Metoprolol-Akrikhin retard 30 extended-release film-coated tablets 25 mg

Release form of Metoprolol

Metoprolol is available in tablet form for systemic treatment. The main substance is metoprolol tartrate, which can be contained in the amount of 25 mg, 50 mg or 100 mg in one tablet. Auxiliary components:

• magnesium stearate;
• silica;
• sodium carboxymethyl starch;
• microcrystalline cellulose.

The drug belongs to the cardioselective beta-blockers.

Metoprolol tablets: what for?

The main directions of action of Metoprolol include:

• antianginal;
• antiarrhythmic;
• hypotensive.

Taking the drug stabilizes blood pressure if it has been elevated as a result of stress or after physical exertion. In addition, due to the antianginal effect, excessive heart rate and myocardial demand for oxygen molecules are reduced.

As a result of a course of taking Metoprolol, the body's ability to tolerate physical activity increases, the risk of developing angina pectoris decreases, making attacks less frequent than before treatment. The medicine helps restore sinus rhythm, normalize heart rate, and prevent the development of migraines.

At small therapeutic doses, Metoprolol does not have a systemic effect on other organs, as well as on carbohydrate metabolism, unlike its analogues. Taking the drug for several years reduces the level of cholesterol in the blood.

Metoprolol tab 50mg No. 50

Compound

Active substance: metoprolol tartrate - 50 mg.
Excipients: lactose monohydrate (milk sugar) - 90 mg, microcrystalline cellulose - 31 mg, corn starch - 6 mg, sodium carboxymethyl starch 8 mg, povidone-K25 - 8 mg, colloidal silicon dioxide - 3 mg, magnesium stearate - 4 mg.

Pharmacokinetics

After oral administration, metoprolol is quickly and almost completely absorbed from the gastrointestinal tract, the Cmax of the active substance in the blood plasma is reached after 1-2 hours. After absorption, metoprolol is largely subject to the “first pass” effect through the liver. Plasma protein binding is low, about 5-10%. Vd is 5.6 l/kg. It is quickly distributed in tissues, penetrates the BBB and the placental barrier. Excreted in breast milk. Metoprolol undergoes oxidative metabolism in the liver (mainly with the participation of the CYP2D6 isoenzyme) with the formation of 3 main metabolites, none of which has a clinically significant beta-blocking effect. T1/2 of metoprolol from plasma is 3-4 hours and does not change during the course of treatment. More than 95% of the dose taken is excreted by the kidneys, about 5% of the dose taken is excreted unchanged by the kidneys.

Indications for use

• arterial hypertension;
• prevention of angina attacks;
• heart rhythm disturbances (supraventricular tachycardia, extrasystole);
• secondary prevention after myocardial infarction;
• hyperkinetic cardiac syndrome (including with hyperthyroidism, NCD);
• prevention of migraine attacks.

Contraindications

• hypersensitivity to metoprolol or other components of the drug, other beta-blockers;
• cardiogenic shock;
• AV block II-III degree (without artificial pacemaker);
• sinoatrial block;
• sick sinus syndrome;
• severe bradycardia;
• chronic heart failure in the stage of decompensation;
• Prinzmetal's angina;
• acute myocardial infarction (heart rate less than 45 beats/min, PQ interval more than 0.24 seconds, systolic blood pressure less than 100 mm Hg);
• lactose intolerance, lactase deficiency and glucose-galactose malabsorption syndrome;
• lactation period (see section “Use during pregnancy and lactation”);
• simultaneous intravenous administration of “slow” calcium channel blockers (SCBC) such as verapamil (see section “Interaction with other drugs”);
• age under 18 years (efficacy and safety have not been established);
• pheochromocytoma (without simultaneous use of alpha-blockers);
• patients receiving long-term or intermittent therapy with inotropic agents acting on beta-adrenergic receptors.

Directions for use and doses

The tablets are taken orally at the same time as a meal or immediately after a meal; the tablets can be divided in half (but not chewed) and filled with liquid.

