General High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. Genetic Implications: Pronunciation: Trade
Name(s) Ther. Class. antianginals antihypertensives Pharm. Class. beta blockers Unlabeled Use(s):
Action Blocks stimulation of beta1 (myocardial)-adrenergic receptors. Does not usually affect beta2 (pulmonary, vascular, uterine)-adrenergic receptor sites. Therapeutic Effect(s):
PharmacokineticsAbsorption: Well absorbed after oral administration. Distribution: Crosses the blood-brain barrier, crosses the placenta; small amounts enter breast milk. Metabolism and Excretion: Mostly metabolized by the liver (primarily by CYP2D6; the CYP2D6 enzyme system exhibits genetic polymorphism); ~7% of population may be poor metabolizers and may have significantly ↑ metoprolol concentrations and an ↑ risk of adverse effects. Half-life: 3–7 hr. TIME/ACTION PROFILE (cardiovascular effects)
Contraindication/PrecautionsContraindicated in:
Use Cautiously in:
Adverse Reactions/Side EffectsCV: BRADYCARDIA, HF, PULMONARY EDEMA, hypotension, peripheral vasoconstriction Derm: rash EENT: blurred vision, stuffy nose Endo: hyperglycemia, hypoglycemia GI: constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, ↑ liver enzymes, nausea, vomiting GU: erectile dysfunction, ↓ libido, urinary frequency MS: arthralgia, back pain, joint pain Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares Resp: bronchospasm, wheezing Misc: drug-induced lupus syndrome * CAPITALS indicate life-threatening. Interactions (adsbygoogle = window.adsbygoogle || []).push({});Drug-Drug
Route/DosageWhen switching from immediate-release to extended-release product, the same total daily dose can be used PO (Adults): Hypertension/angina– 25–100 mg/day as a single dose initially or 2 divided doses; may be ↑ every 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). Extended-release products are given once daily. MI– 25–50 mg (starting 15 min after last IV dose) every 6 hr for 48 hr, then 100 mg twice daily. Heart failure– 12.5–25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day. Migraine prevention– 50–100 mg 2–4 times daily (unlabeled). IV (Adults): MI– 5 mg every 2 min for 3 doses, followed by oral dosing. PO (Children ≥6 yr): Hypertension– 1 mg/kg once daily (extended-release capsules); may be titrated, as needed (not to exceed 50 mg/day). Availability (generic available)Tablets (tartrate): 25 mg, 37.5 mg, 50 mg, 75 mg, 100 mg Cost: Generic: All strengths $7.18/100 Extended-release capsules (succinate; Kapspargo Sprinkle): 25 mg, 50 mg, 100 mg, 200 mg Extended-release tablets (succinate; Toprol XL): 25 mg, 50 mg, 100 mg, 200 mg Cost: Generic: 25 mg $35.68/100, 50 mg $41.93/100, 100 mg $53.95/100, 200 mg $84.54/100 Solution for injection: 1 mg/mL In Combination with: hydrochlorothiazide (Dutoprol, Lopressor HCT). See combination drugs. Assessment
Lab Test Considerations: May cause ↑ BUN, serum lipoprotein, potassium, triglyceride, and uric acid levels.
Implementation
IV Administration
Patient/Family Teaching
Evaluation/Desired Outcomes
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