home Audience 5 What does Metoprolol help with? Instructions for use. To achieve the best effect: rules for taking antihypertensive tablets Metoprolol

What does Metoprolol help with? Instructions for use. To achieve the best effect: rules for taking antihypertensive tablets Metoprolol

“Metoprolol”, what does this beta blocker help with? The medicine has antihypertensive properties. The instructions for use of the drug "Metoprolol" suggest using it for ischemia, high blood pressure, arrhythmias.

Composition and release form

Sold in the form of tablets and solution. One of the manufacturers is the German company Ratiopharm, which produces Metoprolol Ratiopharm tablets.

What does the medicine help with heart problems and blood pressure? The therapeutic effect is due to the inclusion in the composition of the drug active element metoprolol tartrate, the volume of which is 50 or 100 mg. The solution for administration into a vein is released in ampoules of 5 ml, containing 5 mg of metoprolol.

Auxiliary components are magnesium stearate, sodium carboxymethyl starch, cellulose, silicon dioxide, etc.

Pharmacological properties

The active component of the drug "Metoprolol", which creates antiarrhythmic, antianginal and hypotensive effects, reduces the frequency of myocardial oscillations, inhibits AV conduction, and reduces the heart's need for oxygen. The blood pressure returns to normal after 14 days of using the medication.

The instructions confirm the reviews of doctors that the drug Metoprolol reduces the frequency and likelihood of angina attacks. During atrial fibrillation and tachycardia, the drug stabilizes the heart rhythm. A more effective type of drug is Metoprolol Succinate.

This medication remains active for a longer period of time, providing healing effect during the day. In addition, Metoprolol Succinate reduces the risk of weakness and bradycardia and has a positive effect on bronchial smooth muscles.

Metoprolol tablets: what does the medicine help with?

Indications for use include the following conditions and pathologies:

myocardial infarction;
arterial hypertension;
unstable, tense angina;
ischemia;
hypertension.

What else do Metoprolol tablets help with? The drug is prescribed for:

ventricular extrasystole;
supraventricular, atrial fibrillation, ventricular arrhythmia;
atrial, sinus tachycardia;
atrial flutter;
thyrotoxicosis (together with other medications);
withdrawal symptoms;
tremor;
migraine;
akathisia.

The indications for the use of Metoprolol Ratiopharm, for which the tablets are effectively used, are similar.

Contraindications

The instructions for use prohibit the use of the drug "Metoprolol" for:

Prinzmetal's angina;
cardiogenic shock;
arterial hypotension;
sinoatrial, atrioventricular block of 1-2 degrees;
hypersensitivity to the composition of the drug "Metoprolol", which can cause an allergy;
decompensatory heart failure;
hypersensitivity to beta-blockers;
severe bradycardia;
weaknesses sinus node.

The medicine is not prescribed together with monoamine oxidase inhibitors and verapamil to children under adulthood and women who are breastfeeding.

Caution when taking tablets must be observed in patients suffering from pheochromocytoma, diabetes mellitus, pulmonary emphysema, metabolic acidosis, 1st degree AV block, obstructive bronchitis, myasthenia gravis, psoriasis, kidney and liver failure, bronchial asthma, as well as pregnant women and the elderly.

Medicine "Metoprolol": instructions for use

Oral form

The tablets are taken orally with water. The standard dosage is 100 mg per day. The medicine is used in several approaches. If necessary, the volume of the drug is doubled. Higher daily amount The medication is 400 mg.

Instructions for using injections

Metoprolol solution is injected into a vein at a dosage of 2-5 mg. The maximum single dose reaches 20 mg. With absence therapeutic action The injections are performed again after 5 minutes. The withdrawal of medication is carried out gradually under medical supervision.

Dosage of the drug "Metoprolol Succinate" in the treatment of diseases

For the treatment of supraventricular tachycardia, angina pectoris, hypertension, extrasystole, 50-100 mg of the drug per day is prescribed in the initial stages. For myocardial infarction, 200 mg per day should be taken as maintenance treatment. In case of heart failure occurring in chronic form, the dosage is set separately for each patient. The duration of taking Metoprolol Succinate takes about 3 months.

Side effects

The drug "Metoprolol", the instructions and reviews of patients confirm this, causes negative reactions from the nervous, cardiac, digestive, vascular, endocrine, respiratory and other systems. TO side effects the drug refers to:

weakness, eye pain, orthostatic hypotension;
changes in taste, photodermatosis, bronchospasm;
exacerbation of psoriasis, nasal congestion, hypoglycemia;
decreased potency, headaches, decreased vision, exanthema;
loss of consciousness, liver dysfunction, shortness of breath;
increased fatigue, conjunctivitis, dizziness;
alopecia, drowsiness, drop in blood pressure;
hypoglycemia, confusion, dry eyes;
sinus bradycardia, increased sweating;
weight gain, cramps, swelling;
hypothyroid condition, attention disorders, thrombocytopenia;
tremor, cardialgia, joint pain;
insomnia, itching, allergies;
agranulocytosis, hallucinations, asthenia.

If you abruptly stop taking the medication, a “withdrawal syndrome” is observed.

Analogues - synonyms

Medicines with similar composition and indications:

"Metoprolol - Zentiva."
- Akri, -Teva, - Akrikhin.
"Metoprolol-Ratiopharm".
- Organic.
-OBL.

