Indications Dosage

Listed in Dosage. Adult: PO HTN Initial: 50-100 mg/day in single or divided doses; increase slowly according to response. Maintenance: 100-200 mg/day. Extended-release 25-100 mg once daily. Angina pectoris 50-100 mg 2-3 times/day. Cardiac arrhythmias 50 mg 2-3 times/day; up to 300 mg/day in divided doses if needed. Adjunct inhyperthyroidism 50 mg 4 times/day. Migraine prophylaxis 100-200 mg/day in divided doses. Adjunct in the early management of acute MI 100 mg twice daily once clinical condition of patient is stable. Stable symptomatic heart failure As succinate: Extended release Initial: 12.5-25 mg of equiv metoprolol tartrate dose. Increase slowly as needed. Max: 20 mg once daily. IV Emergency treatment of cardiac arrhythmias Initial: 5 mg at a rate of 1-2 mg/min; repeat at 5-min intervals if needed up to a total of 10-15 mg. Maintenance via oral therapy: 50 mg 3 times/day 4-6 hr after IV regimen. Prevention or control of arrhythmias on induction of anesth2-4 mg as slow inj; repeat as needed. Max total: 10 mg. Adjunct in the early management of acute MI Administer w/in 12 hr of the onset of chest pain, 5 mg at 2-min intervals to a total of 15 mg, if tolerated. After 15 mins, initiate oral therapy at 50 mg 6 hrly for 2 days for patients who received the full IV dose. Subsequent maintenance: 100 mg PO twice daily. Click to view metoprolol Dosage by Indications May be taken with or without food. For action to be taken in the event of accidental overdose ... click to view metoprolol 2nd or 3rd degree AV block; sick sinus syndrome; decompensated heart failure; clinically relevant sinus bradycardia. Severe peripheral arterial circulatory disorders. Cardiogenic shock. Asthma. Phaeochromocytoma (without -blockade), systolic BP <100 mmHg. Metabolic acidosis. Pregnancy (2nd and 3rd trimesters). Compensated heart failure, bronchospastic disease, hepatic impairment, AV conduction disorders, bradycardia, peripheral arterial circulatory disorders. An blocker should be given concurrently in patients with phaeochromocytoma. May mask signs of acute hypoglycaemia. May mask symptoms of hyperthyroidism. Caution when used in patients with history of cardiac failure or those with minimal cardiac reserve. Avoid using anaesthetic agents that may depress the myocardium. May impair ability to drive or operate machinery. Myasthenia gravis; history of psychiatric disorder. Lactation. Avoid abrupt drug withdrawal. Bradycardia, hypotension, arterial insufficiency, chest pain, CHF, oedema, palpitation, syncope, gangrene; dizziness, fatigue, depression, confusion, headache, insomnia, short-term memory loss, nightmares, somnolence; pruritus, rash, increased psoriasis, reversible alopecia; sexual dysfunction/impotence, Peyronie's disease; diarrhoea, constipation, flatulence, GI pain, heartburn, nausea, xerostomia; agranulocytosis (rare); musculoskeletal pain; blurred vision, dry eyes, oculomucocutaneous syndrome; tinnitus; dyspnoea, bronchospasm, wheezing, rhinitis; cold extremities. Potentially Fatal: Heart failure, heart block, bronchospasm. Additive effect with catecholamine-depleting drugs e.g. reserpine and MAOIs. May antagonise 1-adrenergic stimulating effects of sympathomimetics. Additive negative effects on SA or AV nodal conduction with cardiac glycosides, nondihydropyridine calcium-channel blockers. Increased oral bioavailability with aluminium/magnesiumcontaining antacids. Paradoxical response to epinephrine may occur. Increased plasma concentrations with CYP2D6 inhibitors (e.g. bupropion, cimetidine, diphenhydramine, fluoxetine, hydroxycholoquine, paroxetine, propafenone, quinidine, ritonavir, terbinafine, thioridazine). Increased risk of hypotension and heart failure with myocardial depressant general anaesthetics (e.g. diethyl ether). Risk of pulmonary hypertension

