[, Liu J, Liu ZQ, Tan ZR, Chen XP, Wang LS, Zhou G, Zhou HH: Gly389Arg polymorphism of beta1-adrenergic receptor is associated with the cardiovascular response to metoprolol. Metoprolol is a selective beta-1 blocker commonly employed as the succinate and tartrate derivatives depending if the formulation is designed to be of immediate release or extended release.2,9 The possibility of the generation of these formulations comes from the lower systemic bioavailability of the succinate derivative.5 To this date, it is one of the preferred beta-blockers in general clinical guidelines and it is widely prescribed in the Netherlands, New Zealand, and the US.3 Metoprolol was developed since 1969 by US Pharmaceutical Holdings I and FDA approved in 1978.8, Metoprolol is indicated for the treatment of angina, heart failure, myocardial infarction, atrial fibrillation, atrial flutter and hypertension.1,14,17, Some off-label uses of metoprolol include supraventricular tachycardia and thyroid storm.1, All the indications of metoprolol are part of cardiovascular diseases. Exceptions: Rifabutin. [, Dudley AJ, Bleasby K, Brown CD: The organic cation transporter OCT2 mediates the uptake of beta-adrenoceptor antagonists across the apical membrane of renal LLC-PK(1) cell monolayers. Improve clinical decision support with information on. Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for the diagnosis and treatment of hypertrophic cardiomyopathy, a beta blocker (eg, metoprolol) is an effective and recommended agent for the treatment of symptoms (eg, angina, dyspnea) in patients with obstructive or nonobstructive hypertrophic cardiomyopathy. Switching between oral and intravenous dosage forms: In most cases, equivalent beta-blocking effect is achieved when a 2.5:1 (Oral:IV) ratio is used. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. Bethesda, MD 20894, Web Policies Monitor therapy, Naftopidil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Patients with this genotype have a greater reduction in blood pressure with metoprolol. Talk to your doctor if you have questions. Instant Pharmacology. Monitor therapy, Levodopa-Containing Products: Blood Pressure Lowering Agents may enhance the hypotensive effect of Levodopa-Containing Products. Put a plan in place to protect yourself from smoke inhalation. [. Monitor therapy, Calcium Channel Blockers (Nondihydropyridine): May enhance the hypotensive effect of Beta-Blockers. 1995;48(1):29-34. doi: 10.1007/BF00202168. Immediate release (metoprolol tartrate): Initial: 25 to 50 mg every 6 to 12 hours in the acute setting; some experts suggest a lower starting dose of 12.5 mg every 6 to 12 hours when concern for adverse effects remain; for outpatients, transition to twice-daily dosing of metoprolol tartrate (immediate release) or to daily metoprolol succinate (extended release); titrate dose based on heart rate and blood pressure as tolerated up to a maximum dose of 200 mg/day (ACCF/AHA [O'Gara 2013]; Rosenson 2018; Simons 2018). Documentation of allergenic cross-reactivity for beta-blockers is limited. Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Extended release (metoprolol succinate): Initial: 25 to 50 mg once daily is also recommended by some experts; titrate dose based on heart rate and blood pressure as tolerated up to 200 mg once daily (Rosenson 2018; Simons 2018). Summarize the contraindications of metoprolol. FOIA Monitor therapy, Ivabradine: Bradycardia-Causing Agents may enhance the bradycardic effect of Ivabradine. The current match involves a Texas lawsuit . Monitor therapy, Panobinostat: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). The cardiovascular diseases are the leading cause of death on a global scale.10, Administration of metoprolol in normal subjects is widely reported to produce a dose-dependent reduction on heart rate and cardiac output.1 This effect is generated due to a decreased cardiac excitability, cardiac output, and myocardial oxygen demand.6 In the case of arrhythmias, metoprolol produces its effect by reducing the slope of the pacemaker potential as well as suppressing the rate of atrioventricular conduction.7, The Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) trial showed a significant improvement in sudden cardiac death and myocardial infarction when patients were given with metoprolol as compared with diuretics. Immediately deliver mixture through a 12 French nasogastric tube. Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Monitor therapy, Dronedarone: May enhance the bradycardic effect of Beta-Blockers. Eur J Clin Pharmacol. Monitor therapy, Cobicistat: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Tablet: Store at 25C (77F); excursions permitted to 15C to 30C (59F to 86F). Disclosure: Jason Morris declares no relevant financial relationships with ineligible companies. Monitor therapy, Brigatinib: May diminish the antihypertensive effect of Antihypertensive Agents. Metoprolol may also produce severe first-, second-, or third-degree heart block. Solution, Intravenous, as tartrate [preservative free]: Solution Cartridge, Intravenous, as tartrate: Lopressor: 100 mg [scored; contains fd&c blue #2 aluminum lake], Generic: 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg. Tablet Extended Release 24 Hour, Oral, as succinate: Selective inhibitor of beta1-adrenergic receptors; competitively blocks beta1-receptors, with little or no effect on beta2-receptors at oral doses <100 mg (in adults); does not exhibit any membrane stabilizing or intrinsic sympathomimetic activity, Vd: 3.2 to 5.6 L/kg; crosses the blood brain barrier; CSF concentrations are 78% of plasma concentrations, Extensively hepatic via CYP2D6; significant first-pass effect (~50%), Urine (95%, <5% to 10% as unchanged drug; increased to 30% to 40% in poor CYP2D6 metabolizers), Oral: Immediate release tablets: Within 1 hour; Peak effect: Oral: 1 to 2 hours (Regardh 1980); IV: 20 minutes (when infused over 10 minutes), Oral: Immediate release: Variable (dose-related; 50% reduction in maximum heart rate after single doses of 20, 50, and 100 mg occurred at 3.3, 5, and 6.4 hours, respectively), Extended release: ~24 hours, Neonates: 5 to 10 hours (Morselli 1989); Adults: 3 to 4 hours (7 to 9 hours in poor CYP2D6 metabolizers or hepatic impairment). Patient was educated on Metoprolol and its mechanism of action as follows: Metoprolol is a selective Beta-1 blocker that inhibits the action of catecholamines (adrenaline and noradrenaline) on the Beta-1 receptors. Talk with the doctor. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. (2005). This kind of receptor is found in your heart. 2000 Nov;28(11):1327-34. The site is secure. Beta-blockers should also be considered in asymptomatic patients who are at increased risk of complications due to worsening hyperthyroidism. The mechanisms of action for these effects are not fully understood but may . Peripheral vascular disease (PVD) and Raynaud disease: May precipitate or aggravate symptoms of arterial insufficiency in patients with PVD and Raynaud disease. Hypotension: Symptomatic hypotension may occur with use. Jones and Bartlett Publishers Inc.. Saeb-Parsy K., Assomull R., Khan F., Saeb-Parsy K. and Kelly A. 2003 Apr 11;466(1-2):1-6. [, Belpaire FM, Wijnant P, Temmerman A, Rasmussen BB, Brosen K: The oxidative metabolism of metoprolol in human liver microsomes: inhibition by the selective serotonin reuptake inhibitors. Management: Consider temporarily withholding blood pressure lowering medications beginning 12 hours prior to obinutuzumab infusion and continuing until 1 hour after the end of the infusion. Exceptions are discussed in separate monographs. Should beta blockers remain first choice in the treatment of primary hypertension? Monitor therapy, EPINEPHrine (Systemic): Beta-Blockers (Beta1 Selective) may diminish the therapeutic effect of EPINEPHrine (Systemic). Treasure Island (FL): StatPearls Publishing; 2023 Jan. Would you like email updates of new search results? The estimated equivalent IV total daily dose should be divided into 4 equal doses. Monitor therapy, Bradycardia-Causing Agents: May enhance the bradycardic effect of other Bradycardia-Causing Agents. The underlying causes of these conditions are variable and can be due to genetic disposition, lifestyle decisions such as smoking, obesity, diet, and lack of exercise, and comorbidity with other conditions such as diabetes. Based on the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) guidelines for the management of adult patients with supraventricular tachycardia, the use of an oral or intravenous beta-blocker, including metoprolol, is effective and recommended for a variety of symptomatic supraventricular tachycardias (atrioventricular nodal reentrant tachycardia [AVNRT], atrioventricular reentrant tachycardia [AVRT], focal atrial tachycardia [AT], and multifocal atrial tachycardia [MAT]). Monitor therapy, Molsidomine: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Refer to adult dosing. Unauthorized use of these marks is strictly prohibited. Monitor therapy, Beta2-Agonists: Beta-Blockers (Beta1 Selective) may diminish the bronchodilatory effect of Beta2-Agonists. If blood pressure lowering therapy cannot be withheld, amifostine should not be administered. Consult individual institutional policies and procedures. Beta blockers aren't usually prescribed for high blood pressure unless other medications, such as diuretics . 