Index of drugs

Angina pectoris. Hypertension. Functional circulatory disorders of the type of hyperkinetic circulation. Tachyarrhythmias.

1 tabl contains 50 mg of metoprolol.

A selective β-blocker whose affinity for β receptors₁ it is larger than for β receptors₂. It has no stabilizing effect on the cell membrane and intrinsic sympathomimetic activity. Metoprolol limits or inhibits the stimulatory effects of catecholamines on the heart. It reduces the tachycardia induced catecholamine burst, increased minute capacity and cardiac contractility and lowers blood pressure. After oral administration, the drug is well absorbed. The bioavailability of a single dose is about 50%, while multiple dosing increases to about 70%. The presence of food increases the bioavailability of the drug. It is metabolised in the liver, mainly by the CYP2D6 isoenzyme. T_0,5 it is on average 3.5 hours. About 5% of the administered dose is excreted in the urine in unchanged form. The remainder of the dose is excreted as metabolites.

Hypersensitivity to metoprolol, other β-blockers with similar structure or to any of the excipients. Severe asthma or severe bronchospastic conditions in an interview. Atrio-ventricular block IIst. or III. .. Cardiogenic shock. Clinically significant sinus bradycardia. Uncompensated heart failure. Severe atherosclerosis of peripheral arteries. Hypotension. Metabolic acidosis. Untreated phaeochromocytoma. Sick node syndrome. Myocardial infarction with significant bradycardia, atrioventricular block Ist, systolic hypotension (<100 mmHg) and / or severe myocardial insufficiency.

The preparation should be used in patients with obstructive pulmonary disease only when it is absolutely necessary and if necessary, start additionally with₂-mimetic or adjust the dose of drugs used to treat obstructive pulmonary disease. Avoid use in patients with an increased risk of anaphylaxis. Metoprolol may increase bradycardia and symptoms of peripheral circulation disorders. If the patient develops severe bradycardia, reduce the dose or gradually discontinue it. In patients with a limited cardiac reserve and / or a history of heart failure, consideration should be given to the need for additional treatment, e.g. diuretics and / or cardiac glycosides. Caution in patients with atrioventricular block Ist (metoprolol inhibits atrioventricular conduction), with diabetes (metoprolol may mask some symptoms of hypoglycaemia, it may be necessary to adjust the doses of antidiabetic agents), with hyperthyroidism or suspected condition (metoprolol may mask some symptoms of thyrotoxicosis, heart and thyroid function should be monitored). Patients with a pheochromocytoma should be treated with an alpha blocker. In patients taking beta-blockers, adrenaline may result in increased blood pressure and bradycardia. Before the surgery, the anesthetist should be informed that the patient is taking the medicine. The decision to continue treatment should be made individually. Continuing treatment reduces the risk of arrhythmia during induction for anesthesia and intubation, however it may increase the risk of hypotension. Patients who are taking β-blockers should be given anesthetics that exert as little asotropic-negative effect (halothane / nitrous oxide). To protect the patient against the effects of vagal nerve stimulation, atropine can be given intravenously. When deciding to discontinue metoprolol, the treatment should be discontinued at least 24 hours before anesthesia. Exercise caution in patients with Prinzmetal angina due to the possibility of increasing the number and prolongation of angina pectoris.In patients with a history of psoriasis, metoprolol should only be used after careful consideration of the benefits and risks of treatment. During the treatment, the patient should be observed for signs of adverse effects on the eyes, if symptoms occur, discontinuation of the drug should be considered. In patients with severely reduced liver function, lower doses may be required.

It must not be used during pregnancy and during breastfeeding unless clearly necessary. β-blockers can cause bradycardia, hypoglycaemia in the fetus and newborn. If it is necessary to take the drug, take the lowest possible dose and leave metoprolol at least 2-3 days before delivery to avoid excessive uterine contractility and adverse reactions in the newborn.

Common: dizziness or headache; bradycardia; fatigue; effort dyspnoea; orthostatic hypotension (sometimes with syncope); nausea and vomiting, abdominal pain. Rarely: depression, decreased consciousness of mind, drowsiness or insomnia, nightmares; paresthesia, muscle cramps; heart failure, arrhythmias, palpitations; edema, Raynaud's phenomenon; bronchial spasm; diarrhea or constipation; skin rash (in the form of urticaria, psoriatic and dystrophic skin lesions). Very rare: thrombocytopenia; weight gain; personality disorders, hallucinations; visual impairment, dryness and / or eye irritation; ringing in the ears, hearing loss; conduction disorders in the heart; gangrene in patients with pre-existing severe peripheral circulation abnormalities; rhinitis; feeling dry in the mouth; hypersensitivity to light, hair loss, worsening of psoriasis; arthritis; libido and potency disorders; pain in the precordium, excessive sweating; abnormal liver function tests. In addition: hepatitis; retroperitoneal fibrosis; Peyronie's disease. Side effects get worse under the influence of alcohol.

Orally.Angina pectoris: on the average 50 mg 2-3 times a day, if necessary, the dose should be increased.Hypertension: usually 100-150 mg per day. The daily dose can be taken once, in the morning. Sometimes a dose of 50-100 mg per day is sufficient.Symptoms of hyperkinetic circulation: usually 50 mg 1-2 times a day.tachyarrhythmia: 50 mg 2-3 times a day. If necessary, the dose can be increased to 200-300 mg per day. Sudden discontinuation of the preparation should be avoided, especially in patients with ischemic heart disease. The preparation should be discontinued for approximately 10 days. A dose of 25 mg should be used within the last 6 days.