En DE FR ES PL
Metoprolol - instructions for use, reviews, analogs and forms of release (tablets 25 mg, 50 mg and 100 mg) drugs for the treatment of heart rhythm disorders and pressure decrease in adults, children and pregnancy. Composition and interaction with alcohol

Metoprolol - instructions for use, reviews, analogs and forms of release (tablets 25 mg, 50 mg and 100 mg) drugs for the treatment of heart rhythm disorders and pressure decrease in adults, children and pregnancy. Composition and interaction with alcohol

In this article, you can read the instructions for using the drug Metoprolol. There are reviews of visitors to the site - consumers of this medication, as well as opinions of specialists in the use of Metoprolol in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Metoprolol in the presence of existing structural analogues.Use to treat heart rhythm disturbances and reduce blood pressure in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

 

Metoprolol - refers to cardioselective blockers of beta-adrenergic receptors, which do not possess internal sympathomimetic activity and membrane-stabilizing properties. Has antihypertensive, antianginal and antiarrhythmic action.

 

Blocking low-dose beta-adrenoreceptors of the heart, reduces catecholamine-stimulated cAMP formation from ATP, reduces intracellular calcium flow, has a negative chrono-, dromo-, batmo-, and inotropic effect (reduces the heart rate, inhibits conduction and excitability, reduces myocardial contractility) .

 

The total peripheral resistance at the beginning of beta-blockers (in the first 24 hours after oral administration) increases (as a result of the reciprocal increase in the activity of alpha-adrenergic receptors and elimination of beta-adrenergic receptor stimulation), which returns to the initial one after 1-3 days, appointment - is reduced.

 

An acute antihypertensive effect is due to a decrease in cardiac output, a stable antihypertensive effect develops within 2-3 weeks and is due to a decrease in renin synthesis, and plasma renin accumulation, inhibition of renin-angiotensin system activity (important in patients with initial hypersecretion of renin) and CNS restoration of sensitivity baroreceptors of the aortic arch (there is no increase in their activity in response to a decrease in blood pressure) and, as a result, a decrease in peripheral sympathetic Lying. Reduces elevated blood pressure at rest, with physical stress and stress.

 

The antianginal effect is determined by the reduction in myocardial oxygen demand as a result of a decrease in the heart rate (diastolic elongation and improvement of myocardial perfusion) and contractility, as well as a decrease in myocardial sensitivity to sympathetic innervation. Reduces the number and severity of angina attacks and increases the tolerance of exercise. BP decreases after 15 minutes, maximum - after 2 hours and lasts for 6 hours, diastolic blood pressure changes more slowly: a stable decrease is observed after several weeks of regular intake.

 

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers, and slowing AV conduction (mainly in the antegrade and, to a lesser extent, retrograde directions via the AV node) and by additional paths. With supraventricular tachycardia, atrial fibrillation, sinus tachycardia in functional heart diseases and hyperthyroidism, it decreases the heart rate, or even can lead to the restoration of sinus rhythm. Prevents the development of migraine.

 

When used at average therapeutic doses, in contrast to nonselective beta-blockers, it exerts a less pronounced effect on organs containing beta-adrenergic receptors (pancreas, skeletal muscles, smooth muscle of peripheral arteries, bronchi and uterus) and carbohydrate metabolism. When used in large doses (more than 100 mg per day) has a blocking effect on both subtypes of beta adrenoreceptors.

 

Composition

 

Metoprolol tartrate + excipients.

 

Pharmacokinetics

 

Metoprolol is absorbed rapidly and almost completely (95%) in the digestive tract. Bioavailability is 50% at the first intake and increases to 70% with repeated application. Food intake increases bioavailability by 20-40%. Bioavailability of metoprolol increases with cirrhosis of the liver. The connection with plasma proteins is on average 10%. The drug penetrates through blood-brain and placental barriers. Excreted in breast milk in small amounts. Metabolised in the liver. Metabolites do not have pharmacological activity. About 5% of the drug is excreted unchanged by the kidneys. Treatment of patients with reduced renal function does not require dose adjustment. Violation of the function of the liver slows the metabolism of the drug, and in cases of inadequate liver function, the dose of the drug should be reduced.