2018 Dec;84(12):2704-2715. doi: 10.1111/bcp.13741. Part 2: Atrial flutter, atrial fibrillation, and junctional and atrial ectopic tachycardia. Circulation. With structured adverse effects data, including: Improve decision support & research outcomes with our structured adverse effects data. Objectives: Identify the mechanism of action of metoprolol. Acute ventricular tachycardia (eg, sustained VT):IV: 5 mg every 5 minutes up to 3 doses (AHA/ACC/HRS [Al-Khatib 2017]), Immediate release (metoprolol tartrate): Oral: Initial: 12.5 to 25 mg twice daily; increase as needed based on patient response; maximum dose: 200 mg/day in 2 or 3 divided doses (Kettering 2002; Kuck 2000; Seidl 1998), Extended release (metoprolol succinate): Oral: 25 to 100 mg 1 to 2 times daily (AHA/ACC/HRS [Al-Khatib 2017]). Monitor therapy, Asunaprevir: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Monitor therapy, Midodrine: May enhance the bradycardic effect of Bradycardia-Causing Agents. Source: Wolters Kluwer Health. 8600 Rockville Pike Mechanism of action. It also is used to prevent angina (chest pain) and to improve survival after a heart attack. Monitor therapy, Yohimbine: May diminish the antihypertensive effect of Antihypertensive Agents. Bromperidol may diminish the hypotensive effect of Blood Pressure Lowering Agents. [, Imai Y, Watanabe N, Hashimoto J, Nishiyama A, Sakuma H, Sekino H, Omata K, Abe K: Muscle cramps and elevated serum creatine phosphokinase levels induced by beta-adrenoceptor blockers. Immediate release (metoprolol tartrate): Oral: Initial: 25 mg twice daily; maximum dose: 400 mg/day (ACC/AHA/HRS [Page 2016]), Extended release (metoprolol succinate): Oral: Initial: 50 mg once daily; maximum dose: 400 mg/day (ACC/AHA/HRS [Page 2016]). In addition, metoprolol is used to treat patients with heart failure. Unable to load your collection due to an error, Unable to load your delegates due to an error. 17.5, packed 96-tips extraction method was compared with protein precipitation for the . However, metoprolol tartrate is typically administered in 2 to 3 divided daily doses and metoprolol succinate is administered once daily. In cirrhotic patients, the clearance rate changes to 0.61 L/min.4, Oral administration of metoprolol to rats presents an LD50 in the range of 3090 to 4670 mg/kg. Hypertension: Management of hypertension. Monitor therapy, Alpha2-Agonists: May enhance the AV-blocking effect of Beta-Blockers. Chronic treatment: Oral: Immediate release (metoprolol tartrate): 0.5 to 1 mg/kg/dose two times daily; maximum daily dose: 6 mg/kg/day (Kliegman 2011; Muller 1993; O'Marcaigh 1994). [, Johnson JA, Zineh I, Puckett BJ, McGorray SP, Yarandi HN, Pauly DF: Beta 1-adrenergic receptor polymorphisms and antihypertensive response to metoprolol. Management: Avoid concurrent use of abiraterone with CYP2D6 substrates that have a narrow therapeutic index whenever possible. Exposure to beta-blockers during pregnancy may increase the risk for adverse events in the neonate. 2022 Sep 3. Hypertension (alternative agent): Note: Not recommended in the absence of specific comorbidities (eg, ischemic heart disease, HFrEF, arrhythmia) (ACC/AHA [Whelton 2017]). It is stimulated by a biochemical called. A meta-analysis. In: StatPearls [Internet]. official website and that any information you provide is encrypted Management: Avoid concurrent use of dacomitinib with CYP2D6 subtrates that have a narrow therapeutic index. Myocardial infarction, early treatment and secondary prevention: Note: An oral beta-blocker is recommended within the first 24 hours if there are no contraindications. Nucleic Acids Res. Dosing based on a multicenter, open-label trial in 15 pediatric patients (age range: 2.5 to 15 years, mean: 8.6 1.3 years) with dilated cardiomyopathy with heart failure that failed to show improvement in left ventricular function on conventional therapy; after 23 months of metoprolol, significant increases in ejection fraction (mean: 41.1%) and fractional shortening (mean: 23.3%) were observed; the reported mean maximum daily dose was 1.1 0.1 mg/kg/day (range: 0.5 to 2.3 mg/kg/day) (Shaddy 1999). 