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Metoprolol Review Article

 

Metoprolol works by blocking the action of the sympathetic nervous system, which is a portion of the involuntary nervous system, by blocking beta receptors on sympathetic nerves and reducing the heart rate. Metoprolol is useful in treating abnormally rapid heart rhythms because the sympathetic nervous system is responsible for increasing the heart beat rate. Also, it reduces the force of contraction of heart muscle and lowers blood pressure. By reducing this, Metoprolol also reduces the need for oxygen by heart muscle and is helpful in treating heart pain, called angina pectoris, which occurs when oxygen demand of the heart muscle exceeds the supply.

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Why is this drug prescribed?
Metoprolol, a type of medication known as a beta blocker, is used in the treatment of high blood pressure, angina pectoris (chest pain, usually caused by lack of oxygen to the heart due to clogged arteries), and heart attack. When prescribed for high blood pressure, it is effective when used alone or in combination with other high blood pressure medications. Beta blockers decrease the force and rate of heart contractions, thereby reducing the demand for oxygen and lowering blood pressure. Occasionally doctors prescribe Lopressor for the treatment of aggressive behavior, prevention of migraine headache, and relief of temporary anxiety.
An extended-release form of this drug, is prescribed for high blood pressure, angina, and heart failure.

Most important fact about this drug:
If you have high blood pressure, you must take Metoprolol regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of Metoprolol; and you must continue taking it even if you are feeling well. Lopressor does not cure high blood pressure; it merely keeps it under control.

How should you take this medication?
Metoprolol should be taken with food or immediately after you have eaten. Take the drug exactly as prescribed, even if your symptoms have disappeared. Try not to miss any doses. If this medication is not taken regularly, your condition may worsen.
• If you miss a dose...
If it is within 4 hours of your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.
• Storage instructions...
Store Metoprolol at room temperature in a tightly closed container, away from light. Protect from moisture.

What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Metoprolol.
• More common side effects may include:
Depression, diarrhea, dizziness, itching, rash, shortness of breath, slow heartbeat, tiredness
• Less common or rare side effects may include:
Blurred vision, cold hands and feet, confusion, congestive heart failure, constipation, difficult or labored breathing, dry eyes, dry mouth, gas, hair loss, headache, heart attack, heartburn, low blood pressure, muscle pain, nausea, nightmares, rapid heartbeat, ringing in the ears, short-term memory loss, stomach pain, swelling due to fluid retention, trouble sleeping, wheezing, worsening of heart irregularities

Why should this drug not be prescribed?
If you have a slow heartbeat, certain heart irregularities, low blood pressure, inadequate output from the heart, or heart failure, you should not take this medication.

Special warnings about this medication:
If you have a history of congestive heart failure, Metoprolol should be used with caution. If you are taking the extended release form of this drug, to relieve heart failure, the condition may temporarily be worsened as your dosage is increased. Be sure to alert your doctor to any signs of worsening heart failure such as weight gain or increasing shortness of breath.
• Do not stop Metoprolol abruptly. This can cause increased chest pain and heart attack. Dosage should be gradually reduced.
If you suffer from asthma, seasonal allergies or other bronchial conditions, or liver disease, this medication should be used with caution.
• Ask your doctor if you should check your pulse while taking Metoprolol. This medication can cause your heartbeat to become too slow.
• This medication may mask some symptoms of low blood sugar in diabetics or alter blood sugar levels. If you are diabetic, discuss this with your doctor.
• Metoprolol may cause you to become drowsy or less alert; therefore, driving or operating dangerous machinery or participating in any hazardous activity that requires full mental alertness is not recommended until you know how you respond to this medication.
• Notify your doctor or dentist that you are taking Metoprolol if you have a medical emergency, or before you have surgery or dental treatment.
Notify your doctor if you have any difficulty in breathing.