 

Indications

  • arterial hypertension (as a monotherapy or in combination with other antihypertensive agents), including hyperkinetic type, tachycardia;
  • ischemic heart disease: myocardial infarction (secondary prevention - complex therapy), prevention of angina attacks;
  • heart rhythm disturbances (supraventricular tachycardia, ventricular extrasystole);
  • hyperthyroidism (complex therapy);
  • prevention of migraine attacks.

 

Forms of release

 

Tablets 25 mg, 50 mg and 100 mg.

 

Instructions for use and dosage

 

Tablets are taken orally with food or immediately after meals, without chewing and washing with liquid.

 

Arterial hypertension. The initial daily dose is 50-100 mg in 1-2 doses (morning and evening). With insufficient therapeutic effect, the daily dose can be gradually increased to 100-200 mg and / or additional prescription of other antihypertensive agents. The maximum daily dose is 200 mg.

 

Angina pectoris, arrhythmias, prevention of migraine attacks - 100-200 mg per day in 2 divided doses (morning and evening).

 

Secondary prevention of myocardial infarction - 200 mg per day 2 admission (morning and evening).

 

Functional disorders of cardiac activity, accompanied by tachycardia - 100 mg per day in 2 divided doses (morning and evening).

 

In elderly patients, with violations of the kidneys, as well as the need for hemodialysis do not change the dose.

 

For violations of liver function, the dose of the drug should be reduced depending on the clinical condition.

 

Side effect

  • increased fatigue;
  • weakness;
  • headache;
  • slowing the speed of mental and motor reactions;
  • paresthesia in the extremities (in patients with intermittent claudication and Raynaud's syndrome);
  • depression;
  • anxiety;
  • decreased attention;
  • drowsiness;
  • insomnia;
  • nightmarish dreams;
  • confusion of consciousness;
  • short-term memory impairment;
  • muscle weakness;
  • decreased vision;
  • dryness and soreness of the eyes;
  • conjunctivitis;
  • noise in ears;
  • sinus bradycardia;
  • palpitation;
  • a decrease in blood pressure;
  • orthostatic hypotension;
  • dizziness;
  • decreased myocardial contractility;
  • temporary worsening of symptoms of chronic heart failure (swelling, swelling of the feet and / or lower leg, shortness of breath);
  • arrhythmias;
  • manifestation of angiospasm (increased peripheral circulatory disturbance, coldness of the lower limbs, Raynaud's syndrome);
  • nausea, vomiting;
  • abdominal pain
  • dry mouth;
  • diarrhea;
  • constipation;
  • change in taste;
  • hives;
  • itching;
  • rash;
  • exacerbation of psoriasis;
  • hyperemia of the skin;
  • increased sweating;
  • reversible alopecia;
  • nasal congestion;
  • dyspnea;
  • thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia;
  • intrauterine growth retardation;
  • pain in the back or joints;
  • a slight increase in body weight;
  • decreased libido and / or potency.

 

Contraindications

  • cardiogenic shock;
  • AV-blockade of 2-3 degrees;
  • sinoatrial (SA) block;
  • syndrome of weakness of the sinus node;
  • severe bradycardia;
  • heart failure in the stage of decompensation;
  • angina of Prinzmetal;
  • arterial hypotension (in case of use in secondary prevention of myocardial infarction - systolic blood pressure less than 100 mm Hg, heart rate less than 45 bpm);
  • simultaneous administration of MAO inhibitors or simultaneous iv injection of verapamil;
  • lactation period;
  • age under 18 years (effectiveness and safety not established);
  • increased sensitivity to metoprolol or other components of the drug, other beta-blockers.

 

Application in pregnancy and lactation

 

At pregnancy appoint or nominate under strict indications taking into account a parity or ratio favors / risk (in connection with development at a fetus of a bradycardia, an arterial hypotension, a hypoglycemia). At the same time, careful monitoring is carried out, especially for fetal development. Strict monitoring of newborns is necessary within 48-72 hours after delivery.

 

Influence of metoprolol on the newborn, with breastfeeding has not been studied, therefore, women taking metoprolol should stop breastfeeding.

 

Use in children

 

Contraindicated in children under the age of 18 years (efficacy and safety not established).

 

special instructions

 

Control of patients taking beta-blockers includes regular monitoring of heart rate and blood pressure, blood glucose in diabetic patients. If necessary, for patients with diabetes mellitus, a dose of insulin or hypoglycemic drugs prescribed inside, should be selected individually.