Arterial hypertension

The initial daily dose is 50-100 mg in 1-2 doses (morning and evening). If the therapeutic effect is insufficient, the daily dose can be gradually increased to 100-200 mg and/or additional prescription of other antihypertensive drugs.

The maximum daily dose is 200 mg.

Secondary prevention of myocardial infarction 200 mg per day in two doses (morning and evening).

Angina pectoris, arrhythmias, prevention of migraine attacks 100 - 200 mg per day in two doses (morning and evening).

Functional cardiac disorders accompanied by tachycardia 100 mg per day in two doses (morning and evening).

For hyperthyroidism, 150-200 mg per day in 3-4 doses.

In elderly patients, with impaired renal function (creatinine clearance less than 40 ml/min), as well as if hemodialysis is necessary, the dose is not changed.

In case of severe liver dysfunction, the dose of the drug should be reduced depending on the clinical condition.

Storage conditions

Store in a place protected from light at a temperature not exceeding 25 °C.

Keep out of the reach of children.

Best before date

3 years. Do not use after expiration date.

special instructions

Use with caution in patients with chronic obstructive respiratory diseases, diabetes mellitus (especially with a labile course), Raynaud's disease and obliterating diseases of the peripheral arteries, pheochromocytoma (should be used in combination with alpha-blockers), severe renal and liver dysfunction.

During treatment with metoprolol, there may be a decrease in the production of tear fluid, which is important for patients who use contact lenses.

Completion of a long course of treatment with metoprolol should be carried out gradually (over a minimum of 10 days) under the supervision of a physician.

Concomitant use of metoprolol with MAO inhibitors is not recommended.

In combination therapy with clonidine, the latter should be discontinued several days after metoprolol is discontinued in order to avoid a hypertensive crisis. When used simultaneously with hypoglycemic agents, correction of their dosage regimen is required.

A few days before anesthesia, it is necessary to stop taking metoprolol or select an anesthetic agent with minimal negative inotropic effect.

Description

Beta1-adrenergic blocker selective.

Dosage form

Tablets are white or white with a grayish tint, slight marbling is allowed, flat-cylindrical in shape, with a chamfer on both sides and a score on one side.

Use in children

Contraindicated for use in children and adolescents under 18 years of age.

Pharmacodynamics

Cardioselective beta1-blocker without intrinsic sympathomimetic activity.
It has hypotensive, antianginal and antiarrhythmic effects. Reduces the automaticity of the sinus node, reduces heart rate, slows AV conduction, reduces myocardial contractility and excitability, reduces cardiac output, and reduces myocardial oxygen demand. Suppresses the stimulating effect of catecholamines on the heart during physical and psycho-emotional stress. Causes a hypotensive effect, which stabilizes by the end of the 2nd week of course use. For angina pectoris, metoprolol reduces the frequency and severity of attacks. Normalizes heart rhythm during supraventricular tachycardia and atrial fibrillation. In case of myocardial infarction, it helps to limit the ischemia zone of the heart muscle and reduces the risk of developing fatal arrhythmias, and reduces the possibility of relapses of myocardial infarction. Prevents the development of migraine.

When used in average therapeutic doses, in contrast to non-selective beta-blockers, it has a less pronounced effect on organs containing β2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism. When taken for many years, it reduces the concentration of cholesterol in the blood. When used in high doses (more than 100 mg/day), it has a blocking effect on both subtypes of β-adrenergic receptors.

Side effects

From the cardiovascular system: often - sinus bradycardia, decreased blood pressure, orthostatic hypotension (dizziness, sometimes loss of consciousness), postural disturbances (very rarely accompanied by fainting); rarely - decreased myocardial contractility, development (worsening) of chronic heart failure (edema, swelling of the feet and/or lower legs, shortness of breath), heart rhythm disturbances, impaired myocardial conduction, cardialgia, manifestation of vasospasm (increased peripheral circulatory disorders, coldness of the lower extremities, Raynaud's syndrome); very rarely - worsening of pre-existing AV conduction disorders, gangrene in patients with previous severe peripheral circulatory disorders.

