Metoprolol, tablets 25 mg 60 pcs

How to take, the dosage

When administered orally, the average dose is 100 mg/day in 1-2 doses. If necessary, the daily dose is gradually increased to 200 mg. When administered intravenously, the single dose is 2-5 mg; if there is no effect, a second dose may be given after 5 minutes.

Maximum doses: when given orally, the daily dose is 400 mg; when given by IV, the single dose is 15-20 mg.

Interaction

In concomitant use:

• antiarrhythmic drugs (quinine-like agents and amiodarone) may increase inotropic and dromotropic effects;
• inducers or inhibitors of microsomal enzymes may change the plasma concentration of Metoprolol Organic – decrease when taking rifampicin, – increase when taking cimetidine, ethanol, hydralazine, serotonin reuptake inhibitors (paroxetine, fluoxetine, sertraline), oral contraceptives;Inhibitors of serotonin reuptake (paroxetine, fluoxetine, sertraline) and oral contraceptives;
• indomethacin and other NSAIDs, COX inhibitors may decrease antihypertensive effects;
calcium channel blockers, cardiac glycosides, reserpine, nitrates – increased risk of hypotension, bradycardia, AV-blockade, negative inotropic action;
• insulin and oral antidiabetic agents – increased risk of hypoglycemia;
• drugs, inhaled anesthetics and some other drugs affecting the CNS, in particular sleeping pills (bromazepam, lorazepam), tranquilizers (chlordiazepoxide, trimethocin, tofizopam), tri- and tetracyclic antidepressants mutual potentiation of cardiodepressant effects;
• allergens used for immunotherapy or allergen extracts for skin testing increases the risk of severe systemic reactions and anaphylaxis;
• norepinephrine, epinephrine, and other sympathomimetics increase the risk of arterial hypertension;
• phenylpropanolamine in high doses – paradoxical increase in BP (up to hypertensive crisis);
• sympathomimetics, ganglioblocators, other β-adrenoreceptor blockers (e.g., eye drops), MAO type B inhibitors require careful monitoring of the patient;
• diazepam may decrease clearance and increase AUC of diazepam, which may increase its effects and decrease psychomotor reaction rate;
• lidocaine may impair lidocaine excretion;
• fluoxetine. A case of lethargy has been described;
• ciprofloxacin – decreased clearance of Metoprolol Organic from the body;
• ergotamine may increase peripheral circulatory disorders;
• mibefradil in patients with low activity of CYP2D6 isoenzyme may increase the plasma concentration of Metoprolol Organic and increase the risk of toxic effects.

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Special Instructions

With caution: diabetes mellitus, metabolic acidosis, bronchial asthma, chronic obstructive pulmonary disease, enfizema, chronic obstructive bronchitis, hepatic and renal disorders (creatinine clearance less than 40 ml/min), myasthenia, pheochromocytoma (with the simultaneous use of alpha-adrenoblockers), thyrotoxicosis, depression (including anamnesis), psoriasis, peripheral circulatory disorders (intermittent claudication, Raynaud’s syndrome), pregnancy, childhood age (efficacy and safety are not determined).including anamnesis), psoriasis, peripheral circulatory disorders (intermittent claudication, Raynaud’s syndrome), pregnancy, children (safety is not defined), elderly age, history of allergic diseases, 1st degree AV-blockade.

The monitoring of patients taking beta-adrenoblockers includes monitoring HR and . BP (at the beginning of therapy – daily, then – once every 3-4 months), blood glucose concentration in diabetic patients (once every 4-5 months). The patient should be taught the method of heart rate counting and instructed to consult a physician if the heart rate is less than 50/min.

An allergic reaction may be more severe (with a history of poor allergy) and may not respond to the usual doses of epinephrine.

In elderly patients it is recommended to monitor renal function (once every 4-5 months).

May aggravate symptoms of peripheral arterial circulatory disorders.

In tension angina, the selected dose of the drug should provide a resting HR of 55-60 beats/min, and not more than 110 beats/min on exertion.

The effectiveness of beta-adrenoblockers is lower in smokers.

Metoprolol Organica may mask some clinical manifestations of thyrotoxicosis (e.g., tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it may exacerbate the symptoms.