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. Before Beta blockers aren't recommended as a first treatment in people who have only high blood pressure. Consider therapy modification, Opioids (Anilidopiperidine): May enhance the bradycardic effect of Beta-Blockers. . How it works Cost Lopressor and alcohol Interactions Overdose FAQs Precautions Therefore, patient variability may exist and a specific ratio may not apply to all patients, especially if comorbid conditions are present. Of particular concern with nonselective beta-blockers or higher doses of the beta1 selective beta-blockers. Immediate release (metoprolol tartrate): Oral: Initial: 50 mg twice daily; titrate at weekly (or longer) intervals as needed based on patient response; maximum dose: 400 mg/day; usual dosage range: 100 to 200 mg/day in 2 divided doses (ACC/AHA [Whelton 2017]), Extended release (metoprolol succinate): Oral: Initial: 25 to 100 mg once daily; titrate at weekly (or longer) intervals as needed based on patient response; maximum dose: 400 mg/day; usual dosage range: 50 to 200 mg once daily (ACC/AHA [Whelton 2017]). It is used after a heart attack to help prevent future heart attacks and lengthen life. Monitor therapy, Dipyridamole: May enhance the bradycardic effect of Beta-Blockers. Allen LV Jr and Erickson MA 3rd, "Stability of Labetalol Hydrochloride, Metoprolol Tartrate, Verapamil Hydrochloride, and Spironolactone With Hydrochlorothiazide in Extemporaneously Compounded Oral Liquids," Am J Health Syst Pharm, 1996, 53(19):2304-9.8893069. Generic Name Pregabalin DrugBank Accession Number DB00230 Background. Monitor therapy, EPINEPHrine (Oral Inhalation): Beta-Blockers (Beta1 Selective) may diminish the therapeutic effect of EPINEPHrine (Oral Inhalation). INTRODUCTION Raynaud phenomenon (RP) is an exaggerated vascular response to cold temperature or to emotional stress, which is manifested clinically by sharply demarcated color changes of the distal skin of the digits as well as toes, nose, and earlobes. Circ Heart Fail. Specific recommendations vary by guideline but use of metoprolol may be considered (ACOG 203 2019; ESC [Regitz-Zagrosek 2018]; Magee 2014). Beta-blockers such as metoprolol and propranolol are first choice migraine preventive medication. 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). Acetazolamide may increase the excretion rate of Metoprolol which could result in a lower serum level and potentially a reduction in efficacy. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This medication is taken by mouth, typically twice daily, though your dosage depends on what condition you have. An updated review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy, in hypertension, ischaemic heart disease and related cardiovascular disorders. It is also used to lower your risk of death or needing to be hospitalized for heart failure. Label "shake well" and "protect from light". Metoprolol also is used in combination with other medications to treat heart failure. 366(9496):1545-53. The metabolism of Acetaminophen can be decreased when combined with Metoprolol. Monitor therapy, Selective Serotonin Reuptake Inhibitors: May increase the serum concentration of Beta-Blockers. Monitor therapy, Nicorandil: May enhance the hypotensive effect of Blood Pressure Lowering Agents. Women's health is once again the center of a political ping-pong match with evidence-based science on one side and anti-choice advocates on the other. Management: Monitor for reduced theophylline efficacy during concomitant use with any beta-blocker. Off-label uses include supraventricular tachycardia and thyroid storm. Treasure Island (FL): StatPearls Publishing; 2023 Jan. A 10 mg/mL oral suspension may be made with metoprolol tartrate tablets and one of three different vehicles (cherry syrup; a 1:1 mixture of Ora-Sweet and Ora-Plus; or a 1:1 mixture of Ora-Sweet SF and Ora-Plus). Here are 6 benefits of exercise for older adults and seniors. Metoprolol is in a class of medications called beta blockers. 1983 Jun;67(6 Pt 2):I26-32. Monitor therapy, Lidocaine (Systemic): Beta-Blockers may increase the serum concentration of Lidocaine (Systemic). Easily compare up to 40 drugs with our drug interaction checker. 2003 Jul;74(1):44-52. Mechanism of Action. Acute cardiac treatment: Monitor ECG, heart rate, and blood pressure with IV administration; heart rate, rhythm, and blood pressure with oral administration. Heart failure: Use with caution in patients with compensated heart failure; monitor for a worsening of heart failure (only the ER formulation is indicated for use in heart failure). Intravenous or oral metoprolol may be useful for rate control in the acute treatment or ongoing management of hemodynamically stable patients with atrial flutter. Pheochromocytoma (untreated): Adequate alpha-blockade is required prior to use of any beta-blocker. Monitor therapy, Amiodarone: May enhance the bradycardic effect of Beta-Blockers. Immediate release (metoprolol tartrate): Oral: Initial: 50 mg twice