Doctors, if necessary, prescribe the following analogues of Metoprolol:

Price

In Moscow and other regions of Russia, you can buy Metoprolol tablets for 27-55 rubles. In Kyiv, the medicine costs 10 hryvnia. In Minsk, its cost varies from 0.9 to 8.5 Bel. rubles In Kazakhstan, pharmacies offer an analogue of Egilok 25 mg containing metoprolol as active substance, priced at 1170 tenge (60 tablets, EGIS Pharmaceuticals, Ltd. (Hungary)).

Opinions of patients and doctors

On forums about the drug Metoprolol, patient reviews vary. TO positive aspects include the speed of action, low cost, and bioavailability of the drug. Negative reviews associated with multiple negative effects, contraindications, manifestations of withdrawal syndrome.

One of effective drugs for treatment of cardio-vascular system is Metoprolol. What kind of medicine is this, what it is prescribed for, what Metoprolol helps with, we will look at in this article. You will also find out what analogues there are this drug and which of them helps better with diseases of the heart and blood vessels.

Metoprolol - description, release form

This drug belongs to the selective beta-blockers and is available in both tablets and liquid form, in ampoules. Its purpose is to reduce blood pressure and normalize heart rate. The active substance here is metoprolol. The medicine is available in tablet form in different dosages– 25, 50 and 100 mg of active ingredient.

pharmachologic effect

How does this medicine affect a person? Metoprolol helps fight hypertension, migraines, arrhythmia, and tachycardia. When taken, the ability to more easily endure physical activity increases. At long-term use The drug reduces the level of cholesterol in the patient’s blood. The drug helps reduce the myocardial oxygen demand, as well as its excitability. The hypotensive therapeutic effect is most pronounced 2 weeks after the start of its administration. What Metoprolol is prescribed for will be discussed further in Popular Health.

Metoprolol - what is it prescribed for??

1. Neuroleptic akathesia.
2. Hypertension.
3. For the prevention of heart attack.
4. For migraines.
5. Angina pectoris.
6. Various heart rhythm disturbances.
7. In case of cardiovascular failure, to reduce the likelihood of death of the patient.
8. For ischemia.
9. Mitral valve prolapse.
10. For thyrotoxicosis (used in combination with other medications).
11. Idiopathic cardiomyopathy and other heart diseases.

Self-medication with this drug is unacceptable; only a doctor should prescribe Metoprolol and select the dosage, taking into account the characteristics of a person’s health.

What do Metoprolol tablets and ampoules help with??

Tablets and solution in ampoules Metoprolol helps to improve the health of patients with various cardiac disorders, for example:

1. The medicine helps reduce arterial pressure.
2. Helps normalize heart rate during tachycardia.
3. Treats coronary disease.
4. Helps prevent heart attack, reduce the likelihood of a recurrent heart attack.
5. Helps fight migraines
6. Heals unstable angina voltage.

Instructions for use

Metoprolol is taken orally with water. The therapeutic dose at the initial stage can be 50-100 mg, but in the future, to achieve a better effect, it is gradually adjusted upward by the attending physician. Maximum dose per day cannot exceed 400 mg of active substance. The drug is taken once a day. The minimum duration of the treatment course is 90 days. The drug is also withdrawn gradually under medical supervision.

Metoprolol analogues, which is better?

This medication has a fairly extensive list of analogues. Determine what works best for specific disease, only a doctor can do it after examining the patient. You cannot choose heart medications on your own. Let's look at the analogues for reference:

Emzok.
Vasocardin.
Bisoprolol.
Anaprilin.
Concor.
Metoprol.
Anepro.
Corvitol.
Metocard.

You can check with your doctor about whether Metoprolol will work better for arrhythmia or hypertension. He will recommend the most suitable analogue Metoprolol, if this drug is not available at the pharmacy. Is everyone allowed to take this medicine, or are there contraindications to it?

Contraindications and side effects

There are many contraindications to the use of the drug; it is advisable to familiarize yourself with them in advance. Let's look at some of them:

1. Hypotension.
2. Cardiogenic shock.
3. Decompensatory heart failure.
4. Allergy to the constituent components (especially to beta-blockers).
5. Bradycardia.
6. Weakness of the sinus node.
7. Prinzmetal's angina and other conditions.

When taking the medicine you may feel unpleasant symptoms, side effects. These include dry eyes, skin reaction to Sun rays, slowing of psychomotor reactions, increased sweating, decreased libido, headaches, decreased visual acuity, swelling, sleep disturbances, nasal congestion. Patients taking the drug Metoprolol may experience changes in taste preferences. In particular difficult cases tremors, confusion, and hallucinations occur. If you experience any unpleasant or strange sensations, you should inform your doctor. It is especially important to inform the anesthesiologist about taking the drug if you are planning to have surgery.

So, our acquaintance with the drug Metoprolol took place. General overview received information about it, for example, what it is prescribed for, what it helps with, how to take it. You also learned about drug analogues and side effects that often occur during treatment. Remember, you should start taking heart medications only as prescribed by your doctor.

Atenolol tablets

Best before date

The period during which Metoprolol retains its properties depends on the release date, storage conditions and on specific manufacturer. Check the expiration date on the outer packaging. After its expiration, the drug is no longer suitable for use.