From the nervous system: very often - increased fatigue, often - weakness, headache, slowdown in the speed of mental and motor reactions; rarely - paresthesia, convulsions, tremor, convulsions, depression, anxiety, decreased attention, drowsiness, insomnia, nightmares, confusion or short-term memory loss, hallucinations, asthenia, myasthenia gravis, impotence/sexual dysfunction, Peyronie's disease; very rarely - amnesia/memory impairment, depression, hallucinations.

From the respiratory system: often - nasal congestion; uncommon - bronchospasm when prescribed in high doses (loss of selectivity in predisposed patients), shortness of breath; rarely - rhinitis.

From the digestive system: often - nausea, vomiting, abdominal pain, dry mouth, constipation or diarrhea; rarely - dryness of the oral mucosa; very rarely - a change in taste.

From the liver and biliary tract: rarely - impaired liver function (dark urine, yellowness of the sclera or skin, cholestasis), increased activity of liver transaminases.

On the part of the organ of vision: rarely - decreased vision, decreased secretion of tear fluid, dry and sore eyes, conjunctivitis.

From the organ of hearing and labyrinthine disorders: rarely - tinnitus, hearing loss.

From the endocrine system: rarely - hyperglycemia (in patients with non-insulin-dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroid state.

From the skin and subcutaneous tissues: uncommon - skin rashes (exacerbation of psoriasis), psoriasis-like skin reactions, skin hyperemia, exanthema, photodermatosis, increased sweating, reversible alopecia.

Allergic reactions: uncommon - urticaria.

General reactions: rarely - pain in the back or joints, weight gain, decreased libido and/or potency, with abrupt cessation of treatment - withdrawal syndrome (increased angina attacks, increased blood pressure).

Laboratory data: rarely - thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, hyperbilirubinemia.

Use during pregnancy and breastfeeding

Use during pregnancy is possible only when the expected benefit to the mother outweighs the potential risk to the fetus. Metoprolol penetrates the placental barrier. Due to the possible development of bradycardia, arterial hypotension, hypoglycemia and respiratory arrest in the newborn, metoprolol should be discontinued 48-72 hours before the planned date of delivery. After delivery, it is necessary to ensure strict monitoring of the newborn’s condition for 48-72 hours.

Excreted in breast milk. Use is contraindicated during breastfeeding.

