Generic Name: metoprolol

Brand Name: Apo-Metoprolol, Betaloc, Lopressor, Novo-Metoprolol , Nu-

Metop , Toprol XL
Drug Classification:
pharmacotherapeutic: Beta1 -adrenergic blocker
clinical: Antianginal, antihypertensive, MI adjunct
pregnancy category C
Mode of Action:
Selectively blocks beta1 -adrenergic receptors. Therapeutic
Effect: Slows heart rate, decreases cardiac output, reduces B/P.
Decreases myocardial ischemia severity.
Suggested Dose:
Hypertension PO(Immediate-Release):
 ADULTS, ELDERLY: Initially, 50 mg twice daily. Increase
at wkly (or longer) intervals. Maintenance: 100–450
mg/day in 2–3 divided doses.
 CHILDREN: Initially, 0.5–1 mg/kg/dose. Maximum Initial
Dose: 25 mg. Maximum Daily Dose: 6 mg/kg/day or 200
mg/day, whichever is less.
Hypertension PO (Extended-Release):
 ADULTS, ELDERLY: Initially, 25–100 mg/day as single
dose. May increase at least at wkly intervals until
optimum B/P attained. Maximum: 400 mg/day.
 CHILDREN 6 YRS OR OLDER: Initially, 1 mg/kg once
daily. Maximum: 50 mg. May increase to 2 mg/kg/day or
200 mg/day, whichever is less.
Angina Pectoris PO(Immediate-Release):
 ADULTS: Initially, 50 mg twice daily. Increase at wkly (or
longer) intervals. Usual range: 50–200 mg twice daily.
Maximum: 400 mg/day.
Angina Pectoris PO (Extended-Release):
 ADULTS: Initially, 100 mg/day as single dose. May
increase by at least at wkly intervals until optimum clinical
response achieved. Maximum: 400 mg/day.
Heart Failure PO (Extended-Release):
 ADULTS: Initially, 12.5–25 mg/day. May double dose
q2wks up to target dose of 200 mg/day.
Early Treatment of Myocardial Infarction IV:
  ADULTS: 5 mg q5min for up to 3 doses, followed by 25–
50 mg orally q6– 12h for 48–72 hrs. Transition over 2–3
days to twice daily Lopressor or once daily Toprol XL.
May increase up to a maximum of 200 mg/day
Indications:
Mild to moderate hypertension, acute MI to reduce cardiovascular
mortality, angina pectoris, New York Heart Association class II, III
heart failure, cardiomyopathy
Contraindications:
Hypersensitivity to b-blockers, cardiogenic shock, heart block
(2nd and 3rd degree), sinus bradycardia, pheochromocytoma, sick
sinus syndrome
Precautions: Pregnancy C, breastfeeding, geriatric, major
surgery, diabetes mellitus, thyroid/renal/hepatic disease, COPD,
CAD, nonallergic bronchospasm, CHF, bronchial asthma,
Side Effects:
Metoprolol is generally well tolerated, with transient and mild side
effects.
Frequent: Diminished sexual function, drowsiness, insomnia,
unusual fatigue/weakness.
Occasional: Anxiety, diarrhea, constipation, nausea, vomiting,
nasal congestion, abdominal discomfort, dizziness, difficulty
breathing, cold hands/feet.
Rare: Altered taste, dry eyes, nightmares, paresthesia, allergic
reaction (rash, pruritus).
Adverse Effects:
Overdose may produce profound bradycardia, hypotension,
bronchospasm. Abrupt withdrawal may result in diaphoresis,
palpitations, headache, tremulousness, exacerbation of angina, MI,
ventricular arrhythmias. May precipitate HF, MI in pts with heart
disease, thyroid storm in those with thyrotoxicosis, peripheral
ischemia in those with existing peripheral vascular disease.
Hypoglycemia may occur in pts with previously controlled diabetes
(may mask signs of hypoglycemia)
Drug Interactions:
Individual drugs
Cimetidine: increased metoprolol level
 Epinephrine, hydralazine, methyldopa prazosin, reserpine:
increased hypotension, bradycardia
Insulin: increased hypoglycemia
Drug classifications
Antidiabetics (oral): increased hypoglycemia
Amphetamines, calcium channel blockers, histamine H2
antagonists: increased hypotension, bradycardia
Barbiturates: decreased metoprolol level
MAOIs: do not use together
NSAIDs, salicylates: decreased antihypertensive effect
Xanthines: decreased effects of xanthines
Drug/food
Increased: absorption with food
Drug/lab test
Increased: BUN, potassium, ANA titer, serum lipoprotein,
triglycerides, uric acid, alkaline phosphatase, LDH, AST, ALT
Nursing Responsibility:
1. Monitor ECG directly when giving IV during initial treatment
2. Assess B/P, apical pulse immediately before drug
administration (if pulse is 60/min or less or systolic B/P is less
than 90 mm Hg, withhold medication, contact physician)
3. Check for baselines in renal, liver function tests before
therapy begins and periodically thereafter
4. Monitor B/P for hypotension, respiration for shortness of
breath. Assess pulse for quality, rate, rhythm.
5. Assess for evidence of HF: dyspnea (esp. on exertion, lying
down), night cough, peripheral edema, distended neck veins.
6. Monitor I&O (increased weight, decreased urinary output may
indicate HF).
7. Teach patient not to use OTC products containing a-
adrenergic stimulants (such as nasal decongestants, cold
preparations);
8. Advise patient to avoid alcohol, smoking and to limit sodium
intake as prescribed
9. Instruct patient to comply with weight control, dietary
adjustments, modified exercise program
10. Teach patient to take product as prescribed, not to double
doses or skip doses; take any missed doses as soon as
remembered if at least 4 hr until next dose
11. Teach patient to report symptoms of CHF; difficult breathing,
especially with exertion or when lying down, night cough,
swelling of extremities or bradycardia, dizziness, confusion,
depression, fever, decreased vision
12. Caution patient to avoid hazardous activities if dizziness,
drowsiness is present, to avoid driving until product response
is known