What happens if I overdose Metodil XL?
Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local, or emergency room immediately. Symptoms may include difficult or slowed breathing; fainting; severe dizziness; very slow heart rate; weakness.
Proper storage of Metodil XL tartrate:
Store Metodil XL tartrate at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Metodil XL tartrate out of the reach of children and away from pets.
Overdose of Metodil XL in details
Signs and Symptoms - Overdosage of Metodil XL succinate may lead to severe bradycardia, hypotension, and cardiogenic shock. Clinical presentation can also include: atrioventricular block, heart failure, bronchospasm, hypoxia, impairment of consciousness/coma, nausea and vomiting.
Treatment – Consider treating the patient with intensive care. Patients with myocardial infarction or heart failure may be prone to significant hemodynamic instability. Beta-blocker overdose may result in significant resistance to resuscitation with adrenergic agents, including beta-agonists. On the basis of the pharmacologic actions of Metodil XL, employ the following measures.
There is very limited experience with the use of hemodialysis to remove Metodil XL, however Metodil XL is not highly protein bound.
Bradycardia: Evaluate the need for atropine, adrenergic-stimulating drugs or pacemaker to treat bradycardia and conduction disorders.
Hypotension: Treat underlying bradycardia. Consider intravenous vasopressor infusion, such as dopamine or norepinephrine.
Heart failure and shock: May be treated when appropriate with suitable volume expansion, injection of glucagon (if necessary, followed by an intravenous infusion of glucagon), intravenous administration of adrenergic drugs such as dobutamine, with α1 receptor agonistic drugs added in presence of vasodilation.
Bronchospasm: Can usually be reversed by bronchodilators.
What should I avoid while taking Metodil XL?
Avoid driving or hazardous activity until you know how Metodil XL will affect you. Your reactions could be impaired.
Drinking alcohol can increase certain side effects of Metodil XL.
Metodil XL warnings
With careful use in patients with chronic obstructive airways disease, diabetes (especially during labile), Raynaud's disease and obliterative peripheral arterial disease, pheochromocytoma (to be used in combination with alpha-blockers), pronounced renal and liver functions impairment.
During treatment with Metodil XL a production of lacrimal fluid may decreases, which is important for patients who use contact lenses.
Completion of a long course of treatment with Slow-Metodil XL CR should be gradual (at least 10 days) under the supervision of a physician.
There is not recommended for concurrent use of Metodil XL with MAO inhibitors.
Combined therapy with clonidine should receive the later stop in a few days after discontinuation of Metodil XL, in order to avoid a hypertensive crisis. Simultaneous administration of Slow-Metodil XL CR with hypoglycemic agents require correction of their dosing regimen.
A few days before the anesthesia it is necessary to stop taking this drug or find any anesthesia medication with minimal negative inotropic effects.
Patients whose work requires more attention, the application of Metodil XL outpatients should be addressed only after the evaluation of individual patient response.
What should I discuss with my healthcare provider before taking Metodil XL?