daily; may increase dose at weekly intervals to desired effect; usual dosage range: 50 to 200 mg twice daily; maximum dose: 400 mg/day, Extended release (metoprolol succinate): Oral: Initial: 100 mg once daily; may increase dose at weekly intervals to desired effect; maximum dose: 400 mg/day. It is used to treat chest pain or pressure. and transmitted securely. [. Use of metoprolol may be considered if migraine prophylaxis is needed in a pregnant woman (Pringsheim 2012). However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty. Disclaimer. Pregabalin is structurally similar to gamma-aminobutyric acid (GABA) - an inhibitory neurotransmitter. Metoprolol is a beta-blocker used in the treatment of hypertension and angina, and used to reduce mortality due to myocardial infarction. Careers. NIFEdipine may enhance the negative inotropic effect of Beta-Blockers. If maternal use of a beta-blocker is needed, fetal growth should be monitored during pregnancy and the newborn should be monitored for 48 hours after delivery for bradycardia, hypoglycemia, and respiratory depression (ESC [Regitz-Zagrosek 2018]). Atrial fibrillation prevention after cardiac surgery: Note: Initiate prior to surgery (preferentially at least 48 hours before) or postoperatively when hemodynamically stable. Consider therapy modification, Darunavir: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Metoprolol may be used for the treatment of maternal ventricular arrhythmias, atrial fibrillation/atrial flutter, or supraventricular tachycardia during pregnancy; consult current guidelines for specific recommendations (ACC/AHA/HRS [Page 2016]; ESC [Regitz-Zagrosek 2018]). 4 Bisoprolol is generally well tolerated, likely due to its 1-adrenergic . Thyroid disease: May mask signs of hyperthyroidism (eg, tachycardia). Extended release (metoprolol succinate): Oral: Initial: 12.5 to 25 mg once daily; up-titrate gradually (eg, doubling the dose every 2 or more weeks) to the maximum tolerated dose while monitoring for signs and symptoms of HF; maximum dose: 200 mg/day (ACCF/AHA [Yancy 2013]; ACC/AHA/HFSA [Yancy 2017]; MERIT-HF Study Group 1999). Avoid in patients with decompensated heart failure; electrical cardioversion preferred (ACC/AHA/HRS [Page 2016]; AHA [Neumar 2010]). Lopressor is used to treat angina (chest pain) and hypertension ( high blood pressure ). When concurrent use is not avoidable, monitor patients closely for signs/symptoms of toxicity. May divide tablets in half; do not crush or chew. Prinzmetal variant angina: 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 1998). Note: Additional contraindications are formulation and/or indication specific. Monitor therapy, Methacholine: Beta-Blockers may enhance the adverse/toxic effect of Methacholine. government site. Monitor therapy, Prostacyclin Analogues: May enhance the hypotensive effect of Blood Pressure Lowering Agents. If hyperthyroidism is suspected, carefully manage and monitor; abrupt withdrawal may exacerbate symptoms of hyperthyroidism or precipitate thyroid storm. Monitor therapy, Methoxyflurane: May enhance the hypotensive effect of Beta-Blockers. Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for coronary artery bypass graft surgery, beta-blockers are recommended to help prevent postoperative atrial fibrillation. Drugs A to Z Print Drug Interactions between metoprolol and Viagra This report displays the potential drug interactions for the following 2 drugs: metoprolol Viagra (sildenafil) Edit list (add/remove drugs) Consumer Professional Interactions between your drugs Moderate metoprolol sildenafil Applies to: metoprolol and Viagra (sildenafil) It is a relatively cardioselective -adrenoceptor blocking medicine without intrinsic sympathomimetic activity, and is suited for the treatment of hypertension. Management: Avoid the concomitant use of fingolimod and beta-blockers if possible. Of particular concern are the potential for cardiac conduction abnormalities and bronchoconstriction. Metoprolol is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. Abiraterone with CYP2D6 Substrates ( High risk with Inhibitors ) the adverse/toxic effect Blood... Administered once daily Store at 25C ( 77F ) ; excursions permitted to to. Health condition chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity can not withheld. - an inhibitory neurotransmitter compare up to 40 drugs with our drug interaction checker any beta-blocker use of any.. Woman ( Pringsheim 2012 ) 25C ( 77F ) ; excursions permitted to 15C 30C! Metoprolol is used to treat heart failure and propranolol are first choice in the acute or... 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