Possible food and drug interactions when taking this medication:
If Metoprolol is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Metoprolol with certain high blood pressure drugs such as reserpine (Ser-Ap-Es). Other medications that might interact with Metoprolol include:
Albuterol (Proventil, Ventolin)
Amiodarone (Cordarone)
Barbiturates such as phenobarbital
Calcium channel blockers such as Calan and Cardizem
Cimetidine (Tagamet)
Ciprofloxacin (Cipro)
Clonidine (Catapres)
Epinephrine (EpiPen)
Fluoxetine (Prozac)
Hydralazine (Apresoline)
Insulin
Nonsteroidal anti-inflammatory drugs such as Motrin and Indocin
Oral diabetes drugs such as Glucotrol and Micronase
Paroxetine (Paxil)
Prazosin (Minipress)
Propafenone (Rythmol)
Quinidine (Quinaglute)
Ranitidine (Zantac)
Rifampin (Rifadin)

Special information if you are pregnant or breastfeeding:
The effects of Metoprolol during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Metoprolol appears in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with this medication is finished.

Recommended dosage
ADULTS:
Dosages of Metoprolol should be individualized by your doctor. It should be taken with or immediately following meals.
High Blood Pressure. The initial dosage of Metoprolol extended release tablets ranges from 50 to 100 milligrams once a day. Your doctor may gradually increase the dosage up to 400 milligrams a day. Generally, the effectiveness of each dosage increase will be seen within a week.
Angina Pectoris
The usual starting dosage is a total of 100 milligrams a day taken in single dose of Metoprolol extended release tablet. Your doctor may gradually increase the dosage up to 400 milligrams a day.
Generally, the effectiveness of each dosage increase will be seen within a week. If treatment is to be discontinued, your doctor will withdraw the drug gradually over a period of 1 to 2 weeks.
Heart Attack
Metoprolol can be used for treatment of heart attack both in the hospital during the early phases and after the individual's condition has stabilized. Your doctor will determine the dosage according to your needs.
Heart Failure
The recommended starting dose of Metoprolol is 25 milligrams once daily for 2 weeks (12.5 milligrams in severe cases). Your doctor will double the dose every 2 weeks up to the highest level that works without side effects. The maximum recommended dose is 200 milligrams daily.

CHILDREN:
The safety and effectiveness of Metoprolol have not been established in children.

Overdosage
Any medication taken in excess can cause symptoms of overdose. If you suspect an overdose, seek medical attention immediately.
• The symptoms of Metoprolol overdose may include:
Asthma-like symptoms, coma, heart failure, irregular heartbeat, low blood pressure, nausea and vomiting, shock, slow heartbeat, stopped heart



Metoprolol notes:

The medication Metoprolol, otherwise known as beta blocker is used widely for treating angina pectoris i.e. nothing but the chest pain due to choked arteries, blood pressure and heart attack. It generally lowers the rate of heart contraction hence reducing oxygen demand and blood pressure. Cold hands and feet, confusion, hairloss, short-term hair loss etc are the rare side effects and headache, dizziness, tiredness, itching etc are the more common side effects during this drug treatment.

The dose for adults can be 20-1000 mgs per day and can be increased later and it’s still not given to children for safety purpose. Metoprolol succinate is used for the treatment of angina. And it is given as 50 mg each in a packet of 100 tablets each. Metoplorol ER is a medicine which is made up of this, should not be used if you have an allergic tendency towards metoprolol. This medicine should be taken just after you have your food or when you have eaten something.

Metoprolol dose is taken only after doctor’s consideration. Metaprolol side effects are very mild as well as less common that includes are confusion, blurred vision, congestive heart fail, constipation, dry mouth, hair loss, gas, headache, muscle pain, cold feet and hand, labored or difficult breathing, heart burn, dry eyes, nausea, rapid heart beat, and short-term memory loss. Metoprolol effects are less as compared to other drugs.

This medicine should be taken after a physician’s permission only if in case you have history of any congestive heart-failure. Once you have started the intake of metaprolo then do not debarred taking the medicine abruptly, otherwise it may cause bad effects on your health. In case of overdose of this medication, it is advisable to seek for some medical attention. When you are on metoprolo medication then keep on checking your pulse rate.


 

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