 

It is necessary to teach the patient how to calculate heart rate and instruct about the need for medical consultation at a heart rate of less than 50 beats per minute. When taking a dose above 200 mg per day, cardioselectivity decreases.

 

With heart failure, metoprolol treatment begins only after the compensation stage has been reached.

 

It is possible to increase the severity of reactions of hypersensitivity (against a background of a burdened allergic anamnesis) and the absence of the effect of the administration of usual doses of epinephrine (epinephrine).

 

It can intensify the symptoms of peripheral arterial circulation.Cancellation of the drug is carried out gradually, reducing the dose for 10 days.

 

With a sharp cessation of treatment, withdrawal can occur (increased angina attacks, increased blood pressure).

 

Particular attention should be paid to patients with angina when removing the drug. With angina pectoris, the selected dose of the drug should provide a heart rate at rest within 55-60 beats / min, with a load - no more than 110 beats / min.

 

Patients using contact lenses should take into account that, against the background of beta-blocker therapy, tear production can be reduced.

 

Metoprolol may mask certain clinical manifestations of hyperthyroidism (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, since it can strengthen symptoms.

 

In diabetes mellitus can mask tachycardia caused by hypoglycemia. In contrast to nonselective beta-blockers, there is almost no increase in insulin-induced glycemia and does not delay the restoration of blood glucose to normal levels.

 

If it is necessary to prescribe to patients with bronchial asthma, beta2-adrenostimulants are used as concomitant therapy; when pheochromocytoma - alpha-adrenoblockers.

 

If it is necessary to perform a surgical procedure, it is necessary to warn the anesthesiologist about the therapy (choice of a means for general anesthesia with minimal negative inotropic action), drug discontinuation is not recommended.

 

Drugs that reduce the reserves of catecholamines (for example, reserpine), can enhance the action of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision for the detection of excessive lowering of blood pressure and bradycardia. In elderly patients - it is recommended to regularly monitor liver function. Correction of the dosing regimen is required only in the case of an elderly patient with an increasing bradycardia (less than 50 beats per minute), a marked decrease in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe disorders liver function, sometimes it is necessary to stop treatment.

 

Patients with severe renal failure are advised to monitor kidney function.

 

It should be carried out special control over the condition of patients with depressive disorders,receiving metoprolol; In the case of development of depression caused by the use of beta-blockers, it is recommended to stop therapy.

 

Due to the lack of sufficient clinical data, the drug is not recommended for use in children.

 

Impact on the ability to drive vehicles and manage mechanisms

 

At the beginning of metoprolol treatment, patients may experience dizziness, fatigue. In this case, they should refrain from driving vehicles and practicing potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions. In the future, the definition of dose safety is carried out individually.

 

Drug Interactions

 

It is not recommended simultaneous use with MAO inhibitors due to a significant increase in antihypertensive effect. A break in treatment between taking MAO inhibitors and metoprolol should be at least 14 days.

 

Simultaneous intravenous administration of Verapamil may provoke cardiac arrest.

 

Simultaneous administration of Nifedipine leads to a significant reduction in blood pressure.

 

Means for inhalation anesthesia (derivatives of hydrocarbons) increase the risk of oppression of myocardial function and development of arterial hypotension.

 

Beta-adrenostimulators, theophylline, cocaine, estrogens (sodium retention), Indomethacin and other non-steroidal anti-inflammatory drugs (NSAIDs) (sodium retention and blockage of prostaglandin synthesis by the kidneys) weaken the hypotensive effect.

 

Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), sedative and hypnotic drugs increase the CNS depression.

 

Increased oppressive effect on the central nervous system - with ethanol (alcohol); the summation of the cardiodepressive effect - with anesthesia; increased risk of violations of peripheral circulation - with ergot alkaloids.

 

When combined with hypoglycemic agents for oral administration, a decrease in their effect is possible; with insulin - increased risk of hypoglycemia, increased its severity and lengthening, masking of some symptoms of hypoglycemia (tachycardia, sweating, increased blood pressure).

 

When combined with antihypertensive drugs, diuretics,nitroglycerin or blockers of slow calcium channels can lead to a sharp decrease in blood pressure) special caution is necessary when combined with prazosin); increased severity of heart rate reduction and AV conduction suppression - with metoprolol with verapamil, diltiazem, antiarrhythmics (amiodarone), reserpine, alpha-methyl dopa, clonidine, guanfacin, general anesthetic agents and cardiac glycosides.

