry mouth, heartburn. General disorders and administration site conditions: Fatigue. Immune system disorders: Psoriasis. Metabolism and nutrition disorders: Peripheral oedema. Musculoskeletal and connective tissue disorders: Musculoskeletal pain. Nervous system disorders: Headache. Psychiatric disorders: Depression, confusion, nightmares, insomnia, hallucinations. Respiratory, thoracic and mediastinal disorders: Bronchospasm. Skin and subcutaneous tissue disorders: Photosensitivity, skin rash. Vascular disorders: Orthostatic hypotension (occasionally with syncope), cold extremities.

May enhance cardiodepressant effect with anaesthetic drugs (e.g. cyclopropane). May enhance hypoglycaemic effects of insulin. Increased serum concentration with CYP2D6 inhibitors (e.g. quinidine, fluoxetine, paroxetine, propafenone). May increase atrioventricular conduction and decrease heart rate with digitalis glycosides, clonidine, diltiazem, verapamil. Additive effects with catecholamine-depleting drugs (e.g. reserpine) and MAO inhibitors. Increased blood pressure lowering effect with TCA, barbiturates, phenothiazines, and other antihypertensive agents. Reduced antihypertensive effects with NSAIDs (e.g. indometacin). May enhance vasoconstrictive action of ergot alkaloids.

Antimigraine Preparations / Beta-Blockers

C07AB02 - metoprolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.