Price and where to buy

The price of the drug varies from 26 to 323 rubles per package, depending on the manufacturer and form of release. The drugs are sold in almost all pharmacy chains.

During pregnancy and lactation

In this case, careful monitoring of the fetus is required to avoid developmental abnormalities.

Once in the blood, Metoprolol can lead to a slower heart rate, decreased blood pressure and difficulty breathing.

When feeding, the drug passes into the milk in small quantities, which practically does not harm the baby.

For children

There are no studies on the effect of Metoprolol on children's body has not been carried out, therefore it is strictly contraindicated for persons under 18 years of age.

In old age

Elderly people should take Metoprolol with caution and only as prescribed by a specialist. However, there are no specific contraindications.

With alcohol

If the main active ingredient is tartrate, then the drug will be poorly tolerated with alcohol, and sometimes there is an increase in side effects, up to the occurrence of hypotension.

When the main component is metoprolol succinate, the medicine can be taken together with alcoholic drinks, but in moderation.

Metoprolol is one of the most popular cardioselective beta-1 adrenergic receptor blockers. Adrenergic blockade causes a decrease in heart rate, a decrease in the heart's oxygen demand, and ultimately leads to a decrease in blood pressure. The above effects of metoprolol underlie its use in the treatment of patients suffering from arterial hypertension, cardiac arrhythmias, coronary disease heart, chronic heart failure. The drug reduces the automaticity of the first-order pacemaker, reduces the heart rate, slows down atrioventricular conduction, reduces contractility and suppresses the excitability of the heart muscle, reduces cardiac output and harmonizes the heart's need for oxygen with the ability to deliver it. The antihypertensive effect of metoprolol stabilizes by 10-14 days of the drug course.

Metoprolol is a lipophilic beta-blocker, therefore, to improve its solubility, it is used in the form of a salt: tartrate, succinate or fumarate, of which metoprolol tartrate has the best solubility. Attaching a salt “tail” to the molecule of the active substance of the drug not only improves its solubility, but also allows you to regulate the rate of penetration into the blood, thereby determining the time of absorption, distribution and elimination of the drug. It was found that metoprolol in the form of tartrate is 30% more bioavailable than metoprolol succinate, which, however, has practically no effect when comparing the beta-adrenergic blocking effect over a 24-hour period. In any case, before absorption into gastrointestinal tract the metoprolol salt is hydrolyzed and free metoprolol becomes the pharmacologically active substance.

In this regard, the effectiveness of the drug is determined purely by the concentration of the active ingredient in the blood. An exhaustive evidence base that formed the basis for the mass introduction of beta-blockers in clinical practice, the latter are due precisely to metoprolol, which was used in most randomized studies. The first of these was the MAPHY study, which fully demonstrated the drug’s ability to reduce the risk of developing cardiovascular complications in hypertensive patients, as well as to prevent mortality from ischemia and stroke. Subsequently, the antianginal (anti-ischemic) effectiveness of metoprolol in the treatment and prevention of stable angina. Metoprolol is one of the few beta-blockers that can reliably improve the long-term prognosis of patients who have suffered a myocardial infarction. Along with other fat-soluble beta-blockers, the drug is effective means treatment ventricular arrhythmias caused by myocardial ischemia. About 50% deaths as a result of myocardial infarction are associated with ventricular fibrillation. It has been experimentally established that beta blockers reduce the risk sudden death, while the most distinct protective properties manifested in beta-blockers with high degree lipophilicity. They are believed to penetrate the brain and tonify parasympathetic system under stress. All of the above is fully true for lipophilic metoprolol.

Metoprolol is available in tablets. When taken orally, its traditional dose is 100 mg per day, taken 1-2 times. With a weak therapeutic response daily dose can be doubled.

Pharmacology

Cardioselective beta 1-blocker without intrinsic sympathomimetic activity. It has hypotensive, antianginal and antiarrhythmic effects. Reduces the automaticity of the sinus node, reduces heart rate, slows AV conduction, reduces myocardial contractility and excitability, reduces cardiac output, and reduces myocardial oxygen demand. Suppresses the stimulating effect of catecholamines on the heart during physical and psycho-emotional stress.

Causes a hypotensive effect, which stabilizes by the end of the 2nd week of course use. For angina pectoris, metoprolol reduces the frequency and severity of attacks. Normalizes heartbeat with supraventricular tachycardia and atrial fibrillation. In case of myocardial infarction, it helps to limit the ischemia zone of the heart muscle and reduces the risk of developing fatal arrhythmias, and reduces the possibility of relapses of myocardial infarction. When used in medium therapeutic doses has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers.

Pharmacokinetics

After oral administration, metoprolol is quickly and almost completely absorbed from the gastrointestinal tract, the Cmax of the active substance in the blood plasma is reached within 1-2 hours. After absorption, metoprolol is largely subject to the “first pass” effect through the liver. Intensively metabolized in the liver with the participation of isoenzymes of the cytochrome P450 system with the formation of non-catative metabolites. T1/2 of metoprolol from plasma is 3-4 hours and does not change during the course of treatment. More than 95% of the dose taken is excreted by the kidneys, of which only 3% is unchanged.

