Names and pronunciation
(meh-toe′proe-lole) Kapspargo Sprinkle, Lopressor, Toprol , Toprol-XL
Source page 878
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Individual generic drug information
Extracted information for metoprolol only.
(meh-toe′proe-lole) Kapspargo Sprinkle, Lopressor, Toprol , Toprol-XL
Source page 878
Func. class.: Antihypertensive, antianginal
Source page 878
Chem. class.: β1-Blocker
Source page 878
Do not confuse: Lopressor/Lyrica Toprol-XL/Topamax
Source page 878
ACTION: Lowers B/P by β-blocking effects; reduces elevated renin plasma lev- els; blocks β2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect
Source page 878
USES: Mild to moderate hypertension, acute MI to reduce cardiovascular mor- tality, angina pectoris, NYHA class II, III heart failure, cardiomyopathy
Source page 878
Extracted information for metoprolol only.
CONTRAINDICATIONS: Hyper- sensitivity to β-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, sick sinus syndrome Precautions: Pregnancy, breastfeeding, geriatric patients, major surgery, diabe- tes mellitus, thyroid/renal/hepatic dis- ease, COPD, CAD, nonallergic broncho- spasm, bronchial asthma, CVA, children, depression, vasospastic angina, pheochromocytoma
Source page 878
Black Box Warning: Abrupt discontinu- ation Black Box Warning: Abrupt withdraw- al: may cause MI, ventricular dysrhyth- mias, myocardial ischemia; taper dose over 7-14 days • Hypertension/angina: ECG directly when giving IV during initial treatment • I&O, weight daily; check for heart failure (weight gain, jugular venous dis- tention, crackles, edema, dyspnea) • Monitor B/P during initial treatment, periodically thereafter; pulse; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes or pulse <50 bpm; atropine 0.25-0.5 mg IV may be given for heart rate <40 bpm • Baselines of renal, hepatic studies be- fore therapy begins • Pregnancy/breastfeeding: use only if clearly needed, no well-controlled stud- ies, excreted in breast milk in small quantities; American Academy of Pediat- rics considers this product to be compat- ible with breastfeeding Black Box Warning: Not to discontinue product abruptly; to taper over 2 wk; may cause angina • Not to use OTC products containing α-adrenergic stimulants (nasal decon- gestants, OTC cold preparations) unless directed by prescriber; to avoid alcohol, smoking, sodium intake • To report bradycardia, dizziness, con- fusion, depression, fever, sore throat, SOB, decreased vision to prescriber • To take pulse, B/P at home; when to notify prescriber • To comply with weight control, dietary adjustments, modified exercise program • To carry emergency ID to identify product, allergies, prescriber • To monitor blood glucose closely if diabetic, hypo/hyperglycemia • To avoid hazardous activities if dizzi- ness is present • To report symptoms of heart failure: difficult breathing, especially on exertion or when lying down; night cough; swell- ing of extremities • To rise slowly to decrease orthostatic hypertension • To report Raynaud’s symptoms • That product may increase sensitivity to cold
Source pages 878, 880, 881
SIDE EFFECTS CNS: Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confu- sion, fatigue, weakness CV: Hypotension, bradycardia, HF, pal- pitations, dysrhythmias, cardiac arrest, AV block, pulmonary/peripheral edema, chest pain EENT: Blurred vision GI: Nausea, vomiting, colitis, cramps, diarrhea, constipation, flatulence, dry mouth, hiccups GU: Impotence, urinary frequency HEMA: Agranulocytosis, eosinophilia, thrombocytopenia, purpura INTEG: Rash, purpura, alopecia, dry skin, urticaria, pruritus RESP: Bronchospasm, dyspnea, wheezing ENDO: Hyper/hypoglycemia
Source pages 879, 880
INTERACTIONS Increase: hypoglycemic digoxin, diltia- zem, bradycardia effects—verapamil, insulin, oral antidiabetics Increase: metoprolol level—cimetidine Increase: effects of benzodiazepines Decrease: antihypertensive effect—salic- ylates, NSAIDs Decrease: metoprolol level—barbiturates Decrease: effects of—xanthines Decrease: effects of each—dopamine, theophylline Drug/Food Increase: absorption with food Drug/Lab Test Increase: blood glucose, BUN, potas- sium, ANA titer, serum lipoprotein, triglycerides, uric acid, alk phos, LDH, AST, ALT
Source page 880
TREATMENT OF OVERDOSE: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodi- alysis, administer vasopressor
Source page 881
Extracted information for metoprolol only.
