Metoprolol

2nd- or 3rd-degree atrioventricular block, overt or unstable decompensated cardiac failure, clinically relevant sinus bradycardia, sick-sinus syndrome (without pacemaker), severe peripheral arterial disease, cardiogenic shock, hypotension, untreated phaeochromocytoma, metabolic acidosis; severe asthma; MI complicated with severe sinus bradycardia (heart rate: <45 beats/min), significant 1st-degree heart block (P-R interval ≥0.24 seconds), systolic blood pressure of <100 mmHg, and/or moderate to severe heart failure.

Patient with history of severe anaphylaxis to allergens, diabetes mellitus, compensated heart failure, 1st-degree atrioventricular block, poor cardiac reserve, bronchospastic disease (who do not respond to or are intolerant of other treatment), psoriasis, myasthenia gravis, peripheral vascular disease, Prinzmetal's angina, thyroid disease. Patient undergoing surgery. Avoid abrupt withdrawal; chronic therapy must not be routinely withdrawn before major surgery. May mask the signs and symptoms of hypoglycaemia and hyperthyroidism. Hepatic impairment. Elderly. Pregnancy and lactation. CYP2D6 poor, intermediate, and ultrarapid metabolisers. Monitoring Parameters Monitor blood pressure, heart rate; ECG (with IV use), heart rhythm (with oral use).

Significant: Bradycardia (including sinus pause, heart block, and cardiac arrest); may precipitate or aggravate symptoms of arterial insufficiency (in patients with peripheral vascular disease), worsening heart failure (particularly during up-titration of metoprolol succinate). Cardiac disorders: Palpitations. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain, constipation. General disorders and administration site conditions: Fatigue. Nervous system disorders: Dizziness, headache. Psychiatric disorders: Depression, insomnia, nightmares. Respiratory, thoracic and mediastinal disorders: Dyspnoea on exertion, bronchospasm. Skin and subcutaneous tissue disorders: Pruritus, rash. Vascular disorders: Orthostatic hypotension (occasionally with syncope), cold extremities.

Additive effects with catecholamine-depleting drugs (e.g. reserpine). Increased plasma concentration with CYP2D6 inhibitors (e.g. fluvoxamine, fluoxetine, paroxetine, sertraline, bupropion, clomipramine, desipramine, chlorpromazine, fluphenazine, haloperidol, thioridazine, propafenone, ritonavir, diphenhydramine, hydroxychloroquine, quinidine, terbinafine, cimetidine). Reduced plasma concentration with CYP2D6 inducers (e.g. rifampicin). May result in excessive bradycardia when given with digitalis glycosides, clonidine, diltiazem, verapamil. May enhance cardiodepressant effect with inhalation anaesthetic drugs. Enhanced hypotensive effect with other antihypertensive agents or agents that may reduce blood pressure (e.g. TCAs, barbiturates, phenothiazines). Metoprolol may enhance the rebound hypertension that can follow the withdrawal of clonidine. Reduced antihypertensive effects with NSAIDs (e.g. indometacin). May enhance the vasoconstrictive action of ergot alkaloids.

Antimigraine Preparations / Beta-Blockers

C07AB02 - metoprolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases.