Pharmacological action Metoprolol 25 mg
Cardioselective beta1-blocker without intrinsic sympathomimetic activity. Has antihypertensive, antianginal and antiarrhythmic action. Decreases automaticity of sinus node, reducing heart rate, slows AV conduction, decreases myocardial contractility and excitability, reduces cardiac output, reduces myocardial oxygen demand. Inhibits the stimulatory effect of catecholamines on the heart during physical and psycho-emotional stress.
Causes a hypotensive effect, which is stabilized by the end of the 2 nd week of a course. When angina Metoprolol reduced the incidence and severity of attacks. It normalizes the heart rate during supraventricular tachycardia and atrial fibrillation. Myocardial infarction contributes to limit the zone of ischemia of the heart muscle and reduces the risk of developing fatal arrhythmias, reduces the risk of recurrence of myocardial infarction. When used in the medium therapeutic doses has a less pronounced effect on smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers.
Statement Metoprolol 25 mg
Hypertension, prevention of angina, cardiac arrhythmias (supraventricular tachycardia, extrasystoles), Secondary prevention after myocardial infarction, cardiac hyperkinetic syndrome (including in hyperthyroidism, NDCs). Prophylaxis of migraine.
Dosing regimen Metoprolol 25 mg
At intake the average dose is 100 mg / day in 1-2 reception. If necessary, the daily dose gradually increased to 200 mg. With / in the introduction a single dose – 2.5 mg, with no effect re-introduction of possible in 5 minutes.
Maximum dose: ingestion dose – 400 mg, at iv administration a single dose – 15-20 mg.
Side effect Metoprolol 25 mg
With the cardiovascular system: possible bradycardia, hypotension, AV conduction disorders, symptoms of heart failure.
From the digestive system: at the beginning of therapy may include dry mouth, nausea, vomiting, diarrhea, constipation, and in some cases – liver function abnormalities.
CNS and peripheral nervous system: at the beginning of therapy may be weakness, fatigue, dizziness, headache, muscle cramps, coldness and paresthesia in the limbs, may decrease the secretion of tear fluid, conjunctivitis, rhinitis, depression, sleep disturbances, nightmares.
From the hemopoietic system: in some cases – thrombocytopenia.
From the endocrine system: hypoglycemic state in patients with diabetes.
With the respiratory system: in predisposed patients may cause symptoms of bronchial obstruction.
Allergic reactions: skin rash, itching.
Contraindications Metoprolol 25 mg
AV block II and III degree sinoatrial block, bradycardia (heart rate below 50 beats / min), SSS, hypotension, congestive heart failure II B-III stage congestive heart failure, cardiogenic shock, metabolic acidosis, marked disturbances of peripheral circulation, increased sensitivity to Metoprolol.
Pregnancy and lactation Metoprolol 25 mg
Application of pregnancy is only possible if the intended benefits to the mother outweighs the potential risk to the fetus. Metoprolol crosses the placenta. In connection with the possible development of a newborn bradycardia, hypotension, hypoglycemia, and respiratory failure Metoprolol should be abolished for 48-72 hours before the scheduled date of delivery. After delivery to ensure strict monitoring of the newborn within 48-72 hours
Metoprolol in small amounts excreted in breast milk. Use during lactation is not recommended.
Cautions
With careful use in patients with chronic obstructive airways disease, diabetes (especially labile stream), Raynaud’s disease and obliterative peripheral arterial disease, pheochromocytoma (to be used in combination with alpha-blockers), severe renal impairment and liver.
The treatment Metoprolol may reduce production lacrimal fluid, which is important for patients who use contact lenses.
Completion of a long course of treatment Metoprolol should be gradual (at least 10 days) under the supervision of a physician.
Not recommended for concurrent use of Metoprolol with MAO inhibitors.
Combined therapy with clonidine should receive the last stop in a few days after discontinuation of Metoprolol, in order to avoid a hypertensive crisis. In an application with hypoglycemic agents require correction of their dosing regimen.
A few days before the anesthesia is necessary to stop taking Metoprolol or find a means of anesthesia with minimal negative inotropic effects.
Effects on ability to drive vehicles and management mechanisms
Patients whose work requires more attention, the application of ambulatory Metoprolol should be addressed only after the evaluation of individual patient response.
Drug Interactions Metoprolol 25 mg
With the simultaneous application of Metoprolol and verapamil a reduction in minute and stroke volume, heart rate. At iv administration of verapamil in patients receiving Metoprolol there is a threat of cardiac arrest.
With the simultaneous application of Metoprolol with calcium channel blockers, cardiac glycosides, reserpine, nitrates, clonidine increases the risk of hypotension, bradycardia, AV block. Metoprolol increases the effects of hypoglycemic agents. Indomethacin and other NSAIDs, as well as estrogen reduces the hypotensive effect of Metoprolol.
Introduction of tools for inhalation anesthesia during treatment with Metoprolol increases the risk of depression of the myocardium and the development of arterial hypotension.
Rifampicin reduces the concentration of Metoprolol in the blood. Metoprolol level in blood plasma increased, while taking hydralazine, oral contraceptives, ranitidine, cimetidine.