Interaction

• When used simultaneously with antihypertensive drugs, diuretics, antiarrhythmic drugs, nitrates, there is a risk of developing severe arterial hypotension, bradycardia, and AV block.
• When used simultaneously with barbiturates, the metabolism of metoprolol is accelerated, which leads to a decrease in its effectiveness.
• When used simultaneously with hypoglycemic agents, the effect of hypoglycemic agents may be enhanced.
• When used simultaneously with NSAIDs, the hypotensive effect of metoprolol may be reduced.
• When used simultaneously with opioid analgesics, the cardiodepressive effect is mutually enhanced.
• When used simultaneously with peripheral muscle relaxants, neuromuscular blockade may be enhanced.
• When used simultaneously with drugs for inhalation anesthesia, the risk of suppression of myocardial function and the development of arterial hypotension increases.
• When used simultaneously with oral contraceptives, hydralazine, ranitidine, cimetidine, the concentration of metoprolol in the blood plasma increases.
• When used simultaneously with amiodarone, arterial hypotension, bradycardia, ventricular fibrillation, and asystole are possible.
• When used simultaneously with verapamil, the plasma Cmax and AUC of metoprolol increases. The minute and stroke volume of the heart, pulse rate, and arterial hypotension decrease. Possible development of heart failure, dyspnea and sinus node block.
• With intravenous administration of verapamil while taking metoprolol, there is a risk of cardiac arrest.
• With simultaneous use, bradycardia caused by digitalis glycosides may increase.
• When used simultaneously with dextropropoxyphene, the bioavailability of metoprolol increases.
• When used concomitantly with diazepam, a decrease in clearance and an increase in the AUC of diazepam is possible, which can lead to an increase in its effects and a decrease in the speed of psychomotor reactions.
• When used simultaneously with diltiazem, the concentration of metoprolol in the blood plasma increases due to inhibition of its metabolism under the influence of diltiazem. The effect on cardiac activity is additively inhibited due to the slowing of impulse transmission through the AV node caused by diltiazem. There is a risk of developing severe bradycardia, a significant decrease in stroke and minute volume.
• When used simultaneously with lidocaine, the elimination of lidocaine may be impaired.
• When used simultaneously with mibefradil in patients with low activity of the CYP2D6 isoenzyme, it is possible to increase the concentration of metoprolol in the blood plasma and increase the risk of developing toxic effects.
• When used simultaneously with norepinephrine, epinephrine, other adrenergic and sympathomimetics (including in the form of eye drops or as part of antitussives), a slight increase in blood pressure is possible.
• When used simultaneously with propafenone, the concentration of metoprolol in the blood plasma increases and a toxic effect develops. It is believed that propafenone inhibits the metabolism of metoprolol in the liver, reducing its clearance and increasing serum concentrations.
• When used simultaneously with reserpine, guanfacine, methyldopa, clonidine, severe bradycardia may develop.
• When used simultaneously with rifampicin, the concentration of metoprolol in the blood plasma decreases.
• Metoprolol may cause a slight decrease in the clearance of theophylline in patients who smoke.
• Fluoxetine inhibits the CYP2D6 isoenzyme, which leads to inhibition of metoprolol metabolism and its accumulation, which can enhance the cardiodepressive effect and cause bradycardia. A case of the development of lethargy is described.
• Fluoxetine and mainly its metabolites are characterized by a long T1/2, so the likelihood of drug interactions remains even several days after fluoxetine is discontinued.
• There are reports of a decrease in the clearance of metoprolol from the body when used simultaneously with ciprofloxacin.
• When used simultaneously with ergotamine, peripheral circulatory disorders may increase.
• When used simultaneously with estrogens, the antihypertensive effect of metoprolol is reduced.
• With simultaneous use, metoprolol increases the concentration of ethanol in the blood and prolongs its elimination.

Overdose

Symptoms: severe sinus bradycardia, dizziness, AV block (up to the development of complete transverse block and cardiac arrest), marked decrease in blood pressure, fainting, arrhythmia, ventricular extrasystole, heart failure, cardiogenic shock, cardiac arrest, bronchospasm, loss of consciousness, coma, nausea , vomiting, cyanosis. The first signs of overdose appear 20 minutes to 2 hours after taking the drug.

Treatment: gastric lavage, taking adsorbent medications; symptomatic therapy: with a pronounced decrease in blood pressure, the patient should be in the Trendelenburg position. In case of excessive decrease in blood pressure, bradycardia and heart failure - intravenously, at intervals of 2-5 minutes, a beta-adrenergic agonist - until the desired effect is achieved or intravenous 0.5 - 2 mg of atropine. If there is no positive effect, dopamine, dobutamine or norepinephrine (norepinephrine). As subsequent measures, it is possible to administer 1-10 mg of glucagon and install an artificial pacemaker. For bronchospasm, beta2-agonists should be administered intravenously. For convulsions - slow intravenous administration of diazepam.

Hemodialysis is ineffective.

Impact on the ability to drive vehicles and operate machinery

During the treatment period, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.

Metoprolol: instructions for use

Depending on the disease, a specific dose of the active substance is prescribed. For angina pectoris, take 50 mg three times a day. Tachyarrhythmia, Thyrotoxicosis, and hyperkinetic cardiac syndrome are treated with a single or double dose of the drug at a dosage of 50 mg.

To prevent migraines, take 25 mg of the drug every 4 hours during the day, but not more than 200 mg/day.

In case of myocardial infarction, a single dose is determined by the attending physician, who objectively assessed the patient’s condition. Important indications that influence the dose size are the pulse rate, the height of the heart muscle peaks on the ECG, as well as the level of blood pressure at the time of admission to the medical facility.

People aged 60+ are generally not recommended to start treatment with a dose exceeding 50 mg per day.

