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GENERIC NAME: metoprolol

DRUG CLASS AND MECHANISM
Metoprolol is a beta-adrenergic blocking agent that is used for treating high blood pressure, heart pain, abnormal rhythms of the heart, and some neurologic conditions. Examples of beta-adrenergic blockers include propanolol (Inderal), atenolol (Tenormin), and timolol (Blocadren). Metoprolol blocks the action of the sympathetic nervous system, a portion of the involuntary nervous system, by blocking beta receptors on sympathetic nerves. Since the sympathetic nervous system is responsible for increasing the rate with which the heart beats, by blocking the action of these nerves metoprolol reduces the heart rate and is useful in treating abnormally rapid heart rhythms.

Metoprolol also reduces the force of contraction of heart muscle and thereby lowers blood pressure. By reducing the heart rate and the force of muscle contraction, metoprolol reduces the need for oxygen by heart muscle. Since heart pain (angina pectoris) occurs when oxygen demand of the heart muscle exceeds the supply of oxygen, metoprolol, by reducing the demand for oxygen, is helpful in treating heart pain. The FDA approved metoprolol in August 1978.

PRESCRIPTION: Yes

GENERIC AVAILABLE: Yes

PREPARATIONS
Tablets: 25, 50, and 100 mg. Tablets (extended release): 25, 50, 100, and 200 mg. Injection: 1 mg/ml

PRESCRIBED FOR
Metoprolol is prescribed for patients with high blood pressure (hypertension). It is also used to treat chest pain (angina pectoris) related to coronary artery disease. Metoprolol is also useful in slowing and regulating certain types of abnormally rapid heart rates (tachycardias). Other uses for metoprolol include the prevention of migraine headache and the treatment of certain types of tremors (familial or hereditary essential tremors).

DOSING
Metoprolol should be taken before meals or at bedtime. The dose for treating hypertension is 100-450 mg daily in single or divided doses. Angina is treated with 100-400 mg daily in two divided doses. Acute myocardial infarction is treated with three 5 mg injections administered 2 minutes apart followed by treatment with 50 mg oral metoprolol every 6 hours for 48 hours. After 48 hours, patients should receive 100 mg orally twice daily for at least 3 months.

DRUG INTERACTIONS
This drug should not be used with the following medications because very serious interactions may occur: mibefradil, psychiatric drugs (phenothiazines such as chlorpromazine, thioridazine). If you are currently using any of these medications, tell your doctor or pharmacist before starting this drug. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription products you may use, especially of: alpha-blockers (e.g., prazosin), anti-diabetic drugs (e.g., glipizide, glyburide, insulin), barbiturates (e.g., phenobarbital), calcium channel blockers (e.g., diltiazem, verapamil), cimetidine, epinephrine, general anesthesia, non-steroidal anti-inflammatory drugs (e.g., indomethacin, ibuprofen), other heart drugs (e.g., amiodarone, digoxin, propafenone, quinidine, intravenous lidocaine), other drugs to treat high blood pressure (e.g., clonidine, hydralazine, reserpine), medications for overactive thyroid disease (e.g., methimazole, propylthiouracil), paroxetine, rifamycins (e.g., rifampin), St. John's wort. Check the labels on all your medicines (e.g., cough-and-cold products, diet aids) because they may contain ingredients that could increase your heart rate or blood pressure. Ask your pharmacist about the safe use of those products. Do not start or stop any medicine without doctor or pharmacist approval.

USES
This medication is a beta-blocker used to treat chest pain (angina) and high blood pressure. It is also used after an acute heart attack to improve survival. High blood pressure reduction helps prevent strokes, heart attacks and kidney problems. This drug works by blocking the action of certain natural chemicals in your body such as epinephrine on the heart and blood vessels. This results in a lowering of the heart rate, blood pressure, and strain on the heart.

OTHER USES
This medication may also be used for irregular heartbeats, heart failure, migraine headache prevention, tremors and other conditions as determined by your doctor.

HOW TO USE
Take this medication by mouth, with or right after a meal, as directed by your doctor. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same time(s) each day. This drug is not effective if you use it only when chest pain or a migraine headache occurs. It is very important to take this medication regularly as prescribed to help prevent these conditions. The dosage is based on your medical condition and response to therapy. It may take one or two weeks before the full benefit of this drug takes effect. It is important to continue taking this medication even if you feel well. Most people with high blood pressure do not feel sick. Do not suddenly stop taking this medication without consulting your doctor. Your condition may become worse when the drug is suddenly stopped. Refer to the Warning section.

SIDE EFFECTS
Metoprolol is generally well tolerated. Side effects include abdominal cramps, diarrhea, constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence, lightheadedness, slow heart rate, low blood pressure, cold extremities, sore throat, and shortness of breath or wheezing. Metoprolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema.

In patients with existing slow heart rates (bradycardias) and heart blocks (defects in the electrical conduction of the heart), metoprolol can cause dangerously slow heart rates, and even shock. Metoprolol reduces the force of heart muscle contraction and can aggravate symptoms of heart failure. In patients with coronary artery disease, abruptly stopping metoprolol can suddenly worsen angina, and occasionally precipitate heart attacks. If it is necessary to discontinue metoprolol, its dosage should be reduced gradually over several weeks.

Initiation of high-dose extended release metoprolol in patients undergoing non-cardiac surgery is associated with bradycardia (slow heart rate), hypotension, stroke, and death. However, long-term therapy should with metoprolol should not be routinely withdrawn prior to major surgery. Impaired ability of the heart to respond to reflex adrenergic stimuli may increase the risks of general anesthesia and surgery.

OVERDOSE
If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include unusually slow heartbeat, severe dizziness, slow or shallow breathing, weakness, or fainting.

MISSED DOSE
If you miss a dose, take it as soon as you remember, but not if it is within 4 hours of the next dose. If it is within 4 hours of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

STORAGE
Store at room temperature between 59 and 86 degrees F (between 15 and 30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

WARNING
If you have chest pain (angina) or have heart disease (e.g., coronary artery disease, ischemic heart disease, high blood pressure), do not stop using this drug without first consulting your doctor. Your condition may become worse when the drug is suddenly stopped. If your doctor decides you should no longer use this drug, you must gradually decrease your dose according to your doctor's instructions. When gradually stopping this medication, it is recommended that you temporarily limit physical activity to decrease the work on the heart. Seek immediate medical attention if you develop: worsening chest pain, tightness or pressure in the chest, chest pain spreading to the jaw/neck/arm, sweating, trouble breathing or fast/irregular heartbeat.


Note : This product information is intended only for residents of the India. Taj Pharmaceuticals Limited, medicines help to treat and prevent a range of conditions—from the most common to the most challenging—for people around the world.