Description overdue on 03.06.2012

Cardioselective beta-blockers . The drug has an antiarrhythmic, antianginal and hypotensive effects. The drug does not have the inner CMA, it has no membrane stabilizing action. The hypotensive effect is due to a decrease in the synthesis of renin, monooxygenase, inhibition of activity of the "renin-angiotensin system," the central nervous system. The drug is able to reduce blood pressure during stress, physical exertion alone. Antianginal effect   provides a reduced rate, as well as myocardial tissue decreased need for oxygen. Long-term use of the drug metoprolol improves exercise tolerance and reduces the severity of angina attacks and their frequency. As a result of the elimination of arrhythmogenic factors (hypertension, increased cAMP, tachycardia, increased activity of the sympathetic nervous system) achieved antiarrhythmic effect. When hyperthyroidism, heart diseases functional origin, sinus tachycardia , Atrial fibrillation, supraventricular tachycardia form of metoprolol allows to restore the sinus rhythm, reduce the rate of heart rate. The drug prevents the formation of migraine. The average therapeutic dose of metoprolol, unlike other beta-blockers have a less pronounced effect on the organs, which are beta2-adrenergic blockers (uterus, bronchi smooth muscle peripherally located arteries, skeletal muscles, pancreas), on carbohydrate metabolism . Long-term medications is to reduce cholesterol   in blood. Metoprolol is available as a tablet, liquid.

Indications:

Metoprolol is used in myocardial infarction, unstable form of angina, angina When CHD in hypertension, hypertension crisis course. The drug is used for rhythm disturbances: supraventricular arrhythmia , Ventricular form of arrhythmia, sinus tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, ventricular arrythmia. The drug is used for hyperthyroidism (in combination therapy), and tremor (senile, essential forms), migraine, withdrawal syndrome , Akathisia while taking antipsychotic drugs, with anxiety.

Contraindications:

Metoprolol is not prescribed for atriventrikulyarnoy blockade of 2-3 degrees, cardiogenic shock , Hypersensitive to the active substance, acute heart failure, hypotension, Prinzmetal angina , Breastfeeding, in acute myocardial infarction, simultaneous MAO inhibitors, by intravenous infusion of verapamil. At   metabolic acidosis , Myasthenia gravis, diabetes, liver failure, pheochromocytoma, chronic renal failure, COPD (chronic obstructive bronchitis, emphysema), bronchial asthma, obliterating diseases of the peripheral receptacles, pregnancy, thyrotoxicosis, psoriasis, depression, pediatric, elderly Metoprolol is prescribed with caution.

Side effect:

Nervous system:   deceleration of the motor, mental reactions, fatigue, headaches, fatigue, paresthesias in extremities , Seizures, tremor, sleepiness, attention deficit disorder, anxiety, insomnia, myasthenia gravis, hallucinations, memory impairment, confusion, "nightmarish" dreams, asthenia. Senses:   eye pain, decreased vision, conjunctivitis, dry eyes, decreased production of tear fluid. Cardiovascular system: orthostatic hypotension , Loss of consciousness, dizziness, drop in blood pressure, sinus bradycardia, edema, decreased myocardial contractility, false angina, myocardial conduction disorders, the manifestation of vasospasm, heart failure, rarely marked aggravation of the violation of atrioventricular conduction. The digestive tract:   changes in taste, disorders of the liver (cholestasis, dark urine, yellowing of the skin and sclera). Skin: photodermatosis , Psoriasiform skin reactions, exacerbation of psoriasis, skin rashes, rash, reversible form of alopecia, increased sweating. Respiratory system:   bronchospasm, nasal congestion, shortness of breath. Endocrine system:   hypoglycemia (when insulinopotrebnom diabetes), hyperglycemia (in patients with insulin dependent diabetes mellitus), hypothyroid state. Perhaps the development of a rash, itching, allergy, thrombocytopenia, hyperbilirubinemia, agranulocytosis. The impact of the drug on the fetus Metoprolol: hypoglycemia, intrauterine growth restriction, bradycardia. The drug may cause reduced potency Libido, weight gain, pain in the joints. Abrupt cessation of the drug metoprolol causes the development of the syndrome of "cancellation".

