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
METOPROLOL-TEVA TAB 100MG N30
Concomitant use with MAO inhibitors is not recommended due to a significant increase in antihypertensive effect. The treatment break between taking MAO inhibitors and metoprolol should be at least 14 days.
β-adrenergic stimulants, theophylline, cocaine, glucocorticoids, estrogens (sodium ion retention), indomethacin and other non-steroidal anti-inflammatory drugs (sodium ion retention and blocking renal prostaglandin synthesis) weaken the antihypertensive effect of metoprolol.
When taken together with hypoglycemic agents for oral administration, their effect may be reduced; with insulin - increasing the risk of developing hypoglycemia, increasing its severity and duration, masking some symptoms of hypoglycemia (tachycardia, increased sweating, increased blood pressure).
When combined with antihypertensive drugs, diuretics, angiotensin-converting enzyme inhibitors, nitroglycerin or blockers of “slow” calcium channels, it can lead to a significant decrease in blood pressure (special caution is required when combined with prazosin); the risk of bradycardia increases when combined with mefloquine; pronounced decrease in blood pressure and bradycardia when combined with epinephrine; a pronounced decrease in heart rate and inhibition of AV conduction up to complete blockade - when using metoprolol with verapamil, diltiazem, reserpine, methyldopa, clonidine, guanfacine and cardiac glycosides, agents for general anesthesia (along with cardiodepressive and antihypertensive effects).
Drugs that induce or inhibit CYP2D6 may affect plasma levels of metoprolol. The plasma concentration of metoprolol may increase when taken concomitantly with other drugs that are substrates for CYP2D6, for example, antiarrhythmic drugs, antihistamines, H2 receptor antagonists, antidepressants (selective serotonin reuptake inhibitors, for example, paroxetine, fluoxetine, sertraline), antipsychotics and cyclooxygenase-2 inhibitors.
Class I antiarrhythmic drugs can lead to additive negative inotropic effects with the development of severe hemodynamic side effects in patients with impaired left ventricular function (this combination should be avoided in patients with sick sinus syndrome and atrioventricular conduction disorders). Quinidine inhibits the metabolism of metoprolol in rapid metabolizers, leading to a significant increase in the concentration of metoprolol in plasma and an increase in its β-adrenergic blocking effect. Combination with amiodarone increases the risk of developing severe sinus bradycardia (including long after discontinuation of amiodarone, due to its long half-life).
If metoprolol and clonidine are taken simultaneously, then when metoprolol is discontinued, clonidine is discontinued after a few days (due to the risk of withdrawal syndrome).
Inducers of microsomal liver enzymes (rifampicin, barbiturates) lead to increased metabolism of metoprolol, a decrease in the concentration of metoprolol in the blood plasma and a decrease in the effect. Inhibitors (cimetidine, oral contraceptives, phenothiazines) - increase the concentration of metoprolol in the blood plasma.
Diphenhydramine reduces the clearance of metoprolol, enhancing its effect.
Concomitant use with high doses of phenylpropanolamine can lead to a paradoxical increase in blood pressure (up to a hypertensive crisis).
Allergens used for immunotherapy or allergen extracts for skin testing when used in combination with metoprolol increase the risk of systemic allergic reactions or anaphylaxis; iodine-containing radiocontrast agents for intravenous administration increase the risk of anaphylactic reactions.
Reduces the clearance of xanthine (except for diphylline), especially with the initially increased clearance of theophylline under the influence of smoking. Reduces the clearance of lidocaine, increases the concentration of lidocaine in the blood plasma.
Strengthens and prolongs the effect of antidepolarizing muscle relaxants; prolongs the anticoagulant effect of coumarins.
When used together with anxiolytics and drugs with hypnotic activity, the antihypertensive effect is enhanced; with ethanol, the risk of a pronounced decrease in blood pressure increases and the inhibitory effect on the central nervous system increases.
There is an increased risk of peripheral circulatory disorders with ergot alkaloids.
When used simultaneously with aldesleukin, the risk of a pronounced and sharp decrease in blood pressure increases.
With simultaneous use, the effectiveness of alprostadil is reduced.