Release form

Tablets are white or white with a grayish tint, round, flat, scored on one side and chamfered on both sides.

Excipients: lactose monohydrate 180 mg, microcrystalline cellulose 72 mg, potato starch 12 mg, sodium carboxymethyl starch 16 mg, povidone 16 mg, magnesium stearate 4 mg.

10 pieces. - contour cellular packaging (1) - cardboard packs.
10 pieces. - contour cell packaging (2) - cardboard packs.
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10 pieces. - contour cell packaging (10) - cardboard packs.
30 pcs. - contour cellular packaging (1) - cardboard packs.
30 pcs. - contour cell packaging (2) - cardboard packs.
30 pcs. - contour cell packaging (3) - cardboard packs.
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30 pcs. - contour cell packaging (5) - cardboard packs.
30 pcs. - contour cell packaging (6) - cardboard packs.
30 pcs. - contour cell packaging (7) - cardboard packs.
30 pcs. - contour cell packaging (8) - cardboard packs.
30 pcs. - contour cell packaging (9) - cardboard packs.
30 pcs. - contour cell packaging (10) - cardboard packs.
10 pieces. - polymer containers (1) - cardboard packs.
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70 pcs. - polymer containers (1) - cardboard packs.
80 pcs. - polymer containers (1) - cardboard packs.
90 pcs. - polymer containers (1) - cardboard packs.
100 pieces. - polymer containers (1) - cardboard packs.

Dosage

When taken orally average dose is 100 mg/day in 1-2 doses. If necessary, the daily dose is gradually increased to 200 mg. When administered intravenously, a single dose is 2-5 mg; if there is no effect, repeated administration is possible after 5 minutes.

Maximum doses: when taken orally, the daily dose is 400 mg, when administered intravenously, a single dose is 15-20 mg.

Interaction

When used simultaneously with antihypertensive drugs, diuretics, antiarrhythmic drugs, nitrates, there is a risk of developing severe arterial hypotension, bradycardia, and AV block.

When used simultaneously with barbiturates, the metabolism of metoprolol is accelerated, which leads to a decrease in its effectiveness.

When used simultaneously with hypoglycemic agents, the effect of hypoglycemic agents may be enhanced.

When used simultaneously with NSAIDs, a decrease in hypotensive effect metoprolol.

When used simultaneously with opioid analgesics, the cardiodepressive effect is mutually enhanced.

When used simultaneously with peripheral muscle relaxants, neuromuscular blockade may be enhanced.

When used simultaneously with drugs for inhalation anesthesia, the risk of suppression of myocardial function and the development of arterial hypotension increases.

When used simultaneously with oral contraceptives, hydralazine, ranitidine, cimetidine, the concentration of metoprolol in the blood plasma increases.

When used simultaneously with amiodarone, arterial hypotension, bradycardia, ventricular fibrillation, and asystole are possible.

When used simultaneously with verapamil, the Cmax in the blood plasma and the AUC of metoprolol increase. The minute and stroke volume of the heart, pulse rate, and arterial hypotension decrease. Possible development of heart failure, dyspnea and sinus node block.

With intravenous administration of verapamil while taking metoprolol, there is a risk of cardiac arrest.

With simultaneous use, bradycardia caused by digitalis glycosides may increase.

When used simultaneously with dextropropoxyphene, the bioavailability of metoprolol increases.

When used concomitantly with diazepam, a decrease in clearance and an increase in the AUC of diazepam is possible, which can lead to an increase in its effects and a decrease in the speed of psychomotor reactions.

When used simultaneously with diltiazem, the concentration of metoprolol in the blood plasma increases due to inhibition of its metabolism under the influence of diltiazem. The effect on cardiac activity is additively inhibited due to the slowing of impulse transmission through the AV node caused by diltiazem. There is a risk of developing severe bradycardia, a significant decrease in stroke and minute volume.

When used simultaneously with lidocaine, the elimination of lidocaine may be impaired.

When used simultaneously with mibefradil in patients with low activity of the CYP2D6 isoenzyme, it is possible to increase the concentration of metoprolol in the blood plasma and increase the risk of developing toxic effects.

When used simultaneously with norepinephrine, epinephrine, other adrenergic and sympathomimetics (including in the form eye drops or as part of antitussives), a slight increase in blood pressure is possible.

When used simultaneously with propafenone, the concentration of metoprolol in the blood plasma increases and develops toxic effect. It is believed that propafenone inhibits the metabolism of metoprolol in the liver, reducing its clearance and increasing serum concentrations.

When used simultaneously with reserpine, guanfacine, methyldopa, clonidine, severe bradycardia may develop.

When used simultaneously with rifampicin, the concentration of metoprolol in the blood plasma decreases.

Metoprolol may cause a slight decrease in the clearance of theophylline in patients who smoke.

Fluoxetine inhibits the CYP2D6 isoenzyme, which leads to inhibition of metoprolol metabolism and its accumulation, which can enhance the cardiodepressive effect and cause bradycardia. A case of the development of lethargy is described.

Fluoxetine and mainly its metabolites are characterized by a long T1/2, so the likelihood drug interactions persists even several days after discontinuation of fluoxetine.

There are reports of a decrease in the clearance of metoprolol from the body when used simultaneously with ciprofloxacin.

When used simultaneously with ergotamine, peripheral circulatory disorders may increase.

When used simultaneously with estrogens, the antihypertensive effect of metoprolol is reduced.

With simultaneous use, metoprolol increases the concentration of ethanol in the blood and prolongs its elimination.

Side effects

From the cardiovascular system: bradycardia, arterial hypotension, AV conduction disturbances, and symptoms of heart failure are possible.

From the outside digestive system: at the beginning of therapy, dry mouth, nausea, vomiting, diarrhea, constipation are possible; in some cases - liver dysfunction.

From the central nervous system and peripheral nervous system: at the beginning of therapy, weakness, fatigue, dizziness, headache, muscle cramps, feeling of coldness and paresthesia in the extremities; possible decrease in the secretion of tear fluid, conjunctivitis, rhinitis, depression, sleep disturbances, nightmares.

From the hematopoietic system: in some cases - thrombocytopenia.

From the outside endocrine system: hypoglycemic conditions in patients with diabetes mellitus.

From the outside respiratory system: Predisposed patients may experience symptoms of bronchial obstruction.

Allergic reactions: skin rash, itching.

Indications

Arterial hypertension, prevention of angina attacks, heart rhythm disturbances (supraventricular tachycardia, extrasystole), secondary prevention after suffered a heart attack myocardium, hyperkinetic cardiac syndrome (including with hyperthyroidism, NCD). Prevention of migraine attacks.

Contraindications

AV block II and III degrees, sinoatrial block, bradycardia (heart rate less than 50 beats/min), CVS, arterial hypotension, chronic heart failure stage IIB-III, acute heart failure, cardiogenic shock, metabolic acidosis, severe peripheral circulatory disorders, increased sensitivity to metoprolol.

Features of application

Use during pregnancy and breastfeeding

Use during pregnancy is possible only when the expected benefit to the mother outweighs the potential risk to the fetus. Metoprolol penetrates the placental barrier. Due to possible development in a newborn with bradycardia, arterial hypotension, hypoglycemia and respiratory arrest, metoprolol should be discontinued 48-72 hours before the planned date of delivery. After delivery, it is necessary to ensure strict monitoring of the newborn’s condition for 48-72 hours.

Metoprolol is excreted in breast milk in small quantities. Use during lactation is not recommended.

Use for liver dysfunction

Use with caution in patients with severe liver dysfunction.

Use for renal impairment

Use with caution in patients with severe renal impairment.

special instructions

Use with caution in patients with chronic obstructive diseases respiratory tract, diabetes mellitus (especially in a labile course), Raynaud's disease and obliterating diseases of the peripheral arteries, pheochromocytoma (should be used in combination with alpha-blockers), severe renal and liver dysfunction.

During treatment with metoprolol, there may be a decrease in the production of tear fluid, which is important for patients using contact lenses.

Completion of a long course of treatment with metoprolol should be carried out gradually (over a minimum of 10 days) under the supervision of a physician.

At combination therapy with clonidine, the latter should be stopped a few days after stopping metoprolol, in order to avoid hypertensive crisis. When used simultaneously with hypoglycemic agents, correction of their dosage regimen is required.

A few days before anesthesia, it is necessary to stop taking metoprolol or select an anesthetic agent with minimal negative inotropic effect.

Impact on the ability to drive vehicles and operate machinery

In patients whose activities require increased attention, the issue of using metoprolol on an outpatient basis should be decided only after assessing the patient's individual response.

Composition and release form

Sold in the form of tablets and solution. One of the manufacturers is the German company Ratiopharm, which produces Metoprolol Ratiopharm tablets.

What does the medicine help with heart problems and blood pressure? The therapeutic effect is due to the inclusion of the active element metoprolol tartrate in the composition of the drug, the volume of which is 50 or 100 mg. The solution for administration into a vein is released in ampoules of 5 ml, containing 5 mg of metoprolol.

Auxiliary components are magnesium stearate, sodium carboxymethyl starch, cellulose, silicon dioxide, etc.

Pharmacological properties

This medication remains active for a longer period of time and provides a therapeutic effect throughout the day. In addition, Metoprolol Succinate reduces the risk of weakness and bradycardia and has a positive effect on bronchial smooth muscles.

Metoprolol tablets: what does the medicine help with?

Indications for use include the following conditions and pathologies:

myocardial infarction;
arterial hypertension;
unstable, tense angina;
ischemia;
hypertension.

What else do Metoprolol tablets help with? The drug is prescribed for:

ventricular extrasystole;
supraventricular, atrial fibrillation, ventricular arrhythmia;
atrial, sinus tachycardia;
atrial flutter;
thyrotoxicosis (together with other medications);
withdrawal symptoms;
tremor;
migraine;
akathisia.

The indications for the use of Metoprolol Ratiopharm, for which the tablets are effectively used, are similar.

Contraindications

The instructions for use prohibit the use of the drug "Metoprolol" for:

Prinzmetal's angina;
cardiogenic shock;
arterial hypotension;
sinoatrial, atrioventricular block of 1-2 degrees;
hypersensitivity to the composition of the drug "Metoprolol", which can cause an allergy;
decompensatory heart failure;
hypersensitivity to beta-blockers;
severe bradycardia;
weakness of the sinus node.

The medicine is not prescribed together with monoamine oxidase inhibitors and verapamil to children under adulthood and women who are breastfeeding.