DOSAGE AND ROUTES Angina • Adult: PO 100 mg/day as a single dose or in 2 divided doses, increase weekly prn or 100 mg EXTENDED RELEASE daily, max 400 mg/day extended release Hypertension • Adult: PO 50 mg bid or 100 mg/day; may give up to 100-450 mg in divided doses; EXT REL 25-100 mg daily, titrate at weekly intervals; max 400 mg/day • Geriatric: PO 25 mg/day initially, in- crease weekly as needed • Child and adolescent 6-16 yr: PO Regular release 1-2 mg/kg divided bid; PO EXT REL 1 mg/kg up to 50 mg daily Myocardial infarction • Adult: IV BOL (early treatment) 5 mg q2min × 3, then 50 mg PO 15 min after last dose and q6hr × 48 hr; (late treat- ment) PO maintenance 50-100 mg bid for 1-3 yr
Source pages 878, 879
Available forms: Tabs 25, 50, 100 mg; inj 1 mg/mL; ext rel tab (succinate) (XL) 25, 50, 100, 200 mg; ext rel tabs, tar- trate: 100 mg, sprinkle 25, 50, 100, 200 mg
Source page 879
Administer: PO route • Take apical pulse before giving; if <50 bpm, hold and notify prescriber • Do not break, crush, or chew ext rel tabs • Regular release tab after meals, at bedtime; tab may be crushed or swal- lowed whole; take at same time each day Sprinkle Capsule: May be swallowed whole or opened and sprinkled on a small amount of soft food • Store in dry area at room temperature; do not freeze Direct IV route • IV, undiluted, give 1 mg/mL over 1 min × 3 doses at 2- to 5-min intervals; start PO 15 min after last IV dose • Check dose with another person to prevent errors that could be fatal Y-site compatibilities: Abciximab, acyclo- vir, alemtuzumab, alfentanil, alteplase, amikacin, aminophylline, amiodarone, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, azaTHIOprine, aztreonam, benz- tropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, ceFAZolin, cefonicid, cefo- perazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cef- TRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cyanocobalamin, cyclophos- phamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexametha- sone, dexmedetomidine, digoxin, diltia- ZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, DOXOrubicin, doxycycline, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, epoetin alfa, eptifibatide, esmolol, etopo- side, etoposide phosphate, famotidine, fenoldopam, fentaNYL, fluconazole, flu darabine, fluorouracil, folic acid, furose- mide, ganciclovir, gemcitabine, gentami- cin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDAru- bicin, ifosfamide, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketorolac, labetalol, linezolid, LORazepam, magnesium sulfate, mannitol, mechloreth- M amine, meperidine, metaraminol, metho- trexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, midazolam, milrinone, mitoXANTRONE, morphine, multivitamins, nafcillin, nalbuphine, naloxone, nitroprus- side, norepinephrine, octreotide, ondanse- tron, oxacillin, oxaliplatin, oxytocin, PACLi- taxel, palonosetron, pancuronium, papaverine, PEMEtrexed, penicillin G, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenyleph- rine, phytonadione, piperacillin/tazobac- tam, potassium chloride, procainamide, prochlorperazine, promethazine, propran- olol, protamine, pyridoxime, quinupristin/ dalfopristin, raNITIdine, rocuronium, sodium bicarbonate, succinylcholine, SUF- entanil, tacrolimus, teniposide, theophyl- line, thiamine, thiotepa, ticarcillin/clavula- nate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan, urokinase, vanco- mycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, voriconazole
Source page 879
Extracted information for metoprolol only.
Assess:
Source page 880
Evaluate: • Therapeutic response: decreased B/P after 1-2 wk, decreased anginal pain
Source page 880
CLINICAL CONSIDERATIONS
Source page 880
Patient and caregiver information: • To take immediately after meals; to take medication at bedtime to prevent effect of orthostatic hypotension
Source page 880
Extracted information for metoprolol only.
PHARMACOKINETICS Half-life 3-7 hr, metabolized in liver (metabolites) by CYP2D6 some may be poor metabolizers, excreted in urine; crosses placenta, enters breast milk PO: Peak 2-4 hr, duration 13-19 hr PO-ER: Peak 6-12 hr, duration 24 hr IV: Onset immediate, peak 20 min, dura- tion 6-8 hr
Source page 880
Filter the extracted dose blocks for this individual drug.
Angina
• Adult: PO 100 mg/day as a single dose or in 2 divided doses, increase weekly prn or 100 mg EXTENDED RELEASE daily, max 400 mg/day extended release Hypertension
Candidate age grouping · source pages 878, 879
Angina
• Adult: PO 50 mg bid or 100 mg/day; may give up to 100-450 mg in divided doses; EXT REL 25-100 mg daily, titrate at weekly intervals; max 400 mg/day
Candidate age grouping · source pages 878, 879
Angina
• Geriatric: PO 25 mg/day initially, in- crease weekly as needed
Candidate age grouping · source pages 878, 879
Angina
• Child and adolescent 6-16 yr: PO Regular release 1-2 mg/kg divided bid; PO EXT REL 1 mg/kg up to 50 mg daily Myocardial infarction
Candidate age grouping · source pages 878, 879
Angina
• Adult: IV BOL (early treatment) 5 mg q2min × 3, then 50 mg PO 15 min after last dose and q6hr × 48 hr; (late treat- ment) PO maintenance 50-100 mg bid for 1-3 yr
Candidate age grouping · source pages 878, 879