Metoprolol has no intrinsic sympathomimetic activity, and membrane-stabilizing activity is detectable only at plasma concentrations much greater than required for beta-blockade. Animal and human experiments indicate that metoprolol slows the sinus rate and decreases AV nodal conduction. The relative beta1-selectivity of metoprolol has been confirmed by the following: This contrasts with the effect of nonselective beta-blockers, which completely reverse the vasodilating effects of epinephrine.

The relationship between plasma metoprolol levels and reduction in exercise heart rate is independent of the pharmaceutical formulation. Although beta-adrenergic receptor blockade is useful in the treatment of angina , hypertension , and heart failure there are situations in which sympathetic stimulation is vital.

In patients with severely damaged hearts, adequate ventricular function may depend on sympathetic drive. In the presence of AV block, beta-blockade may prevent the necessary facilitating effect of sympathetic activity on conduction. Do not take any medicines used to treat colds or congestion without first consulting with your doctor or pharmacist.

Diabetes patients - Toprol XL may hide signs of low blood sugar, such as rapid heartbeat. Be sure to watch for other signs or low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. Check blood sugar levels closely. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.

Cold extremities, arterial insufficiency usually of the Raynaud type , palpitations, peripheral edema, syncope, chest pain and hypotension. Wheezing bronchospasm , dyspnea. Confusion, short-term memory loss, headache, somnolence, nightmares, insomnia. Nausea, dry mouth, constipation, flatulence, heartburn, hepatitis, vomiting. In addition, there are adverse reactions not listed above that have been reported with other beta-adrenergic blocking agents and should be considered potential adverse reactions to Metoprolol Succinate extended-release.

Reversible mental depression progressing to catatonia; an acute reversible syndrome characterized by disorientation for time and place, short-term memory loss, emotional lability, clouded sensorium, and decreased performance on neuropsychometrics. Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura.

Laboratory Test Findings Clinical laboratory findings may include elevated levels of serum transaminase, alkaline phosphatase, and lactate dehydrogenase. Observe patients treated with Metoprolol Succinate extended-release plus a catecholamine depletor for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension. In healthy subjects with CYP2D6 extensive metabolizer phenotype, coadministration of quinidine mg and immediate release metoprolol mg tripled the concentration of S-metoprolol and doubled the metoprolol elimination half-life.

In four patients with cardiovascular disease, coadministration of propafenone mg t. These increases in plasma concentration would decrease the cardioselectivity of metoprolol. Digitalis, Clonidine, and Calcium Channel Blockers Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate.

Concomitant use with beta-blockers can increase the risk of bradycardia. If clonidine and a beta-blocker, such as metoprolol are coadministered, withdraw the beta-blocker several days before the gradual withdrawal of clonidine because beta-blockers may exacerbate the rebound hypertension that can follow the withdrawal of clonidine.

If replacing clonidine by beta-blocker therapy, delay the introduction of beta-blockers for several days after clonidine administration has stopped [see Warnings and Precautions 5. Distribution studies in mice confirm exposure of the fetus when metoprolol tartrate is administered to the pregnant animal. These studies have revealed no evidence of impaired fertility or teratogenicity.

There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, use this drug during pregnancy only if clearly needed. How much to take For high blood pressure: The usual starting dose is one 50mg or mg tablet once a day for one week.

The dose is then usually increased to 50mg or mg once or twice daily. Follow your doctor's instructions carefully. If you are taking other prescription medicines which lower blood pressure, your doctor may need to change the dose of them to obtain the best results for you.

The usual dose is 50mg or mg taken two or three times a day. After myocardial infarction heart attack: The usual dose is mg taken twice a day, often starting with a lower dose for 2 days. The usual dose is mg a day, taken in divided doses morning and evening. Ask your doctor or pharmacist if you are unsure of the correct dose for you.

They will tell you exactly how much to take. How to take it Swallow the tablet with a glass of fluid. Taking it at the same time each day will have the best effect. Your doctor may increase the dose to 1. Larger than the mg dose in children and adolescents has not been studied. Z Metoprolol Sandoz tablets are not recommended for use in children less than 6 years of age.

The duration of treatment prescribed by your doctor. If you think that Metoprolol Sandoz Z caused by too strong or too weak effects, talk to your doctor or pharmacist. Elderly Older than 80 years of clinical studies, your gydyojas didinandamas doses have to be particularly careful if you are older than 80 years.

You have to drink a prolonged-release tablets once a day, preferably at breakfast. You can swallow the prolonged-release tablet whole or in part, but avoid them chew or crush. Metoprolol Sandoz Z always exactly as directed by your doctor. If you take a large dose of Metoprolol Sandoz Z Immediately contact your doctor or emergency doctor, who will decide this case based on the severity of the symptoms of poisoning, what measures are appropriate.

Keep the medicine container with you to the doctor to find out what materials you have taken, and the introduction of appropriate measures. Hypotensive anaesthesia for operations on the ear, nose and parotid gland. Use of intravenous metoprolol as an adjunct to sodium nitroprusside and halothane. Intravenous metoprolol and cardiac dysrhythmias.