Caution when taking tablets should be observed in patients suffering from pheochromocytoma, diabetes mellitus, pulmonary emphysema, metabolic acidosis, 1st degree AV block, obstructive bronchitis, myasthenia gravis, psoriasis, kidney and liver failure, bronchial asthma, as well as pregnant women and the elderly.

Medicine "Metoprolol": instructions for use

Oral form

The tablets are taken orally with water. The standard dosage is 100 mg per day. The medicine is used in several approaches. If necessary, the volume of the drug is doubled. The highest daily amount of medication is 400 mg.

Instructions for using injections

Metoprolol solution is injected into a vein at a dosage of 2-5 mg. The maximum single dose reaches 20 mg. If there is no therapeutic effect, the injections are performed again after 5 minutes. The withdrawal of medication is carried out gradually under medical supervision.

Dosage of the drug "Metoprolol Succinate" in the treatment of diseases

For the treatment of supraventricular tachycardia, angina pectoris, hypertension, extrasystole, 50-100 mg of the drug per day is prescribed in the initial stages. For myocardial infarction, 200 mg per day should be taken as maintenance treatment. In case of chronic heart failure, the dosage is set separately for each patient. The duration of taking Metoprolol Succinate takes about 3 months.

Side effects

weakness, eye pain, orthostatic hypotension;
changes in taste, photodermatosis, bronchospasm;
exacerbation of psoriasis, nasal congestion, hypoglycemia;
decreased potency, headaches, decreased vision, exanthema;
loss of consciousness, liver dysfunction, shortness of breath;
increased fatigue, conjunctivitis, dizziness;
alopecia, drowsiness, drop in blood pressure;
hypoglycemia, confusion, dry eyes;
sinus bradycardia, increased sweating;
weight gain, cramps, swelling;
hypothyroid condition, attention disorders, thrombocytopenia;
tremor, cardialgia, joint pain;
insomnia, itching, allergies;
agranulocytosis, hallucinations, asthenia.

If you abruptly stop taking the medication, a “withdrawal syndrome” is observed.

Analogues - synonyms

Medicines with similar composition and indications:

"Metoprolol - Zentiva."
- Akri, -Teva, - Akrikhin.
"Metoprolol-Ratiopharm".
- Organic.
-OBL.

Doctors, if necessary, prescribe the following analogues of Metoprolol:

Price

In Moscow and other regions of Russia, you can buy Metoprolol tablets for 27-55 rubles. In Kyiv, the medicine costs 10 hryvnia. In Minsk, its cost varies from 0.9 to 8.5 Bel. rubles In Kazakhstan, pharmacies offer an analogue of Egilok 25 mg, containing metoprolol as an active substance, at a price of 1170 tenge (60 tablets, EGIS Pharmaceuticals, Ltd. (Hungary)).

Opinions of patients and doctors

On forums about the drug Metoprolol, patient reviews vary. The positive aspects include the speed of action, low cost, and bioavailability of the drug. Negative reviews are associated with multiple negative effects, contraindications, and symptoms of withdrawal syndrome.

In this article you can find instructions for use medicinal product Metoprolol. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Metoprolol in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications and side effects were observed, perhaps not stated by the manufacturer in the annotation. Analogues of Metoprolol, if available structural analogues. Use for the treatment of cardiac arrhythmias and blood pressure reduction in adults, children, as well as during pregnancy and lactation. Composition and interaction of the drug with alcohol.

Metoprolol- refers to cardioselective beta-adrenergic receptor blockers, which does not have internal sympathomimetic activity and membrane-stabilizing properties. It has hypotensive, antianginal and antiarrhythmic effects.

By blocking beta-adrenergic receptors of the heart in low doses, it reduces the formation of cAMP from ATP, stimulated by catecholamines, reduces the intracellular current of calcium, has a negative chrono-, dromo-, batmo- and inotropic effect (reduces the heart rate, inhibits conductivity and excitability, reduces myocardial contractility) .

Total peripheral resistance at the beginning of the use of beta-blockers (in the first 24 hours after oral administration) - increases (as a result of a reciprocal increase in the activity of alpha-adrenergic receptors and the elimination of stimulation of beta-adrenergic receptors), which after 1-3 days returns to the original level, and with long-term administration it decreases.

The acute antihypotensive effect is due to a decrease cardiac output, a stable antihypertensive effect develops over 2-3 weeks and is due to a decrease in renin synthesis, and accumulation of plasma renin, inhibition of the activity of the renin-angiotensin system (has great importance in patients with initial hypersecretion of renin) and the central nervous system by restoring the sensitivity of the baroreceptors of the aortic arch (there is no increase in their activity in response to a decrease in blood pressure) and, ultimately, a decrease in peripheral sympathetic influences. Reduces high blood pressure at rest, during physical exertion and stress.

The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (prolongation of diastole and improvement of myocardial perfusion) and contractility, as well as a decrease in the sensitivity of the myocardium to the effects of sympathetic innervation. Reduces the number and severity of angina attacks and increases tolerance physical activity. Blood pressure decreases after 15 minutes, to a maximum after 2 hours and continues for 6 hours; diastolic blood pressure changes more slowly: a stable decrease is observed after several weeks of regular use.