Instructions for use METOPROLOL

In case of 1st degree AV block, the drug is prescribed with caution, taking into account the dromotropic effect it has. In Prinzmetal's angina, beta blockers may increase the number and duration of attacks. In patients with peripheral arterial diseases, the administration of beta-blockers may lead to an exacerbation of the course of these diseases. For elderly people, the drug is prescribed with caution in low doses and under constant medical supervision with regular monitoring of kidney function indicators. In patients with non-insulin-dependent diabetes mellitus, plasma glucose levels should be monitored. If it is necessary to prescribe Metoprolol to patients with pheochromocytoma, alpha-blockers should be prescribed simultaneously. In patients with psoriasis, while taking Metoprolol, an exacerbation of the disease is possible. If you are predisposed to severe anaphylactic reactions, regardless of their origin (especially after the administration of iodinated contrast agents or during desensitizing treatment), the use of beta-blockers may lead to increased allergic reactions and to the lack of effect from the use of epinephrine in medium doses. Before conducting a radiological examination with iodinated contrast agents, treatment with Metoprolol should be discontinued in advance. In cases where the use of metoprolol is absolutely necessary and cannot be discontinued, appropriate treatment must be prescribed. When performing general anesthesia while taking beta-blockers, the risk of developing arterial hypotension increases. If surgical intervention is necessary, the anesthesiologist should be informed about the therapy being carried out in order to select an anesthetic agent with minimal negative inotropic effect, however, discontinuation of the drug before surgery in patients with coronary artery disease is not recommended. When prescribing the drug to patients with impaired renal function, periodic monitoring of heart rate is necessary. The use of the drug may mask the symptoms of hypoglycemia and thyrotoxicosis. Patients who use contact lenses should take into account that during treatment with beta-blockers, there may be a decrease in the production of tear fluid.

Effect on driving a car and working with machinery

Use with caution while working for vehicle drivers and people whose profession involves increased concentration.

Metoprolol overdose

When taking any medication, you must follow the recommended dosage. Excessive use of Metoprolol leads to the following side effects:

• dizziness;
• a sharp decrease in blood pressure;
• arrhythmia;
• ventricular extrasystole;
• cardiogenic shock.

In addition, an overdose can lead to fainting, cardiac arrest or coma.

The fact that the patient took the medicine in a dose exceeding the norm can be guessed after 20 minutes by the symptoms. To save the patient, it is necessary to perform gastric lavage and give enterosorbent. If the patient's blood pressure drops below a critical level, dopamine and norepinephrine are used. An electrical stimulator can be installed using the transvenous method. If convulsions occur, diazepam is administered as a bolus. In case of severe bronchospasm caused by an overdose of Metoprolol, long- or short-acting beta-2 adrenergic agonists are used.

Side effects of Metoprolol

Taking Metoprolol in rare cases can cause a number of side effects:

• increased fatigue;
• drowsiness;
• decreased concentration;
• sleep disorders.

Less common are negative effects on the organ of vision: dry tear duct, dry eye syndrome and pain.

From the digestive tract - taste disturbance and decreased liver function. In addition, skin reactions in the form of photodermatosis also occur. If the patient has a manifestation of psoriasis on the skin, the affected area may increase or enter an acute stage. In some patients, the intensity of sweating increases.

From the respiratory system - nasal congestion, bronchospasm or shortness of breath appears.

Metoprolol-Teva tablet 50 mg x30

Trade name: Metoprolol-Ratiopharm International name: Metoprolol

Release forms: tablets 50, 100 mg (blisters)

Composition: metoprolol tartrate 50/100 mg

Pharmacological group: selective beta1-adrenergic blocker

Pharmacological group according to ATK: C07AB02 (Metoprolol)

Pharmacological action: antianginal, antiarrhythmic, selective beta-adrenergic blocking, hypotensive,

Indications: IHD, exertional angina, unstable angina, myocardial infarction (acute phase, as well as secondary prevention). Arterial hypertension, hypertensive crisis. CHF (compensated) in combination with diuretics, ACE inhibitors and cardiac glycosides. Rhythm disturbances (including during general anesthesia) - sinus tachycardia, ventricular and supraventricular arrhythmias (including supraventricular tachycardia, atrial fibrillation, atrial flutter, atrial tachycardia, tachyarrhythmias caused by digitalis, catecholamines, ventricular extrasystole, arrhythmias on background of mitral valve prolapse), congenital long QT syndrome. Thyrotoxicosis (complex therapy), withdrawal syndrome, migraine (prevention), tremor (essential, senile), anxiety (auxiliary treatment), akathisia against the background of antipsychotics.

