Metoprolol Warnings
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Metoprolol Warnings
Hypertension and Angina
Cardiac Failure:
Sympathetic stimulation is a vital component supporting circulatory function in congestive heart failure, and beta blockade through Metoprolol carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure. In hypertension and angina patients who have congestive heart failure controlled by digitalis and diuretics, Metoprolol (metoprolol tartrate) should be administered cautiously. Both digitalis and metoprolol tartrate AV conduction.
Ischemic Heart Disease:
Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered Metoprolol (metoprolol tartrate), particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 to 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, Metoprolol (metoprolol tartrate) administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician's advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue Metoprolol (metoprolol tartrate) therapy abruptly even in patients treated only for hypertension.
Bronchospastic Diseases:
PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS SUCH AS Metoprolol. Because of its relative beta1 selectivity, however, Metoprolol (metoprolol tartrate) may be used with caution in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Since beta1 selectivity is not absolute, a beta2-stimulating agent should be administered concomitantly, and the lowest possible dose of metoprolol tartrate should be used. In these circumstances it would be prudent initially to administer Metoprolol (metoprolol tartrate) in smaller doses 3 times daily, instead of larger doses 2 times daily, to avoid the higher plasma levels associated with the longer dosing interval.
Myocardial Infarction
Cardiac Failure:
Sympathetic stimulation is a vital component supporting circulatory function, and beta blockade through Metoprolol carries the potential hazard of depressing myocardial contractility and precipitating or exacerbating minimal cardiac failure.
During treatment with Metoprolol (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 (metoprolol tartrate) produces a decrease in sinus heart rate in most patients; this decrease is greatest among patients with high initial heart rates 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 (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 (metoprolol tartrate) should be discontinued and atropine (0.25-0.5 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 (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.
Bronchospastic Disease: PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS.
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