Mild to Moderate Hypertension: Recommended Dose: 50 mg once daily. In patients not responding to 50 mg, the dose could be increased to 100-200 mg once daily and/or in combination with other antihypertensive agents.
Angina Pectoris: Recommended Dose: 100-200 mg once daily. If needed, Betaloc ZOK can be in combination with other antianginal agents.
Stable Symptomatic Chronic Heart Failure with Impaired Systolic Left Ventricular Function as an Adjunct to Existing Heart Failure Therapy: The patients should have a stable chronic heart failure, without acute failure for the last 6 weeks and an essentially unchanged basal therapy for the last 2 weeks.
Treatment of heart failure with β-blockers may sometimes cause a temporary exacerbation of the symptoms picture. In some cases, it is possible to continue the therapy or reduce the dose, and in other cases, it may be necessary to discontinue the treatment. Initiation of Betaloc ZOK therapy in patients with severe heart failure (NYHA IV) should only be made by physicians especially trained in treatment of heart failure (see Precautions).
Patients with Stable Heart Failure, Function Class II: Recommended Initial Dose: 25 mg once daily for the first 2 weeks.
After 2 weeks, the dose can be increased to 50 mg once daily and thereafter it can be doubled every 2nd week. The target dose for long-term treatment is 200 mg once daily.
Patients with Stable Heart Failure, Function Classes III-IV: Recommended Initial Dose: 12.5 mg (1/2 of a 25-mg tablet) given once daily. The dose should be individually adjusted and the patient should be closely monitored during the increase of the dosage as heart failure symptoms may be aggravated in some patients. After 1-2 weeks, the dose can be raised to 25 mg given once daily. Then, after further 2 weeks, the dosage can be increased to 50 mg given once daily. In those patients who tolerate a higher dose, the dosage can be doubled every 2nd week up to a maximal dose of 200 mg daily.
In case of hypotension and/or bradycardia, decrease in concomitant medication or lowering of the Betaloc ZOK dose may be necessary. Initial hypotension does not necessarily mean that the dose of Betaloc ZOK cannot be tolerated in chronic treatment, but the dose must not be raised until the condition has been stabilized and increased control of renal function, among other things, may be required.
Cardiac Arrhythmias: Recommended Dose: 100-200 mg once daily.
Prophylactic Treatment After Myocardial Infarction: Long-term oral treatment with metoprolol in doses of 200 mg given once daily has been shown to reduce the risk of death (including sudden death) and to reduce the risk of reinfarction (also in patients with diabetes mellitus).
Children: There is limited experience with Betaloc Zok treatment in children.
Elderly: Dose adjustment is not needed in the elderly.
Renal Impairment: Dose adjustment is not needed in patients with impaired renal function.
Hepatic Impairment: Dose adjustment is normally not needed in patients suffering from liver cirrhosis because metoprolol has a low protein-binding (5-10%). When there are signs of serious impairment of liver function (e.g. shunt-operated patients), a dose reduction should be considered.
Administration: Betaloc ZOK is intended for once-daily treatment and is preferably taken in the morning. The Betaloc ZOK tab should be swallowed with liquid. The tablets and the divided halves should not be chewed or crushed. Concomitant intake of food does not influence the bioavailability.
Dosage should be adjusted to avoid bradycardia.