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Published by: api-3797941 on Oct 17, 2008
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(me toe' proe lole)
Apo-Metoprolol (CAN), Betaloc (CAN), Lopresor (CAN), Lopressor, Novometoprol (CAN), Nu-Metop (CAN), Toprol XL Pregnancy Category C
Drug classes

Beta1-selective adrenergic blocker Antihypertensive
Therapeutic actions

Competitively blocks beta-adrenergic receptors in the heart and juxtaglomerular apparatus, decreasing the influence of the sympathetic nervous system on these tissues and the excitability of the heart, decreasing cardiac output and the release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and vasoconstrictor tone.

• • • •

Hypertension, alone or with other drugs, especially diuretics Immediate-release tablets and injection: Prevention of reinfarction in MI patients who are hemodynamically stable or within 3–10 days of the acute MI Treatment of angina pectoris Toprol XL only: Treatment of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin Contraindicated with sinus bradycardia (HR < 45 beats/min), second- or thirddegree heart block (PR interval > 0.24 sec), cardiogenic shock, CHF, systolic BP < 100 mm Hg; lactation. Use cautiously with diabetes or thyrotoxicosis; asthma or COPD; pregnancy.

Contraindications and cautions

• •

Available forms

Tablets—50, 100 mg; ER tablets—25, 50, 100, 200 mg; injection—1 mg/mL
Dosages ADULTS

• • •

Hypertension: Initially, 100 mg/day PO in single or divided doses; gradually increase dosage at weekly intervals. Usual maintenance dose is 100–450 mg/day. Angina pectoris: Initially, 100 mg/day PO in 2 divided doses; may be increased gradually, effective range 100–400 mg/day. MI, early treatment: Three IV bolus doses of 5 mg each at 2-min intervals with careful monitoring. If these are tolerated, give 50 mg PO 15 min after the last IV dose and q 6 hr for 48 hr. Thereafter, give a maintenance dosage of 100 mg PO bid. Reduce initial PO doses to 25 mg, or discontinue in patients who do not tolerate the IV doses.

• • • •

MI, late treatment: 100 mg PO bid as soon as possible after infarct, continuing for at least 3 mo and possibly for 1–3 yr. Hypertension: 50–100 mg/day PO as 1 dose. Angina: 100 mg/day PO as 1 dose. CHF: 12.5–25 mg/day Toprol XL for 2 wk; may then be increased by 25 mg every 2 wk to a maximum of 200 mg.

Extended-release tablets


Safety and efficacy not established.
Route Oral IV Onset 15 min Immediate Peak 90 min 60–90 min Duration 15–19 hr 15–19 hr

Metabolism: Hepatic; T1/2: 3–4 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine
IV facts

Preparation: No additional preparation is required. Infusion: Inject directly into vein or into tubing of running IV over 1 min. Inject as a bolus; monitor carefully; wait 2 min between doses; do not give if bradycardia of < 45 beats/min, heart block, systolic pressure < 100 mm Hg. Incompatibilities: Do not mix with amino acids, aztreonam, dopamine.
Adverse effects

• • • • • • • • • •

Allergic: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CV: CHF, cardiac arrhythmias, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal fibrosis, hepatomegaly, acute pancreatitis GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination Musculoskeletal: Joint pain, arthralgia, muscle cramp Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis Other: Decreased exercise tolerance, development of antinuclear antibodies (ANA), hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline phosphatase


Drug-drug • Increased effects of metoprolol with verapamil, cimetidine, methimazole, propylthiouracil • Increased effects of both drugs if metoprolol is taken with hydralazine • Increased serum levels and toxicity of IV lidocaine, if given concurrently • Increased risk of orthostatic hypotension with prazosin • Decreased antihypertensive effects if taken with NSAIDs, clonidine, rifampin • Decreased therapeutic effects with barbiturates • Hypertension followed by severe bradycardia if given concurrently with epinephrine Drug-lab test • Possible false results with glucose or insulin tolerance tests (oral)
Nursing considerations Assessment

• •

History: Sinus bradycardia (HR < 45 beats/min), second- or third-degree heart block (PR interval > 0.24 sec), cardiogenic shock, CHF, systolic BP < 100 mm Hg; diabetes or thyrotoxicosis; asthma or COPD; lactation Physical: Weight, skin condition, neurologic status, P, BP, ECG, respiratory status, kidney and thyroid function, blood and urine glucose Do not discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing exacerbation of angina, MI, and ventricular arrhythmias). Taper drug gradually over 2 wk with monitoring. Ensure that patient swallows the ER tablets whole; do not cut, crush, or chew them. Consult physician about withdrawing drug if patient is to undergo surgery (controversial). Give oral drug with food to facilitate absorption. Provide continual cardiac monitoring for patients receiving IV metoprolol. Do not stop taking this drug unless instructed to do so by a health care provider. Swallow the ER tablets whole; do not cut, crush, or chew them. These side effects may occur: Dizziness, drowsiness, light-headedness, blurred vision (avoid driving or dangerous activities); nausea, loss of appetite (eat frequent small meals); nightmares, depression (discuss change of medication); sexual impotence. Report difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, depression, rash, fever, sore throat.


• • • • • • • •

Teaching points

Adverse effects in Italic are most common; those in Bold are life-threatening.

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