Overdose:

Manifested dizziness, drop in blood pressure, severe sinus bradycardia   severe arrhythmia, fainting, ventricular premature beats , Cardiogenic shock, heart failure, cardiac arrest, bronchospasm , Nausea, vomiting, coma, loss of consciousness. The first symptoms are noted after 20 minutes after administration of high doses of the drug. Enterosorbents assignment is required, early gastric lavage. In marked fall in blood pressure patient give Trendelenburg position, injected norepinephrine, dobutamine, dopamine. Later prescribed Glucagon, establish requirements for transvenous pacemaker intracardiac way. In the formation of seizures slow intravenous diazepam. With the development of bronchospasm intravenous beta-2 adrenostimulyatorov. Hemodialysis is not proven effective.

Mode of application:

Metoprolol is taken orally .  The tablets can not be divided in half, chew, crush .  Average dose for hypertension is 100-150 mg 1-2 times daily .  Stenokarliya: 2-3 times a day 50mg .  Thyrotoxicosis, hyperkinetic cardiac syndrome, tachyarrhythmia: 1-2 times a day, 50 mg .  For secondary prevention of myocardial infarction is shown receiving 200 mg of metoprolol .  To prevent migraine administered 100-200 mg per day for reception 2-4 .  When paroxysmal supraventricular tachycardia with a view to attack heavily administered parenterally in a stationary observation .  In acute myocardial infarction Metoprolol administered immediately after hospitalization, always monitoring the level of blood pressure, pulse, ECG conduction atriventrikulyarnoy .  Elderly therapy starts with 50 mg per day .  In the pathology of hepatic dosage adjustment is not carried out (preferably, a drug that is not metabolized by the hepatic system) .

Special instructions:

Monitoring of patients who used beta-blockers, including regular monitoring of blood pressure, pulse, sugar. It is important to teach the patient to keep records of the index pulse, in the case of bradycardia he needs to ask for help physician. The elderly need to follow the work of the renal system. Metoprolol can cause disorders of peripheral arterial blood flow. Cancel metoprolol made gradually over a minimum of 10 days. Receiving more than 200mg per day leads to a decrease of cardioselective. When receiving the drug can disguise clinical hyperthyroidism (tachycardia). When planning the surgery necessary to notify the anesthesiologist medication metoprolol, the drug is not stopped. When registering in the elderly hypotension , Increasing bradycardia, ventricular form of arrhythmia, atrioventricular block, severe liver disease, kidney, reduce the dosage of the drug, it gradually overturned. Treatment with the development of depression, the appearance of skin rash. When receiving the drug during pregnancy gestation, its cancellation is made for 48-72 hours before the expected birth. Metoprolol affects the management of vehicles, execution of complex work.

Drug Interactions:

Allergen extracts used for skin testing, allergens themselves significantly increases the risk of anaphylaxis, severe systemic allergic reactions in patients who use metoprolol. The risk of anaphylactic reactions increases with intravenous radiopaque drugs based on iodine. Medicines for general inhalation anesthesia, phenytoin when administered intravenously increase the likelihood of a drop in blood pressure, increase the severity cardiodepressive action . Metoprolol may mask the symptoms hypoglycemia   (high blood pressure, tachycardia ), Change the effectiveness of oral forms of hypoglycemic agents, insulin. The drug reduces the clearance xanthines, lidocaine, increasing their concentration in the blood plasma, particularly in patients with increased clearance of theophylline with concomitant smoking. Estrogens glucocorticosteroids NSAIDs weaken hypotensive effect of the drug. Methyldopa, reserpine, BCCI, cardiac glycosides , Antiarrhythmics amiodarone, diltiazem , Verapamil, guanfacine worsen over   bradycardia , Congestive heart failure, atrioventricular block. When receiving nifedipine has been a significant drop in blood pressure. Hydralazine, sympatholytic, clonidine diuretics, other antihypertensive agents may provoke an abrupt and excessive fall in blood pressure. Metoprolol extends the period of exposure to coumarin anticoagulant increases the duration of the non-depolarizing muscle relaxants . Antipsychotic drugs, tetracyclic antidepressants, antipsychotics, tricyclic antidepressants, hypnotics and sedatives, ethanol dampening effects of metoprolol on the central nervous system. It is unacceptable the simultaneous appointment of MAO inhibitors because of the risk of a sharp drop in blood pressure. Violation of peripheral blood circulation observed in the appointment of non-hydrogenated ergot alkaloids.