Dosage regimen: Orally, with food or immediately after a meal, the tablets can be divided in half, but not chewed and washed down with liquid; for long-acting dosage forms - swallow whole, do not crush, do not break (except for metoprolol succinate and tartrate), do not chew. For arterial hypertension, the average dose is 100-150 mg/day in 1-2 doses, if necessary - 200 mg/day. For angina pectoris - 50 mg 2-3 times a day. For hyperkinetic cardiac syndrome (including thyrotoxicosis) - 50 mg 1-2 times a day. For tachyarrhythmia - 50 mg 2-3 times a day, if necessary - 200-300 mg/day. Secondary prevention of myocardial infarction - 200 mg/day. Prevention of migraine - 100-200 mg/day in 2-4 doses. To relieve paroxysmal supraventricular tachycardia, it is administered parenterally in a hospital setting. Administer slowly, a dose of 2-5 mg (1-2 mg/min). If there is no effect, the administration can be repeated after 5 minutes. Increasing the dose above 15 mg usually does not lead to greater severity of action. After stopping the attack of arrhythmia, patients are transferred to oral administration at a dose of 50 mg 4 times a day, with the first dose taken 15 minutes after stopping the IV administration. In the acute stage of myocardial infarction, immediately after hospitalization of the patient (with constant monitoring of hemodynamics: ECG, heart rate, AV conduction, blood pressure), a bolus of 5 mg should be administered intravenously, the administration should be repeated every 2 minutes until a total dose of 15 mg is reached. If well tolerated, after 15 minutes - orally, 25-50 mg every 6 hours, for 2 days. Patients who do not tolerate the full IV dose should be started on oral administration, starting with a half dose. Maintenance therapy continues at doses of 200 mg/day (in 2 doses) for 3 months to 3 years. Elderly patients are recommended to start treatment with 50 mg/day. Renal failure does not require dose adjustment. In case of liver failure, it is advisable to prescribe other beta-blockers that are not metabolized in the liver.

Contraindications: Hypersensitivity, cardiogenic shock, AV block II-III stage, SA block, SSSU, sinus bradycardia (heart rate less than 50/min), acute HF or decompensated CHF, Prinzmetal's angina, arterial hypotension, acute myocardial infarction (PQ more than 0.24 s or systolic blood pressure less than 100 mm Hg), lactation period, simultaneous use of MAO inhibitors or simultaneous intravenous administration of verapamil.