In diabetic patients may mask tachycardia caused by hypoglycemia. Unlike non-selective beta-adrenoblockers, it practically does not increase insulin-induced hypoglycemia and does not delay the recovery of blood glucose concentration to normal values.

In patients with concomitant bronchial asthma, beta2-adrenomimetics should be used additionally; in pheochromocytoma, alpha-adrenoblockers should be used.

If it is necessary to perform surgery, the anesthesiologist must be warned about taking Metoprolol Organic (the choice of drug for general anesthesia with minimal negative inotropic effect); cancellation of the drug is not recommended.

In case of increasing bradycardia (less than 50/min), arterial hypotension (systolic BP below 100 mmHg), AV blockade, bronchospasm, ventricular arrhythmias, severe hepatic and renal impairment, the dose should be reduced or treatment discontinued.

It is recommended that therapy be discontinued if there are skin rashes and depression caused by taking beta-adrenoblockers.

The drug should be stopped gradually, reducing the dose over 10 days. If treatment is stopped abruptly there may be a “withdrawal” syndrome (increased angina pectoris attacks, increased BP). Special attention should be given to patients with angina pectoris when withdrawing the drug.

Patients who wear contact lenses should be aware that treatment with beta-adrenoblockers may decrease lacrimal fluid production.

Influence on driving and operating machinery

Period of treatment, caution should be exercised when driving motor vehicles and engaging in other potentially dangerous activities requiring increased concentration and rapid psychomotor reactions.

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Contraindications

Hypersensitivity, cardiogenic shock, grade II and III AV block, sinoatrial block, chronic (decompensation stage) heart failure, sinus node weakness syndrome, marked sinus bradycardia (heart rate less than 60 beats per minute)./min), Prinzmetal’s angina, acute myocardial infarction (heart rate less than 45 beats per minute, PQ interval greater than 0.24 sec, systolic BP less than 100 mm PT.st).

Pregnancy, lactation. Concomitant intravenous administration of “slow” calcium channel blockers such as verapamil. Age before 18 years. Pheochromocytoma. patients receiving long-term or intermittent therapy with inotropic agents acting on beta-adrenoceptors.

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Side effects

Cardiovascular system disorders: bradycardia, arterial hypotension, AV conduction disorders, occurrence of symptoms of heart failure are possible.

Digestive system disorders: at the beginning of therapy dry mouth, nausea, vomiting, diarrhea, constipation; liver function disorders in single cases.

CNS and peripheral nervous system disorders: weakness, fatigue, dizziness, headache, muscle cramps, cold sensation and paresthesia in extremities may occur; decreased tear fluid secretion, conjunctivitis, rhinitis, depression, sleep disorders, nightmares may occur.

Hematopoietic system: in some cases – thrombocytopenia.

Endocrine system disorders: hypoglycemic states in patients with diabetes.

Respiratory system: in predisposed patients there may be symptoms of bronchial obstruction.

Allergic reactions: skin rash, itching.

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Overdose

Symptoms: pronounced sinus bradycardia, dizziness, AV-blockade (up to development of complete transverse blockade and cardiac arrest), marked BP decrease, fainting, arrhythmia/ventricular extrasystole, acute heart failure; cardiogenic shock, cardiac arrest, bronchospasm, loss of consciousness, coma, nausea, vomiting, cyanosis, hypoglycemia, seizures. The first signs of overdose occur 20 minutes to 2 hours after taking the drug.

Treatment: gastric lavage and administration of adsorptive drugs, symptomatic therapy: if BP significantly decreased – the patient should be in Trendelenburg position; in case of excessive BP decrease, bradycardia and heart failure – intravenous infusion of beta-adrenostimulants with 2-5 min intervals – until the desired effect is achieved, or intravenous injection of 0.5-2 mg of atropine sulfate. If there is no positive effect – dopamine, dobutamine or norepinephrine. A transvenous intracardiac pacemaker may be used as a follow-up. In bronchospasm, IV beta-adrenomimetics should be administered. Slow IV diazepam should be administered in case of seizures. Hemodialysis is ineffective.

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Similarities

Metocard, Metoprolol, Betaloc Zoc, Egilok, Metoprolol-Teva