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At the simultaneous reception of a dose of metoprolol exceeding the daily norm, within 2 hours there is nausea, vomiting, respiration is broken, consciousness is confused. There may be bronchospasm, convulsions. cardiogenic shock, atrioventricular blockade. Often develops acute heart failure, hypotension, bradycardia. There may come a stop of the heart.
To avoid serious consequences, after taking a large dose of metoprolol, first of all, you need to rinse the stomach with plenty of clean water and call an ambulance. Then, in a hospital, symptomatic treatment is performed:
- with bradycardia and a decrease in atrioventricular conductivity – intravenously injected atropine
- with a decrease in the contraction of the heart muscle – apply glucagon and dobutamine
- with arterial hypotension – use adrenomimetics
- to eliminate seizures – slowly injected intravenously with diazepam
- for suppressing bronchial spasm, inhalation with beta-adrenomimetics or intravenously injecting euphyllin
- to avoid cardiac arrest, use pacemakers.
Control of patients taking beta-blockers includes regular monitoring of heart rate and blood pressure, blood glucose in diabetic patients. If necessary, for patients with diabetes mellitus, a dose of insulin or hypoglycemic drugs prescribed inside, should be selected individually.
It is necessary to teach the patient how to calculate heart rate and instruct about the need for medical consultation at a heart rate of less than 50 beats per minute. When taking a dose above 200 mg / day reduces cardioselectivity.
With heart failure, metoprolol treatment begins only after the compensation stage has been reached.
It is possible to increase the severity of reactions of hypersensitivity (against a background of a burdened allergic anamnesis) and the absence of the effect of the administration of usual doses of epinephrine (epinephrine).
It can intensify the symptoms of peripheral arterial circulation. Cancellation of the drug is carried out gradually, reducing the dose for 10 days.
With a sharp cessation of treatment, withdrawal can occur (increased angina attacks, increased blood pressure).
Particular attention should be paid to patients with angina when removing the drug. With angina pectoris, the selected dose of the drug should provide a heart rate at rest within 55-60 beats/min, with a load – no more than 110 beats / min.
Patients using contact lenses should take into account that, against the background of beta-blocker therapy, tear production can be reduced.
Metoprolol may mask certain clinical manifestations of hyperthyroidism (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated since it can strengthen symptoms.
In diabetes mellitus can mask tachycardia caused by hypoglycemia. Unlike non-diligent beta-blockers, it does not actually increase insulin-induced glycemia and does not delay the restoration of blood glucose to normal levels.
If it is necessary to prescribe to patients with bronchial asthma, beta 2 -adrenostimulants are used as concomitant therapy; when pheochromocytoma – alpha-adrenoblockers.
If it is necessary to perform a surgical procedure, it is necessary to warn the anesthesiologist about the therapy (choice of a means for general anesthesia with minimal negative inotropic action), drug discontinuation is not recommended.
Drugs that reduce the reserves of catecholamines (for example, reserpine), can enhance the action of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision for the detection of excessive lowering of blood pressure and bradycardia. In elderly patients – it is recommended to regularly monitor liver function. Correction of the dosing regimen is required only in the case of an elderly patient with an increasing bradycardia (less than 50 beats per minute), a marked decrease in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe disorders liver function, sometimes it is necessary to stop treatment.
Patients with severe renal failure are advised to monitor kidney function.
Special monitoring of the condition of patients with depressive disorders taking metoprolol should be carried out; In the case of development of depression caused by the use of beta-blockers, it is recommended to stop therapy.
Due to the lack of sufficient clinical data, the drug is not recommended for use in children.
Impact on the ability to drive vehicles and manage mechanisms
At the beginning of metoprolol treatment, patients may experience dizziness, fatigue. In this case, they should refrain from driving vehicles and practice potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions. In the future, the definition of dose safety is carried out individually.
At pregnancy appoint or nominate under strict indications taking into account a parity or ratio favours / risk (in connection with the development of a fetus of a bradycardia, an arterial hypotension, a hypoglycemia). At the same time, careful monitoring is carried out, especially for fetal development. Strict monitoring of newborns is necessary within 48-72 hours after delivery.
Influence of metoprolol on the newborn, with breastfeeding, has not been studied, therefore, women taking metoprolol should stop breastfeeding.
Application in childhood
– age under 18 years (efficiency and safety not established).
In case of violations of kidney function
With violations of liver function
When Its Use Is Dangerous
This beta-blocker is categorically contraindicated in the syndrome of weakness of the sinus node, persistent sinus bradycardia, when the pulse is below 60 beats / min, arterial hypotension (at a systolic pressure below 100 mm r.st.), hypersensitivity, synotrial blockade, heart failure in the decompensation stage , atrioventricular blockade of II and III degree, cardiogenic shock, pronounced violations of the process of blood movement in the circulatory system.
At pregnancy and thoracal feeding the attending physician can appoint reception of this medicine only when the risk of illness of the woman is above danger of influence on a fetus or the child of possible by-effects.
With renal failure, metoprolol can be used.
In hepatic pathologies, this drug is best replaced with another beta-blocker, which is metabolized outside the liver.
Suffering from diabetes and Raynaud’s disease are cautiously prescribed this medicine.
People who use contact lenses should take into account that metoprolol may reduce the production of a lacrimal secretion.
Interaction With Other Substances
In the treatment of metoprolol and the simultaneous use of other drugs, it should be remembered that its effect may increase or decrease, or even the opposite effect.
For example, substances that cause allergies are enhanced in action and can cause a severe allergic reaction. Contraceptives are taken internally, antacids – increase the concentration of metoprolol in the blood, and rifampicin – reduces.
Cardiac funds based on digitalis in combination with metoprolol reduce atrioventricular conductivity. Nonsteroidal anti-inflammatory drugs reduce the antihypertensive effect. The possibility of hypotension and bradycardia can cause painkillers and antiarrhythmics.
Other drugs on the pressure can cause persistent hypotension. The use of alcohol during treatment with metoprolol will lead to an intensification of central nervous system depression.
Also metoprolol reduces the strength of lidocaine, changes the effectiveness of insulin-containing drugs and increases the possibility of progressing hypoglycemia.