The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of the sinus and ectopic pacemakers and a slowdown in AV conduction (mainly in the antegrade and, to a lesser extent, in the retrograde directions through the AV node) and along additional pathways. With supraventricular tachycardia, atrial fibrillation, sinus tachycardia with functional diseases heart and hyperthyroidism, reduces heart rate, or may even lead to recovery sinus rhythm. Prevents the development of migraine.

When used in average therapeutic doses, in contrast to non-selective beta-blockers, it has a less pronounced effect on organs containing beta-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism. When used in large doses(more than 100 mg per day) has a blocking effect on both subtypes of beta-adrenergic receptors.

Metoprolol tartrate + excipients.

Metoprolol is quickly and almost completely (95%) absorbed from the gastrointestinal tract. Bioavailability is 50% at the first dose and increases to 70% with reuse. Eating increases bioavailability by 20-40%. The bioavailability of metoprolol increases in liver cirrhosis. Plasma protein binding averages 10%. The drug penetrates the blood-brain and placental barriers. Stands out in breast milk in small quantities. Metabolized in the liver. Metabolites do not have pharmacological activity. About 5% of the drug is excreted unchanged by the kidneys. Treatment of patients with reduced renal function does not require dose adjustment of the drug. Impaired liver function slows down the metabolism of the drug, and in cases of insufficiency of liver function, the dose of the drug should be reduced.

arterial hypertension (as monotherapy or in combination with other antihypertensive drugs), including hyperkinetic type, tachycardia;
coronary heart disease: myocardial infarction (secondary prevention - complex therapy), prevention of angina attacks;
heart rhythm disturbances (supraventricular tachycardia, ventricular extrasystole);
hyperthyroidism (complex therapy);
prevention of migraine attacks.

Release forms

Tablets 25 mg, 50 mg and 100 mg.

Instructions for use and dosage

The tablets are taken orally with food or immediately after meals, without chewing and with liquid.

Arterial hypertension. The initial daily dose is 50-100 mg in 1-2 doses (morning and evening). In case of insufficient therapeutic effect the daily dose can be gradually increased to 100-200 mg and/or additional prescription of other antihypertensive drugs. The maximum daily dose is 200 mg.

Angina pectoris, arrhythmias, prevention of migraine attacks - 100-200 mg per day in 2 doses (morning and evening).

Secondary prevention of myocardial infarction - 200 mg per day, 2 doses (morning and evening).

Functional cardiac disorders accompanied by tachycardia - 100 mg per day in 2 divided doses (morning and evening).

In elderly patients, with impaired renal function, and also if hemodialysis is necessary, the dose is not changed.

In case of liver dysfunction, the dose of the drug should be reduced depending on the clinical condition.

Side effect

increased fatigue;
weakness;
headache;
slowing down the speed of mental and motor reactions;
paresthesia in the limbs (in patients with intermittent claudication and Raynaud's syndrome);
depression;
anxiety;
decreased attention;
drowsiness;
insomnia;
nightmares;
confusion;
short-term memory impairment;
muscle weakness;
decreased vision;
dry and sore eyes;
conjunctivitis;
noise in ears;
sinus bradycardia;
heartbeat;
decrease in blood pressure;
orthostatic hypotension;
dizziness;
decreased myocardial contractility;
temporary worsening of symptoms of chronic heart failure (edema, swelling of the feet and/or lower legs, shortness of breath);
arrhythmias;
manifestation of vasospasm (increased peripheral circulatory disorders, cold lower limbs, Raynaud's syndrome);
nausea, vomiting;
abdominal pain
dry mouth;
diarrhea;
constipation;
change in taste;
hives;
skin itching;
rash;
exacerbation of psoriasis;
skin hyperemia;
increased sweating;
reversible alopecia;
nasal congestion;
dyspnea;
thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia;
intrauterine growth restriction;
back or joint pain;
slight increase in body weight;
decreased libido and/or potency.

cardiogenic shock;
AV blockade 2-3 degrees;
sinoatrial (SA) block;
sick sinus syndrome;
severe bradycardia;
heart failure in the stage of decompensation;
Prinzmetal's angina;
arterial hypotension (if used for secondary prevention myocardial infarction - systolic blood pressure less than 100 mm Hg, heart rate less than 45 beats/min);
simultaneous use of MAO inhibitors or simultaneous intravenous administration of verapamil;
lactation period;
age under 18 years (efficacy and safety have not been established);
hypersensitivity to metoprolol or other components of the drug, other beta-blockers.

Use during pregnancy and breastfeeding

During pregnancy, it is prescribed according to strict indications, taking into account the benefit/risk ratio (due to the development of bradycardia, arterial hypotension, hypoglycemia in the fetus). At the same time, careful monitoring is carried out, especially over the development of the fetus. Strict monitoring of newborns is necessary for 48-72 hours after delivery.

The effect of metoprolol on a newborn during breastfeeding has not been studied, therefore women taking metoprolol should stop breastfeeding.

Use in children

Contraindicated in children under 18 years of age (efficacy and safety have not been established).

special instructions

Monitoring of patients taking beta-blockers includes regular monitoring of heart rate and blood pressure, blood glucose levels in patients with diabetes mellitus. If necessary, for patients with diabetes mellitus, the dose of insulin or hypoglycemic agents prescribed orally should be selected individually.

