Fapresor Warnings

Myocardial Infarction: Cardiac failure: Sympathetic stimulation is a vital component supporting circulatory function, and beta blockade carries the potential hazard of depressing myocardial contractility and precipitating or exacerbating minimal cardiac failure.
During treatment with Metoprolol tartrate, the hemodynamic status of the patient should be carefully monitored. If heart failure occurs or persists despite appropriate treatment, Metoprolol tartrate should be discontinued.
Bradycardia: Metoprolol tartrate produces a decrease in sinus heart rate in most patients; this decrease is greatest among patients with high initial heart and least among patients with low initial heart rates. Acute myocardial infarction (particularly inferior infarction) may in itself produce significant lowering of the sinus rate. If the sinus rate decreases to <40 beats/min, particularly if associated with evidence of lowered cardiac output, atropine (0.25-0.5 mg) should be administered intravenously. If treatment with atropine is not successful, Metoprolol tartrate should be discontinued and cautious administration of isoproterenol or installation of a cardiac pacemaker should be considered.
AV Block: Metoprolol tartrate slows AV conduction and may produce significant first- (P-R interval ≥0.26 sec), second-, or third degree heart block. Acute myocardial infarction also produces heart block.
If heart block occurs, Metoprolol tartrate should be discontinued and atropine (0.25 to 0.5 mg) should be administered intravenously. If treatment with atropine is not successful, cautious administration of isoproterenol or installation of a cardiac pacemaker should be considered.
Hypotension: If hypotension (systolic blood pressure ≤90 mmHg) occurs, Metoprolol tartrate should be discontinued, and the hemodynamic status of the patient and the extent of myocardial damage carefully assessed. Invasive monitoring of central venous, pulmonary capillary wedge and arterial pressures may be required. Appropriate therapy with fluids, positive inotropic agents, balloon counterpulsation, or other treatment modalities should be instituted. If hypotension is associated with sinus bradycardia or AV block, treatment should be directed at reversing these (see previously mentioned).
Bronchospastic Diseases: Patients with bronchospastic diseases should, in general, not receive beta blockers. Because of its relative beta, selectivity, Metoprolol tartrate may be used with extreme caution in patients with bronchospastic disease. Because it is unknown to what extent beta₂-stimulating agents may exacerbate myocardial ischemia and the extent of infarction, these agents should not be used prophylactically. If bronchospasm not related to congestive heart failure occurs, Metoprolol tartrate should be discontinued. A theophylline derivatives or a beta₂ agonist may be administered cautiously, depending on the clinical condition of the patient. Both theophylline derivatives and beta₂ agonists may produce serious cardiac arrhythmias.