 

If metoprolol and clonidine are taken concomitantly, when metoprolol is withdrawn, clonidine is withdrawn after a few days (due to the risk of withdrawal syndrome).

 

Inducers of microsomal liver enzymes (rifampicin, barbiturates) lead to increased metabolism of metoprolol, a decrease in the concentration of metoprolol in the blood plasma and a decrease in the effect.

 

Inhibitors (cimetidine, oral contraceptives, phenothiazines) increase the concentration of metoprolol in plasma.

 

Allergens used for immunotherapy or allergen extracts for skin tests when combined with metoprolol increase the risk of systemic allergic reactions or anaphylaxis; iodine-containing radiopaque substances for intravenous administration increase the risk of developing anaphylactic reactions.

 

Reduces the clearance of xanthine (except diphylline), especially with the initially elevated clearance of theophylline under the influence of smoking.

 

Reduces the clearance of lidocaine, increases the concentration of Lidocaine in the blood plasma.

 

Strengthens and prolongs the effect of antidepolarizing muscle relaxants; prolongs the anticoagulant effect of coumarins.

 

When combined with ethanol (alcohol), the risk of a marked decrease in blood pressure increases.

 

Analogues of the drug Metoprolol

 

Structural analogs for the active substance:

  • Betalk;
  • Vasocardine;
  • Corvitol;
  • Metodok;
  • Metocard;
  • Metocor Adipharm;
  • Methanol;
  • Metoprolol Organica;
  • Metoprolol OBL;
  • Metoprolol Acry;
  • Metoprolol ratiopharm;
  • Metoprolol succinate;
  • Metoprolol tartrate;
  • Egilok;
  • Egilok Retard;
  • Egilok S;
  • Emzok.

Similar medicines:

Other medicines:

Reviews (7):
Guests
Anna Balashova
Good replacement for expensive and imported drugs. I took bisoprolol, betalk, but now they are expensive. Atenolol did not go to me, but metoprolol well reduced my tachyarrhythmia and kept the pulse under control. So it's cheap, and effective.
Guests
Natalia Natalia
I'm a middle-aged man, two years ago I lost my arrhythmia. What kind of medicine I did not take, helped only for a very small time. The hospital lay several times with bouts of memory loss. The doctors were different, some helped for a while, and one therapist came on the night on duty did not even ask what metoprolol was giving me in the morning, and when I was ill she put a dropper with verapamil and everyone left the room. I felt so sick before my heart stopped working. I insisted on removing the dropper. She did not even know that metoprolol should not be taken with verapamil. The doctor referred to the fact that I was emotional, the entire floor was lying with arrhythmia and that they, too, were all emotional. At night, there were attacks, who worried me all were asleep. I am now lying down drinking metoprolol, which I was prescribed, the heart pops out of the chest rhythm 110, and sometimes up to 160 and sleep pulls, do not want to eat anything, the mouth dries.
Guests
love
love, transferred your feedback to the drug Betaloc, where it is more appropriate.
admin
Visitors
Nikodim
Good afternoon. I have an incomplete blockade of my right leg and a tachycardia. Is metoprolol safe? Appointed by a cardiologist. Thank you.
Administrators
admin
Nikodim, For the treatment of tachycardia, as I can imagine, this drug is prescribed. Contraindications for the appointment of metoprolol, among others, are AV block 2 and 3 degrees and sinoatrial blockade. Probably, your doctor estimated the level of the blockade and allowed the taking of this medicine, but it should be taken carefully, assessing the state of the heart and its rhythm.
Guests
Balda
Metoprolol was prescribed 25 mg 2 times a day under the control of heart rate. This is how to control heart rate? Arterial pressure 93-79, with pulse 95 (71 or 78) is accompanied by atrial fibrillation and still take this medicine? What to do?
Administrators
admin
Balda, Under the control of heart rate - this means to measure the pulse and not to allow its decrease against the background of metoprolol intake less than 60 beats per minute.You can use modern gadgets or bracelets that periodically measure the pulse, or use tonometers with heart rate control functions (the latter can also show arrhythmia during measurement).

Rules for publishing reviews and visitor questions