Metoprolol

CHEMICAL NAME OF THE DRUG

Its chemical name is (±)1-(isopropylamino)-3-[p-(2-methoxyethyl) phenoxy]-2-propanol
succinate (2:1) (salt). Its structural formula is:

GENERIC NAME OF THE DRUG

Metoprolol

TRADE NAME(S) OF THE DRUG

Kapspargo Sprinkle, Lopressor, Toprol XL

CLASSIFICATION OF THE DRUG

Metoprolol is a selective beta-blocker; it blocks the beta-1 receptors. It is also classified as an
antianginal agent and an antihypertensive.

MECHANISM OF ACTION
Metoprolol is a selective inhibitor of beta-1 adrenergic receptors with little to no effect on beta-2
receptors. However, with a larger dose receptor selectivity disappears. Metoprolol decreases
conduction through the atrioventricular node which in turn reduces sympathetic activity.
Metoprolol is mainly lipophilic, and distribution is typical of basic lipophilic drugs. From animal
studies, it shows to be almost completely absorbed from the gastrointestinal tract when taken
orally and excretion occurs primarily via the kidneys.

THERAPEUTIC USES
Metoprolol is approved by the U.S. Food and Drug Administration to treat angina, heart failure,
myocardial infarction and hypertension. It is used for long term treatment of angina pectoris. It is
also used in treatment of stable heart failure of ischemic, hypertensive or cardiomyopathic origin
to reduce the rate of mortality. It is also effective in managing hypertension. Lastly, it is used to
treat hemodynamically stable acute myocardial infarction.

ADVERSE EFFECTS
Adverse effects from use of Metoprolol range from mild to transient. Some of the most frequent
adverse effects involving the central nervous system are tiredness, dizziness and depression.
Mental confusion and short-term memory loss have also been reported.
Adverse effects regarding the cardiovascular system are shortness of breath, bradycardia, cold
extremities, arterial insufficiency, palpations, congestive heart failure, peripheral edema,
syncope, chest pain and hypotension.
Respiratory system adverse effects are bronchospasm, wheezing and dyspnea.
Adverse effects involving the gastrointestinal systems are diarrhea, nausea, xerostomia, gastric
pain, constipation, flatulence, digestive tract disorders and heartburn.
Lastly, hypersensitive reactions have occurred which involve pruritus.

DENTAL CONSIDERATIONS
Metoprolol does affect dental treatment. There have been infrequent occurrences of xerostomia
(dry mouth) reported. Alongside, report of rare occurrences of dysgeusia, also known as
abnormal taste sensation. Contraindications I found were patients with sick sinus syndrome,
second/third-degree heart blocks, decompensated heart failure, hypotension and documented
hypersensitivity. In addition to these also take caution with patients with history of
noncompliance as the abrupt cessation of the drug can lead to withdrawal syndromes such as
angina and myocardial infarction. Patients who have used cocaine or methamphetamines have
also had contraindications to use selective beta-blockers, such as Metoprolol.

COMMENTS
Researching Metoprolol, I found some very interesting and pertinent information. I wanted to
include the note about Metoprolol and the use of anesthetic. According to Lexicomp, local
anesthetic containing a vasoconstrictor can be safely used on patients using Metoprolol. I wanted
to mention this because as hygienists it is important to be aware of any possible contraindications
if there are any regarding medications when administering local anesthetics that contain a
vasoconstrictor.
I also thought it was really important to understand that Metoprolol can cross the placenta.
Exposure to beta-blockers can increase the risk of adverse events in the neonate. If beta-blockers
are needed during pregnancy, the growth of the fetus should be monitored, and the newborn
should be monitored for 48 hours after delivery for possible bradycardia, hypoglycemia and
respiratory depression.

LIST OF REFERENCES

Metoprolol succinate - Food and Drug Administration. (n.d.). Retrieved May 7, 2023, from
https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/019962s032lbl.pdf

National Center for Biotechnology Information. (n.d.). Retrieved May 7, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK532923/

Login. (n.d.). https://online.lexi.com/lco/action/home

Haveles, E. B. (2024). Applied Pharmacology for the dental hygienist. Mosby.