Administration Overdosage Contraindications

Special Precautions

Adverse Drug Reactions

Drug Interactions

with vasodilators e.g. hydralazine in uraemic patients. Reduced plasma levels withrifampicin. May increase negative inotropic and negative dromotropic effect of anti-arrhythmic drugs e.g. quinidine and amiodarone. Propafenone may increase serum levels of metoprolol. Concurrent use with indomethacin may reduce the antihypertensive efficacy of -blocker. May reduce clearance of lidocaine. May increase effects of hypoglycaemics. Efficacy may be reduced by isoprenaline. Concurrent use with digoxin may lead to additive bradycardia. Potentially Fatal: Additive or synergistic effects with verapamil; increased oral bioavailability with verapamil. Exacerbation of rebound hypertension during abrupt clonidine withdrawal. Click to view more metoprolol Drug Interactions Food Interaction Pregnancy Category (US FDA) Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus. For caution against potential drug-food interactions ... click to view metoprolol

in 2nd & 3rd trimesters. Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective). MIMS Class ATC Classification Beta-Blockers / Antimigraine Preparations C07AB02 - Metoprolol ; Belongs to the class of selective beta-blocking agents. Used in the treatment of cardiovascular diseases. MOA = Metoprolol selectively inhibits -adrenergic receptors but has little or no effect on 2-receptors except in high doses. It has no membrane-stabilising nor intrinsic sympathomimetic activity. Indications Dosage Listed in Dosage. Adult: PO Benign gastric and duodenal ulceration 40 mg/day at bedtime for 4-8 wk. GERD 20 mg twice daily for 6-12 wk. May continue to prevent recurrence. Zollinger-Ellison syndrome Initial: 20 mg 6 hrly, up to 800 mg/day if needed. Dyspepsia 10 mg twice daily. IV Benign gastric and duodenal ulceration 20 mg 12 hrly. Click to view famotidine Dosage by Indications May be taken with or without food. Hypersensitivity; lactation. Impaired renal function, liver cirrhosis; pregnancy. Possibility of malignancy should be considered prior to initiating treatment as drug may mask symptoms and delay diagnosis. No safety and efficacy data is available for children <1 yr. Headache, dizziness, constipation, diarrhoea, nausea, rash, GI discomfort, fatigue, gynaecomastia, impotence. Reduced absorption of famotidine with antacids hence admin should be separated by 2 hr. Reduced absorption of ketoconazole and itraconazole. Avoid ethanol (may cause gastric mucosal irritation).

Administration Contraindications Special Precautions

Adverse Drug Reactions Drug Interactions

Pregnancy Category

(US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1 st trimester (and there is no evidence of a risk in later trimesters). MIMS Class ATC Classification Antacids, Antireflux Agents & Antiulcerants A02BA03 - Famotidine ; Belongs to the class of H2-receptor antagonists. Used in the treatment of peptic ulcer and gastro-oesophageal reflux disease (GERD). MOA - Famotidine competitively blocks histamine H2-receptors thus reducing basal, nocturnal and stimulated gastric acid secretion. Pepsin secretion is reduced resulting in decreased peptic activity. It effectively heals duodenal and gastric ulcers and prevents recurrence. Indications Dosage Listed in Dosage. Adult: PO Allergic conditions As HCl: 25-50 mg 3-4 times/day. Max: 300 mg/day. Prevention and treatment of motion sickness As diphenhydramine di (acefyllinate): Usual: 90-135 mg, may repeat if needed at intervals of at least 6 hr. Max: 540 mg/day. IV/IM Allergic conditions As 1 or 5% soln: As HCl: 10-50 mg, up to 100 mg. Not more than 400 mg/24 hr. Click to view diphenhydramine Dosage by Indications May be taken with or without food. For action to be taken in the event of accidental overdose ... click to view diphenhydramine Hypersensitivity ; neonates, lactation. Epilepsy; elderly; performing tasks which require mental alertness; angle-closure glaucoma; pyroduodenal obstruction; urinary tract obstruction; hyperthyroidism; raised intraocular pressure; CV disease; acute asthma; pregnancy. CNS depression, dizziness, headache, sedation; paradoxical stimulation in children; dryness of mouth, thickened respiratory secretion, blurring of vision, urinary retention; GI disturbances; blood dyscrasias. Masks ototoxicity produced by aminoglycosides. Increases gastric degradation of levodopa and decreases its absorption by reduction of gastric emptying. Antagonises therapeutic effects of cholinergic agents e.g. tacrine, donezepil and neuroleptics. Valerian, St. John's wort, Kava Kava and gotu kola may increase CNS depression. Potentially Fatal: Potentiates CNS depression with alcohol, barbiturates, analgesics, sedatives and neuroleptics. Additive antimuscarinic action with MAOIs, atropine and TCAs. Click to view more diphenhydramine Drug Interactions

Administration Overdosage Contraindications Special Precautions

Adverse Drug Reactions Drug Interactions

Pregnancy Category (US FDA) Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1 st trimester (and there is no evidence of a risk in later trimesters). MIMS Class Antihistamines & Antiallergics MOA - Diphenhydramine blocks histamine H1-receptors on effector cells of the GI tract, blood vessels and respiratory tract. It also causes sedation and has some anticholinergic action.