Generic Name: Trade Name: Classification:

metoprolol Lopressor, Toprol-XL Antihypertensive, Antianginal, 1 Blocker mg/mL; ext rel tab (succinate) (XL) 25, 50, 100, 200 mg; ext rel tabs, tartrate 100 mg Hypertension: Adult PO: 50 mg bid or 100 mg/day; may give up to 200450 mg in divided doses; EXT REL: 25-100 mg daily, titrate at weekly intervals; max 400 mg/day Geriatric: PO 25 mg/day initially, increase weekly as needed Child and adolescent: 6-16 yr: PO ER 1 mg/kg up to 50 mg daily IV onset immediate PO: 2-4 hr; PO-ER: 6-12 hr; IV: 20 min

Mechanism of Action:
Lowers B/P by -blocking effects; reduces elevated renin plasma levels; blocks 2-adrenergic receptors in bronchial, vascular, smooth muscle aonly at high doses; negative chronotropic effect

Available Forms: Tabs 50, 100 mg; Inj. 1

Uses: Mild to moderate hypertension, acute MI to reduce

cardiovascular mortality, angina pectoris, NYHA class II, III heart failure Myocardial Infarction: Adult IV BOL (early treatment): 5 mg q2min X 3 then 50 mg PO 15 min after last dose and q6hr X 48 hr; (late treatment) PO maintenance50-100 mg bid for 1-3 yr Heart Failure (NYHA class II/III): Acute myocardial infarction in adults who are hemodynamically stable: PO give 5 mg within 24 of onset of symptoms, then 5 mg after 24 hr, 10 mg after 48 hr, then 10 mg daily Angina: Adult PO: 100 mg/day as a single dose or in 2 divided doses, increase weekly prn or 100 mg EXT REL daily, max 400 mg/day ext rel

Dose:

Common Side Effects:

CNS: Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue; CV: Hypotension, palpitations, CHF, dysrhythmias, bradycardia, cardiac arrest, AV block, pulmonary/peripheral

Onset: Peak:

Half-life: Duration: Route: Time/Frequency:

3-4 hr PO: 13-19 hr; PO-ER: 24 hr; IV 6-8 hr By mouth or IV BOL See dosage

edema, chest pain; EENT: Sore throat; dry, burning eyes GI: Diarrhea, nausea, vomiting, hiccups, colitis, cramps, constipation, flatulence, dry mouth; GU: Impotence; HEMA: Agranulocytosis, eosinophilia, thrombocytopenia, purpura; INTEG: Rash, purpura, alopecia, dry skin, urticaria, pruritis; RESP: Bronchospasm, dyspnea, wheezing

Elimination: Metabolized in liver; excreted in urine; crosses placenta, enters breast milk Contraindications: hypersensitivity to -blockers; cardiogenic shock; heart block (2nd, 3rd degree) sinus bradycardia; pheochromocytoma, sick sinus syndrome; BLACK BOX WARNING Abrupt discontinuation taper over 2 weeks; may cause precipitate angina; Precautions: Pregnancy (C), breastfeeding, geriatric patients, major surgery, diabetes mellitis, thyroid/renal/hepatic disease, COPD, CAD, nonallergic bronchospasm, CHF, bronchial asthma, CVA, children, depression, vasospastic angina. Interactions: DO NOT use with MAOIs; Increase: hypotension, bradycardia reserpine, hydrALAZINE, methyldopa, prazosin, amphetamines, EPINEPHrine, H2-antagonists, calcium channel blockers Increase: hypoglycemic effects insulin, oral antidiabetics; Increase: metoprolol level cimetidine; Increase: effects of benzodiazepines; Decrease: antihypertensive effects salicilates, NSAIDs; Decrease: metoprolol level barbiturates; Decrease: effects of xanthines; Drug/Food: Increase: absorbtion with food Nursing Implications: Assess: ECG directly when giving IV during initial treatment; I&O, weight daily, check for CHF; B/P during initial treatment, periodically thereafter; pulse q4hr: note rate, rhythm, quality; Apical/radial pulse before administration; notify prescriber of any significant changes in pulse <50bpm; Skin turgor, dryness of mucous membranes for hydration status; Evaluate: Therapeutic Response: decreased B/P after 1-2 wk, decreased anginal pain; Patient Teaching: To take immediately after meals; or at bedtime to prevent effect of orthostatic hypostension; Not to use OTC products containing -adrenergic stimulants unless directed by prescriber; to avoid alcohol, smoking, sodium intake; To report bradycardia, dizziness, confusion, depression, fever, sore throat, SOB, decreased vision, changes in B/P or pulse, to comply with wieght control and dietary adjustments; to carry emergency ID; to wear support hose to minimize effects of orthostatic hypotension; To report Raynaud's symptoms