Side effects: From the nervous system: increased fatigue, weakness, headache, slower speed of mental and motor reactions. Rarely: paresthesia in the extremities (in patients with intermittent claudication and Raynaud's syndrome), tremor, convulsions, depression, anxiety, decreased attention, drowsiness, insomnia, nightmares, confusion or short-term memory loss, hallucinations, asthenia, myasthenia gravis . From the senses: rarely - decreased vision, decreased secretion of tear fluid, dry and sore eyes, conjunctivitis, tinnitus, decreased hearing. From the cardiovascular system: sinus bradycardia, decreased blood pressure, orthostatic hypotension (dizziness, sometimes loss of consciousness). Rarely - decreased myocardial contractility, development (worsening) of CHF (edema, swelling of the feet and/or lower legs, shortness of breath), heart rhythm disturbances, manifestation of vasospasm (increased peripheral circulatory disorders, coldness of the lower extremities, Raynaud's syndrome), myocardial conduction disturbances, cardialgia. Very rarely - worsening of pre-existing AV conduction disorders. From the digestive system: nausea, vomiting, abdominal pain, dry mouth, constipation or diarrhea, in some cases - impaired liver function (dark urine, yellowness of the sclera or skin, cholestasis), changes in taste. From the skin: skin rashes (exacerbation of psoriasis), psoriasis-like skin reactions, skin hyperemia, exanthema, photodermatosis, increased sweating, reversible alopecia. From the respiratory system: nasal congestion, bronchospasm when prescribed in high doses (loss of selectivity and/or in predisposed patients), shortness of breath. From the endocrine system: hyperglycemia (in patients with non-insulin-dependent diabetes mellitus), hypoglycemia (in patients receiving insulin), hypothyroid state. Allergic reactions: urticaria, skin itching, rash. Laboratory indicators: thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia, increased activity of liver enzymes, hyperbilirubinemia. Effect on the fetus: intrauterine growth retardation, hypoglycemia, bradycardia. Other: pain in the back or joints, weight gain, decreased libido and/or potency, with abrupt cessation of treatment - “smokers” syndrome; the effectiveness of beta-blockers is lower. In combination therapy with clonidine, the latter should be discontinued several days after metoprolol is discontinued in order to avoid a hypertensive crisis. At a dose above 200 mg/day, cardioselectivity decreases. Metoprolol may mask some clinical manifestations of thyrotoxicosis (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms. In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels. If necessary, beta2-adrenergic stimulants are used as concomitant therapy for patients with bronchial asthma, and alpha-blockers for pheochromocytoma. If surgical intervention is necessary, it is necessary to warn the anesthesiologist about the therapy being performed (choosing a drug for general anesthesia with minimal negative inotropic effect); discontinuation of the drug is not recommended. Reciprocal activation of the n.vagus can be eliminated by intravenous administration of atropine (1-2 mg). Drugs that reduce catecholamine reserves (for example, reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure or bradycardia. If elderly patients develop increasing bradycardia (less than 50/min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV block, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction, it is necessary to reduce the dose or stop treatment . It is recommended to discontinue therapy if skin rashes appear and depression develops caused by taking beta-blockers. The drug is discontinued gradually, reducing the dose over 10 days. With abrupt cessation of treatment, intermittent claudication syndrome, Raynaud's syndrome), pregnancy, childhood (efficacy and safety have not been determined), and old age may occur.

Interactions: Allergens used for immunotherapy or allergen extracts for skin testing increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving metoprolol. Iodine-containing radiopaque drugs for intravenous administration increase the risk of developing anaphylactic reactions. Phenytoin with intravenous administration, drugs for inhalation general anesthesia (hydrocarbon derivatives) increase the severity of the cardiodepressive effect and the likelihood of lowering blood pressure. Changes the effectiveness of insulin and oral hypoglycemic drugs, masks the symptoms of developing hypoglycemia (tachycardia, increased blood pressure). Reduces the clearance of lidocaine and xanthines (except diphylline) and increases their concentration in plasma, especially in patients with initially increased clearance of theophylline under the influence of smoking. The hypotensive effect is weakened by NSAIDs (Na+ retention and blockade of Pg synthesis by the kidneys), corticosteroids and estrogens (Na+ retention). Cardiac glycosides, methyldopa, reserpine and guanfacine, BMCC (verapamil, diltiazem), amiodarone and other antiarrhythmic drugs increase the risk of developing or worsening bradycardia, AV block, cardiac arrest and HF. Nifedipine can lead to a significant decrease in blood pressure. Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs can lead to an excessive decrease in blood pressure. Prolongs the effect of non-depolarizing muscle relaxants and the anticoagulant effect of coumarins. Tri- and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), ethanol, sedative and hypnotic drugs increase CNS depression. Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect; the break in treatment between taking MAO inhibitors and metoprolol should be at least 14 days. Non-hydrogenated ergot alkaloids increase the risk of developing peripheral circulatory disorders.

Dispensed from pharmacies: Available with prescription

Drug registration number: P No. 011845/01

Date of registration (re-registration) of the drug: 02/03/2006