Cardiosel

HTN as monotherapy or in combination w/ other antihypertensives. Long-term prophylaxis of angina pectoris. Disturbances of cardiac rhythm including supraventricular & ventricular arrhythmia. Hemodynamically stable patients w/ definite or suspected acute MI to reduce CV mortality. Adjunct to treatment of thyrotoxicosis. Prevention of migraine.

Adult HTN Initially 50-100 mg daily in single or 2 divided doses. May be increased at wkly (or longer) intervals until optimum BP reduction is achieved. Effective dose range: 100-450 mg daily in divided doses. Angina pectoris Initially 100 mg daily in 2 divided doses. May be increased at wkly intervals until optimum control of angina is obtained or there is pronounced slowing of heart rate. Effective dose range: 100-400 mg daily in divided doses. Cardiac arrhythmias 100-150 mg daily in 2-3 divided doses, may be increased up to 300 mg daily in divided doses. MI: Early treatment Patient who can tolerate full IV dose 50 mg every 6 hr for 48 hr to be given 15 min after the last IV dose, then 100 mg bid as maintenance dose. Patient who cannot tolerate full IV dose 25 or 50 mg every 6 hr to be given 15 min after the last IV dose. Late treatment 100 mg bid for at least 3 mth. Adjunct to treatment of thyrotoxicosis 150-200 mg (may be increased up to 400 mg) daily in 3 or 4 divided doses. Prevention of migraine 100 mg daily as a single dose in the morning. May be increased to 200 mg daily in 2 divided doses if necessary.

Should be taken with food: Take immediately after meals.

Hypersensitivity metoprolol or to other β-blockers. Severe bronchial asthma or history of severe bronchospasm; hypotension; metabolic acidosis. Hypertensive & angina patients w/ sinus bradycardia, heart block >1st degree, cardiogenic shock, overt or decompensated cardiac failure, sick sinus syndrome, severe peripheral arterial circulatory disorders, untreated pheochromocytoma. Patient w/ acute MI w/ heart rate <45 bpm, 2nd- & 3rd-degree heart block, significant 1st degree heart block, systolic BP <100 mmHg, moderate to severe cardiac failure.

Hypertensive & angina patients who have CHF controlled by digitalis & diuretics. MI; bradycardia. Discontinue use if heart failure occurs or persists despite appropriate treatment; hypotension (systolic BP ≤90 mmHg) occurs. Patients w/ bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Avoid abrupt discontinuation. Gradually reduce dosage over a period of 1-2 wk & carefully monitor the patient when discontinuing chronically administered metoprolol, particularly in patients w/ ischemic heart disease. Patients w/ history of cardiac failure; DM receiving insulin or oral hypoglycemic agents; suspected or known to have pheochromocytoma; suspected development of thyrotoxicosis; history of severe anaphylactic reaction to allergens. W/draw β-blockers prior to major surgery. Impaired hepatic failure. Observe for potential ocular effects. Avoid operating machinery or engaging in other tasks requiring alertness. Pregnancy & lactation. Childn.

Arterial insufficiency (eg, Raynaud's phenomenon), bradycardia, cold extremities, cardiac arrhythmias, cardiac conduction disorders, chest pain, claudication, CHF, decreased HDL, edema, 1st-degree heart block, hypotension, increased triglycerides, orthostatic hypotension occasionally w/ syncope, palpitations, peripheral edema, precordial pain, 2nd- or 3rd-degree heart block; decreased libido, hypoglycemia, unstable diabetes, wt gain; increased alkaline phosphatase, transaminases, LDH, BUN, serum creatinine, uric acid; abdominal pain, constipation, diarrhea, digestive tract disorders, dry mouth, flatulence, gastric pain, heartburn, hiccups, nausea, retroperitoneal fibrosis, vomiting, xerostomia; arthritis, general weakness, muscle cramps, musculoskeletal pain, polymyalgia-like syndrome, restless legs; confusion, decreased alertness; depression, dizziness, full-headedness, hallucination, headache, impotence, increased dreaming, insomnia, lethargy, mental confusion, nervousness, nightmares, paresthesia, personality disorder, short-term memory loss, sleep disturbances, somnolence, tiredness, vertigo; bronchospasm, dyspnea, rhinitis, shortness of breath, wheezing; alopecia, dry skin, hyperhidrosis, pruritus, rash, sweating; blurred vision, dry eyes, eye irritation, hearing disorders, tinnitus, visual disturbances; Peyronie's disease, agranulocytosis, fatigue, increased or decreased antinuclear factor (ANF) levels, lassitude, thrombocytopenia.

Additive effect w/ catecholamine-depleting drugs (eg, reserpine). Potentiated depressant effects w/ Ca channel blockers (eg, verapamil, diltiazem), & effects on heart rate & AV conduction w/ amiodarone, propafenone & other class I antiarrhythmic drugs (eg, quinidine, disopyramide). W/draw several days before clonidine use. Increased plasma conc w/ potent inhibitors of CYP2D6 antidepressants (eg, fluoxetine, paroxetine, bupropion), antipsychotics (eg, thioridazine), antiarrhythmics (eg, quinidine, propafenone), antiretrovirals (eg, ritonavir), antihistamines (eg, diphenhydramine), antimalarials (eg, hydroxychloroquine, quinidine), antifungals (eg, terbinafine) & medications for stomach ulcers (eg, cimetidine). May result in excessive bradycardia &/or increased AV conduction time w/ digitalis glycosides. Enhanced cardiodepressant effect w/ general anesth. Reduced plasma conc w/ hepatic enzyme inducers (eg, rifampicin). Increased or prolonged hypoglycemia w/ insulin. May antagonize hypoglycemic effects of sulfonylureas. May reduce clearance of lidocaine. Enhanced hypotensive effect w/ nitroglycerin. Decreased antihypertensive effect w/ NSAIDs (eg, indomethacin). May increase acute postural hypotension following the 1st dose of prazosin. May antagonize the β₁ effects of sympathomimetic agents. Blood alcohol conc may reach higher levels & may decrease more slowly during concomitant ingestion of alcohol. Additive effects w/ other antihypertensive drugs. May affect peripheral circulation w/ drug w/ similar activity eg, ergotamine. Concurrent use w/ sympathetic ganglion blocking agents, other β-blockers (including eye drops) or MAOIs.

Beta-Blockers

C07AB02 - metoprolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.

Rx