Betaloc Zok

Metoprolol succinate

HTN, angina pectoris, heart failure & maintenance treatment after MI.

HTN 50-100 mg once daily. Patient unresponsive to 100-mg dose May be combined w/ other antihypertensives (preferably diuretics & dihydropyridine-type Ca antagonists) or increased dose. Angina pectoris 100-200 mg once daily. May be combined w/ nitrates or increased dose. Chronic heart failure Individually adjusted. Recommended initial dose for 1st 2 wk: 25 mg once daily. Patient w/ NYHA functional classes III-IV Begin w/ ½ a 25 mg tab once daily in the 1st wk. Dose then be doubled every 2nd wk up to a max target dose of 200 mg once daily is recommended. 200 mg once daily during long-term treatment. Maintenance treatment after MI 200 mg once daily. Severe hepatic impairment (eg, shunt-operated patients) Dose reduction should be considered.

May be taken with or without food: May be divided. Do not chew/crush. Swallow w/ atleast ½ a glass of liqd.

Hypersensitivity to metoprolol or other β-blockers. Cardiogenic shock, sick sinus syndrome (provided there is no permanent pacemaker), 2nd- or 3rd-degree AV block, unstable heart failure, symptomatic bradycardia or hypotension, indication heart failure, serious peripheral vascular disease w/ gangrene threat. Patients w/ unstable decompensated heart failure (pulmonary oedema, hypoperfusion or hypotension), & continuous or intermittent inotropic therapy acting through β-receptor agonism; repeated supine BP <100 mmHg should be re-evaluated prior to treatment. Not to be given to patients w/ suspected acute MI as long as the heart rate is <45 bpm, PQ interval is >0.24 sec or systolic BP is <100 mmHg.

Not to be given w/ IV administration of verapamil-type Ca antagonists. Concomitant therapy w/ β₂-agonist should be administered when treating asthma patients; w/ α-blocker in patients suffering from phaeochoromocytoma. May aggravate moderate preexisting AV conduction disorder (possibly leading to AV block); peripheral arterial circulatory disorders symptoms. Gradually w/draw or give in lower doses if increasing bradycardia develops. Avoid abrupt w/drawal of β-blockade in high risk patients. Gradually w/draw dose at least 2 wk into ½ doses until final dose is ½ tab of 25 mg & give for at least 4 days before discontinuation. May aggravate chronic heart failure & increase risk of MI & sudden death after sudden w/drawal of β-blockade. Inform anaesthetist of therapy prior to surgery. Avoid acute initiation of high-dose metoprolol to patients undergoing non-cardiac surgery. Avoid treatment in those at increased risk of anaphylaxis. May affect the ability to drive & use machines. Perform maternofetal monitoring to pregnant women on treatment. Pregnancy & lactation. May cause bradycardia in foetus & newborn infant.

Fatigue. Dizziness, headache; peripheral coldness in extremities, bradycardia, palpitations; shortness of breath when physically active; abdominal pain, nausea, vomiting, diarrhoea, constipation.

CYP2D6 inibitors eg, quinidine, terbinafine, paroxetine, fluoxetine, sertraline, celecoxib, propafenone & diphenhydramine. Induced metabolism w/ barbiturates; rifampicin. Increased plasma conc w/ propafenone; cimetidine or hydralazine. Additive inhibitory effects on AV-conduction & sinus node function w/ verapamil, diltiazem. May develop pronounced sinus bradycardia w/ amiodarone. Additive negative inotropic effects w/ class I antiarrhythmics eg, disopyramide. Counteract the antihypertensive effects w/ NSAID-antiphlogistics. May increase AV conduction time & induce bradycardia w/ digitalis glycosides. Enhanced effects w/ diphenhydramine. Additive inhibitory effects on the AV-conduction & sinus node function w/ diltiazem. Pronounced HTN & bradycardia w/ epinephrine. May increase diastolic BP & provoke paradoxical hypertensive reactions w/ phenylpropanolamine. Markedly elevated plasma levels & enhanced β-blockade w/ quinidine. May potentiate hypertensive reactions when clonidine is suddenly w/drawn. Concomitant treatment w/ other β-blockers (eg, eye drops), or MAOIs. Enhanced cardio-depressant effect w/ inhalation anaesth. Readjust dosage of oral antidiabetics.

Beta-Blockers

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

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