Some medical conditions may interact with Metodil XL tartrate. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:
- if you are pregnant, planning to become pregnant, or are breast-feeding
- if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
- if you have allergies to medicines, foods, or other substances
- if you have an adrenal gland tumor (pheochromocytoma), an overactive thyroid, or are scheduled to have surgery
- if you have low blood pressure or a history of heart attack, slow or irregular heartbeat, heart failure, or other heart problems; chest pain or angina; blood circulation problems; or liver problems
- if you have diabetes mellitus, chronic obstructive pulmonary disease (COPD), bronchitis, breathing problems, or a history of asthma
Some MEDICINES MAY INTERACT with Metodil XL tartrate. Tell your health care provider if you are taking any other medicines, especially any of the following:
- Amiodarone, bupropion, cimetidine, digoxin, diltiazem, diphenhydramine, disopyramide, flecainide, certain HIV protease inhibitors (eg, ritonavir), hormonal contraceptives (eg, birth control pills), hydralazine, hydroxychloroquine, ketanserin, mefloquine, mibefradil, monoamine oxidase inhibitors (MAOIs) (eg, phenelzine), phenothiazines (eg, thioridazine), propafenone, propylthiouracil, quinazolines (eg, alfuzosin), quinidine, reserpine, certain selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, paroxetine), terbinafine, or verapamil because serious side effects, such as very slow heart rate, very low blood pressure, fainting, severe dizziness, or lightheadedness when standing, may occur
- Clonidine because stopping it or Metodil XL tartrate suddenly can lead to a rapid increase in blood pressure
- Barbiturates (eg, phenobarbital), indomethacin, or phenylpropanolamine because they may decrease Metodil XL tartrate's effectiveness
- Bupivacaine, disopyramide, flecainide, hydralazine, ketanserin, or lidocaine because the risk of their side effects may be increased by Metodil XL tartrate
This may not be a complete list of all interactions that may occur. Ask your health care provider if Metodil XL tartrate may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.
Metodil XL precautions
IV administration of calcium antagonists of the verapamil-type should not be given to patients treated with β-blockers.
Generally, when treating patients with asthma, concomitant therapy with a β2-agonist (tablet and/or aerosol) should be administered. The dosage of β2-agonists may require adjustment (increase) when treatment with S-Metodil XL is started. The risk of S-Metodil XL interfering with β2-receptors is however, less than with conventional tablet formulations of β1-selective blockers.
During treatment with S-Metodil XL, the risk of interfering with carbohydrate metabolism or masking hypoglycemia is likely to be less than during treatment with conventional tablet formulations of β1-selective blockers and much less than with nonselective β-blockers.
Patients suffering from heart failure should have their decompensation treated both before and during treatment.
Very rarely, a preexisting AV conduction disorder of moderate degree may become aggravated (possibly leading to AV block).
If the patients develop increasing bradycardia, S-Metodil XL should be given in lower doses or gradually withdrawn.
S-Metodil XL may aggravate the symptoms of peripheral arterial circulatory disorders, mainly due to its blood pressure lowering effect.
Where S-Metodil XL is prescribed for a patient known to be suffering from a phaeochromocytoma, an α-blocker should be given concomitantly.
Prior to surgery, the anesthetist should be informed that the patient is receiving S-Metodil XL. It is not recommended to stop β-blocker treatment in patients undergoing surgery.
Abrupt interruption of Metodil XL is to be avoided. Sudden withdrawal of β-blockade is hazardous, especially in high-risk patients, and may aggravate angina pectoris as well as increase the risk of myocardial infarction and sudden death. Any withdrawal of S-Metodil XL should therefore, if possible, be made gradually over at least 2 weeks when the dose is reduced by ½ in each step, down to the final dose when a 25-mg tablet is reduced to ½ tablet. The final dose should be given for at least 4 days before discontinuation. If symptoms occur, a slower withdrawal rate is recommended.
Use in pregnancy: Pregnancy category C. There are no adequate and well-controlled studies of Metodil XL or S-Metodil XL in pregnant women. Because animal reproduction studies are not always predictive of human response, use S-Metodil XL during pregnancy only if clearly needed.
Use in lactation: Racemic Metodil XL was reported to be excreted in breast milk in very small quantities. An infant consuming 1 L of breast milk daily would receive a dose of <1 mg of Metodil XL. Possible infant exposure must be considered when Metodil XL/S-Metodil XL is administered to a nursing woman.
Use in children: Safety and effectiveness of S-Metodil XL has not been established in children; hence S-Metodil XL is not recommended for use in this population.
What happens if I miss a dose of Metodil XL?
Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.
References
- DailyMed. "METOPROLOL FUMARATE: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- DrugBank. "metoprolol". http://www.drugbank.ca/drugs/DB00264 (accessed September 17, 2018).
- MeSH. "Antihypertensive Agents". https://www.ncbi.nlm.nih.gov/mesh/68... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