Treatment of essential arterial hypertension. Prophylactic use of beta-adrenergic blockade in survivors of myocardial infarction. Heart and Lung A double-blind trial of metoprolol in acute myocardial infarction. Effects of practolol and metoprolol on QT interval, heart rate and arterial pressure during induction of anaesthesia.

Effects of various structurally related beta-adrenoceptor blocking agents on maximum upstroke velocity of action potential in guinea-pig papillary muscles. Archives Internationales de-Pharmacodynamie et de Therapie Disposition of the adrenergic blocker metoprolol in the late pregnant women, the amniotic fluid, the cord blood and the neonate. Metoprolol excretion into breast milk. The pharmacokinetics of metoprolol and its metabolites in dialysis patients. Comparison of two slow-release formulations of metoprolol with conventional metoprolol and atenolol in hypertensive patients.

Polymorphic metabolism of metoprolol: Plasma levels of beta-blocking drugs prior to coronary artery bypass surgery. Metoprolol and propranolol in the treatment of essential hypertension — a long term comparative study. The effects of a cardioselective metoprolol and a nonselective propranolol beta-adrenergic blocker on the response to dynamic exercise in normal men.

Interventions during and after acute myocardial infarction. Postgraduate Medical Journal 59 Suppl. In Avery GS Ed. Comparison of the antihypertensive effect of double dose of metoprolol versus the addition of hydrochlorothiazide to metoprolol. Response of the renin-angiotensin-aldosterone system to upright tilting and to intravenous frusemide: Acute effects of oral metoprolol on ventilatory function in patients with chronic obstructive lung disease.

Evaluation of metoprolol cardioselectivity: Pharmacokinetic and pharmacodynamic interactions between phenprocoumon and atenolol or metoprolol. Influence of ranitidine on plasma metoprolol and atenolol concentrations. Effect of short-term and long-term treatment with metoprolol on renal blood flow and glomerular filtration rate in hypertensive patients with a normal kidney function. Danish Medical Bulletin A comparison between metoprolol and pindolol with special reference to peripheral vascular effects.

Prolongation of survival in congestive cardiomyopathy by beta-receptor blockade. Beneficial effects of long-term beta-blockade in congestive cardiomyopathy.

Adverse effects of beta-blockade withdrawal in patients with congestive cardiomyopathy. Comparison of five beta-adrenoreceptor antagonists with different ancillary properties during sustained twice daily therapy in angina pectoris.

A two year clinical evaluation of atenolol and metoprolol in the treatment of hypertension. British Journal of Clinical Practice Diltiazem in the treatment of mild or moderate essential hypertension.

Comparison with metoprolol in a crossover double-blind trial. Regression of cardiovascular structural changes by antihypertensive treatment.

Effects of metoprolol administered as conventional tablets and as slow-release tablets in the treatment of hypertension. Journal of Cardiovascular Pharmacology 3: Clinical evaluation of the antihypertensive effect of metoprolol in combination with hydrochlorothiazide and hydralazine in an unselected hypertensive population. Ineffectiveness of beta-adrenergic blockers on ventilatory response to carbon dioxide. Metoprolol, nifedipine and the combination in stable effort angina pectoris.

Slow-release metoprolol in angina pectoris. A dose-response study on metoprolol in angina pectoris. Influence of metoprolol on myocardial uptake of free fatty acids in experimental myocardial ischemia.

Influence of beta-adrenergic blockade on the hemodynamic effects of physical training in patients with ischemic heart disease.

Beta blockade and diabetes mellitus: Metoprolol in the jejunum and ileum. Comparative effects of propranolol, timolol and metoprolol on myocardial infarct size after experimental coronary artery occlusion.

Journal of the American College of Cardiology 4: The peripheral platelet count and ADP-induced platelet aggregation response to metoprolol and propranolol as studied in young healthy male volunteers. Scandinavian Journal of Haematology ADP-induced platelet aggregation and metoprolol treatment of myocardial infarction patients. Beta-blockade in dilated cardiomyopathies: Metoprolol in the prevention of dysrhythmias during minor dental surgery. Low-dose beta blockade in the treatment of chronic cardiac failure.

Mechanisms and clinical implications. Kontrollierte Hypotension mit Metoprolol und Nitroprussid-Natrium. Selective and non-selective beta receptor blockade in the reduction of portal pressure in patients with cirrhosis and portal hypertension.

A prospective randomised trial to compare oral metoprolol with injection schlerotherapy in cirrhosis. Metoprolol in anaesthesia for oral surgery. A placebo controlled trial of metoprolol in the treatment of hypertension in pregnancy. Cardiovascular function during long-term antihypertensive adrenergic blockade. Increased cardiac output and lowered peripheral resistance during metoprolol treatment.

Antihypertensive treatment with metoprolol or hydrochlorothiazide in patients aged 60—75 years. The effects of acute or chronic ingestion of propranolol or metoprolol on the physiological responses to prolonged, submaximal exercise in hypertensive men.

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