Dangerous Drug: Metoprolol(me toe’ proe lole)
Metoprolol
Apo-Metoprolol SR (CAN)DNC, Gen-Metoprolol (CAN), Lopressor, Novo-Metoprol (CAN), Nu-Metop (CAN)
Metoprolol Succinate
Toprol-XLDNC
Metoprolol Tartrate
Apo-Metoprolol (CAN), Lopressor Injection, PMS-Metoprolol-L (CAN)
PREGNANCY CATEGORY C
Drug Classes
Antihypertensive
Beta1-selective adrenergic blocker
Therapeutic Actions
Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.
Indications
Hypertension, alone or with other drugs, especially diuretics
Immediate-release tablets and injection: Prevention of reinfarction in MI patients who are hemodynamically stable or within 3–10 days of the acute MI
Long-term treatment of angina pectoris
ER forms only: Treatment of stable, symptomatic heart failure of ischemic, hypertensive, or cardiomyopathic origin
Unlabeled uses: Adult migraine, pediatric hypertension
Contraindications and Cautions
Contraindicated with sinus bradycardia (HR less than 45 beats/min), second- or third-degree heart block (PR interval more than 0.24 sec), cardiogenic shock, HF, second and third trimesters of pregnancy.
Use cautiously with diabetes or thyrotoxicosis; asthma or COPD; history of seizures, history of anaphylaxis, hepatic impairment, myasthenia gravis, pregnancy.
Available Forms
Tablets—25, 50, 100 mg; ER tabletsDNC—25, 50, 100, 200 mg; injection—1 mg/mL
Dosages
Adults
Hypertension: Initially, 100 mg/day PO in single or divided doses; gradually increase dosage at weekly intervals. Usual maintenance dose is 100–450 mg/day.
Angina pectoris: Initially, 100 mg/day PO in two divided doses; may be increased gradually, effective range, 100–400 mg/day.
MI, early treatment: Three IV bolus doses of 5 mg each at 2-min intervals with careful monitoring. If these are tolerated, give 50 mg PO 15 min after the last IV dose and every 6 hr for 48 hr. Thereafter, give a maintenance dose of 100 mg PO bid. Reduce initial PO doses to 25 mg, or discontinue in patients who do not tolerate the IV doses.
MI, late treatment: 100 mg PO bid as soon as possible after infarct, continuing for at least 3 mo and possibly for 1–3 yr.
ER tablets
Hypertension: 25–100 mg/day PO as one dose; may increase at weekly intervals to a maximum of 400 mg/day.
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