1 vial

$6.80

1 tablet 50mg

16 cents

1 tablet 47.5mg CR

25 cents

Imuran, Lopressor, Betaloc, Metoprolol CR

  • Hypertension

  • Acute myocardial infarction

  • Secondary prevention in patients with coronary artery disease

  • Angina

  • Rate control (including supraventricular & ventricular arrhythmias)

PO / NG:
Tablets:
Lopressor 50mg tablets (pink), Lopressor 100mg tablets (light blue)
Controlled Release tablets:
Betaloc CR 23.75mg, 47.5mg, 95mg and 190mg tablets (white to off white)
Oral Suspension:
Metoprolol Suspension 1mg/ml
Note: only
non controlled release tablets should be crushed for NG administration.

IV:
Betaloc 5mg/5ml vial
Inject undiluted solution at a rate of 1-2mg/min; usual maximum dose 10mg
Compatible with the following IV fluids:

Normal saline 5% or 10% glucose Glucose and Sodium Chloride


ADULT DOSE
IV:
5mg injected slowly (1-2mg/min), repeated at 5 minute intervals until response obtained. Total 10-15mg usually sufficient
PO:
25mg-100mg 8-12 hourly OR 23.75mg-190mg daily of controlled release tablets

PAEDIATRIC DOSE
IV:
0.1mg/kg over 5 minutes
PO:
1-2mg/kg 6-12 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose in renal impairment [GFR (ml/min)]
<10 start with small doses
10-20 start with small doses
>20-50 dose as in normal renal function

Dose in renal replacement therapy
CAPD start with small doses
HD start with small doses
CVVHDF start with small doses

Metoprolol is a beta-adrenergic receptor blocking agent. In vitro and in vivo animal studies have shown that it has a preferential effect on beta1 adrenoreceptors, chiefly located in cardiac muscle. This preferential effect is not absolute, however, and at higher doses, metoprolol also inhibits beta2 adrenoreceptors, chiefly located in the bronchial and vascular musculature.

CONTRAINDICATIONS:

  • Sinus bradycardia,

  • Heart block greater than first degree,

  • Cardiogenic shock,

  • Overt cardiac failure

  • Asthma


WARNINGS
Cardiac Failure
Sympathetic stimulation is necessary in supporting circulatory function in congestive heart failure, and beta blockade carries the potential hazard of further depressing myocardial contractility and precipitating more severe failure.
Discontinuation of therapy
Discontinuation of therapy in a patient with coronary artery disease may lead to rebound angina, arrhythmia or myocardial infarction.
Diabetes and Hypoglycemia
Beta blockers may mask tachycardia occurring with hypoglycaemia.
Thyrotoxicosis
Beta-adrenergic blockade may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Abrupt withdrawal of beta blockade might precipitate a thyroid storm.

PRECAUTIONS
General
Metoprolol may aggravate peripheral arterial circulatory disorders.
Laboratory Tests:
No tests in addition to routine ICU tests are required
Drug/Laboratory Test Interactions:
None known

Beta blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine

Body as a Whole:
Tiredness, Fatigue
Cardiovascular System:
Bradycardia, Cold extremities, Hypotension, Leg pain
Respiratory System:
Wheeziness, Dyspnoea
Digestive System:
Diarrhoea, Nausea
Nervous System:
Dizziness, Vertigo, Light-headedness

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