The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min. When taking a dose above 200 mg per day, cardioselectivity decreases.

In case of heart failure, treatment with metoprolol begins only after reaching the compensation stage.

Possible increased severity of hypersensitivity reactions (against the background of a burdened allergic history) and lack of effect from administration usual doses epinephrine (adrenaline).

May increase symptoms of peripheral arterial circulation. The drug is discontinued gradually, reducing the dose over 10 days.

If treatment is abruptly stopped, withdrawal syndrome may occur (increased angina attacks, increased blood pressure).

When discontinuing the drug, special attention should be paid to patients with angina pectoris. For exertional angina, the selected dose of the drug should ensure the heart rate at rest within the range of 55-60 beats/min, and during exercise - no more than 110 beats/min.

Patients who use contact lenses should take into account that during treatment with beta-blockers, the production of tear fluid may decrease.

Metoprolol may mask some clinical manifestations hyperthyroidism (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms.

At diabetes mellitus may mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not increase insulin-induced glycemia and does not delay the recovery of blood glucose concentrations to normal levels.

If it is necessary to prescribe to patients with bronchial asthma, beta2-adrenergic stimulants are used as concomitant therapy; for pheochromocytoma - alpha-blockers.

If necessary surgical intervention it is necessary to warn the anesthesiologist about the therapy being carried out (choice of drug for general anesthesia with minimal negative inotropic effects), discontinuation of the drug is not recommended.

Drugs that reduce the supply of catecholamines (for example, reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure and bradycardia. In elderly patients, it is recommended to regularly monitor liver function. Correction of the dosage regimen is required only if an elderly patient develops increasing bradycardia (less than 50 beats/min), a pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe disorders liver function, sometimes it is necessary to stop treatment.

Patients with severe renal failure It is recommended to monitor renal function.

Should be carried out special control for the condition of patients with depressive disorders taking metoprolol; in case of depression caused by taking beta-blockers, it is recommended to discontinue therapy.

Due to the lack of sufficient clinical data, the drug is not recommended for use in children.

Impact on the ability to drive vehicles and operate machinery

At the beginning of treatment with metoprolol, patients may experience dizziness and fatigue. In this case, they should refrain from driving vehicles and potentially engaging in activities dangerous species activities that require increased concentration and speed of psychomotor reactions. In the future, dose safety is determined individually.

Drug interactions

Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The treatment break between taking MAO inhibitors and metoprolol should be at least 14 days.

Simultaneous intravenous administration verapamil can cause cardiac arrest.

The simultaneous administration of nifedipine leads to a significant decrease in blood pressure.

Inhalation anesthetics (hydrocarbon derivatives) increase the risk of suppression of myocardial function and the development of arterial hypotension.

Beta-agonists, theophylline, cocaine, estrogens (sodium retention), indomethacin and other non-steroidal anti-inflammatory drugs (NSAIDs) (sodium retention and blocking renal prostaglandin synthesis) weaken the hypotensive effect.

Tri- and tetracyclic antidepressants, antipsychotics medicines(neuroleptics), sedatives and hypnotics increase CNS depression.

There is an increased inhibitory effect on the central nervous system - with ethanol (alcohol); summation of the cardiodepressive effect - with anesthesia; increased risk of peripheral circulatory disorders - with ergot alkaloids.

At joint reception with hypoglycemic agents for oral administration, their effect may be reduced; with insulin - increasing the risk of developing hypoglycemia, increasing its severity and prolongation, masking some symptoms of hypoglycemia (tachycardia, sweating, increased blood pressure).

When combined with antihypertensive drugs, diuretics, nitroglycerin or slow calcium channel blockers, a sharp decrease in blood pressure may develop) special caution is required when combined with prazosin); an increase in the severity of the decrease in heart rate and inhibition of AV conduction - when using metoprolol with verapamil, diltiazem, antiarrhythmic drugs (amiodarone), reserpine, alpha-methyl dopa, clonidine, guanfacine, agents for general anesthesia and cardiac glycosides.

If metoprolol and clonidine are taken simultaneously, then when metoprolol is discontinued, clonidine is discontinued after a few days (due to the risk of withdrawal syndrome).

Inducers of microsomal liver enzymes (rifampicin, barbiturates) lead to increased metabolism of metoprolol, a decrease in the concentration of metoprolol in the blood plasma and a decrease in the effect.

Inhibitors (cimetidine, oral contraceptives, phenothiazines) increase the plasma concentration of metoprolol.

Allergens used for immunotherapy or allergen extracts for skin tests at joint use with metoprolol, increase the risk of systemic allergic reactions or anaphylaxis; iodine-containing radiocontrast agents for intravenous administration increase the risk of anaphylactic reactions.

Reduces the clearance of xanthine (except diphylline), especially with the initially increased clearance of theophylline under the influence of smoking.

Reduces the clearance of lidocaine, increases the concentration of lidocaine in the blood plasma.

Strengthens and prolongs the effect of antidepolarizing muscle relaxants; prolongs the anticoagulant effect of coumarins.

When used together with ethanol (alcohol), the risk of a pronounced decrease in blood pressure increases.

Analogues of the drug Metoprolol

Structural analogues according to active substance:

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps and look at the available analogues for the therapeutic effect.