Metoprolol is a cardioselective β-blocker drug that acts on β1-adrenergic receptors of the heart. It has no membrane stabilizing effect neither intrinsic sympathomimetic activity.
Metaprolol is contraindicated in patients with 2nd and 3rd degree atrioventricular blockade, decompensated heart failure patients (pulmonary edema, hypoperfusion or hypotension), patients in continuous or intermittent inotropic treatment that acts by antagonism with ß-adrenergic receptors; sinus bradycardia; sick sinus syndrome, cardiogenic shock, severe peripheral arterial disorder, myocardial infarction with heart rate <45 ppm, a heart rate PQ> 0.24 seconds or systolic pressure <100 mm Hg.
Cautions should be exercised in patients with severe hepatic insufficiency, asthma, heart failure, pheochromocytoma (where metoprolol should be administered together with an alpha-blocker).
It may aggravate the symptoms of peripheral arterial circulatory disorders and rarely aggravate pre-existing atrioventricular conduction disorders of moderate degree. If there is aggravation of bradycardia, administer lower doses of metoprolol or interrupt treatment gradually.
Risk of coronary events during β-blocker withdrawal, so cardiac monitoring is required.
Bradycardia, postural hypotension, hands and feet coldness, palpitations, fatigue, headaches, nausea, abdominal pain, diarrhea, constipation and dyspnea on exertion.
In association with clonidine if it is necessary to discontinue treatment, first interrupt the β-blocker several days before.
Metoprolol potentiates the negative inotropic and negative dromotropic effect of quinidine and amiodarone.
Cardiopressor effect increased with inhaled anesthetics.
The plasma concentration of metoprolol is diminished by the concomitant treatment with rifampicin.
The plasma concentration of metoprolol can be increased by concomitant treatment with cimetidine.
The effect of metoprolol is reduced by indomethacin.
Metoprolol modifies the glucose concentration in diabetics treated with hypoglycemic agents.
Metoprolol increases the toxicity of lidocaine.
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