What is Metoprololsuccinaat retard A?
Metoprololsuccinaat retard A is used alone or together with other medicines to treat high blood pressure (hypertension). High blood pressure adds to the workload of the heart and arteries. If it continues for a long time, the heart and arteries may not function properly. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. A lower blood pressure can reduce the risk of strokes and heart attacks.
Metoprololsuccinaat retard A is also used to treat severe chest pain (angina) and lowers the risk of repeated heart attacks. It is given to people who have already had a heart attack. In addition, Metoprololsuccinaat retard A is used to treat patients with heart failure.
Metoprololsuccinaat retard A is a beta-blocker. It works by affecting the response to nerve impulses in certain parts of the body, like the heart. As a result, the heart beats slower and decreases the blood pressure. When the blood pressure is lowered, the amount of blood and oxygen is increased to the heart.
Metoprololsuccinaat retard A is available only with your doctor's prescription.
Metoprololsuccinaat retard A indications
Hypertension
Metoprololsuccinaat retard A tartrate tablets, USP are indicated for the treatment of hypertension. They may be used alone or in combination with other antihypertensive agents.
Angina Pectoris
Metoprololsuccinaat retard A tartrate tablets, USP are indicated in the long-term treatment of angina pectoris.
Myocardial Infarction
Metoprololsuccinaat retard A tartrate tablets, USP are indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality when used alone or in conjunction with intravenous Metoprololsuccinaat retard A.
Oral Metoprololsuccinaat retard A tartrate tablets, USP therapy can be initiated after intravenous Metoprololsuccinaat retard A therapy or, alternatively, oral treatment can begin within 3 to 10 days of the acute event.
How should I use Metoprololsuccinaat retard A?
Use Metoprololsuccinaat retard A tartrate as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Metoprololsuccinaat retard A tartrate is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Metoprololsuccinaat retard A tartrate at home, a health care provider will teach you how to use it. Be sure you understand how to use Metoprololsuccinaat retard A tartrate. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions.
- Do not use Metoprololsuccinaat retard A tartrate if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged.
- Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal.
- If you miss a dose of Metoprololsuccinaat retard A tartrate, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.
Ask your health care provider any questions you may have about how to use Metoprololsuccinaat retard A tartrate.
Uses of Metoprololsuccinaat retard A in details
Use: Labeled Indications
Angina: Long-term treatment of angina pectoris.
Heart failure with reduced ejection fraction (ER oral formulation): Treatment of stable, symptomatic (NYHA class II or III) heart failure of ischemic, hypertensive, or cardiomyopathic origin to reduce the rate of mortality plus hospitalization in patients already receiving angiotensin-converting enzyme inhibitors, diuretics, and/or digoxin.
Hypertension: Management of hypertension. Note: Beta-blockers are not recommended as first-line therapy (ACC/AHA [Whelton 2017]).
Myocardial infarction: Treatment of hemodynamically stable acute myocardial infarction to reduce cardiovascular mortality (injection to be used in combination with Metoprololsuccinaat retard A oral maintenance therapy).
Off Label Uses
Atrial fibrillation/flutter
Based on the 2014 American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for the management of patients with atrial fibrillation (AF), the use of beta-blockers, including Metoprololsuccinaat retard A, for ventricular rate control in patients with paroxysmal, persistent, or permanent AF is effective and recommended.
Atrial fibrillation prevention after cardiac surgery
Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for coronary artery bypass graft surgery, beta-blockers are recommended to help prevent postoperative atrial fibrillation.
Hypertrophic cardiomyopathy
Based on the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guideline for the diagnosis and treatment of hypertrophic cardiomyopathy, a beta blocker (eg, Metoprololsuccinaat retard A) is an effective and recommended agent for the treatment of symptoms (eg, angina, dyspnea) in patients with obstructive or nonobstructive hypertrophic cardiomyopathy.
Marfan syndrome with aortic aneurysm
Based on the American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery (ACCF/AHA/AATS) guideline for the diagnosis and management of patients with thoracic aortic disease, a beta blocker (eg, Metoprololsuccinaat retard A) is an effective and recommended agent to reduce the rate of aortic dilatation in patients with Marfan syndrome and aortic aneurysm, unless a contraindication exists.
Migraine prophylaxis
Data from small, randomized, active-controlled trials support the use of Metoprololsuccinaat retard A for prevention of migraines.
Based on evidence-based guidelines for pharmacologic treatment for episodic migraine prevention in adults from the American Academy of Neurology and the American Headache Society, Metoprololsuccinaat retard A is effective for migraine prevention in adults.
Supraventricular tachycardia (eg, atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia, focal atrial tachycardia)
Based on the American College of Cardiology/American Heart Association/Heart Rhythm Society (ACC/AHA/HRS) guidelines for the management of adult patients with supraventricular tachycardia, the use of an oral or intravenous beta-blocker, including Metoprololsuccinaat retard A, is effective and recommended for a variety of symptomatic supraventricular tachycardias (atrioventricular nodal reentrant tachycardia [AVNRT], atrioventricular reentrant tachycardia [AVRT], focal atrial tachycardia [AT], and multifocal atrial tachycardia [MAT]). In patients without pre-excitation, intravenous Metoprololsuccinaat retard A is recommended for acute treatment in hemodynamically stable patients and oral Metoprololsuccinaat retard A is recommended for ongoing management of symptomatic supraventricular tachycardias in patients who are not candidates for, or prefer not to undergo, catheter ablation.
Intravenous or oral Metoprololsuccinaat retard A may be useful for rate control in the acute treatment or ongoing management of hemodynamically stable patients with atrial flutter.
Thyrotoxicosis
Based on the American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis, beta-blockers, including Metoprololsuccinaat retard A, are effective and recommended in the treatment of symptomatic thyrotoxicosis. Beta-blockers should also be considered in asymptomatic patients who are at increased risk of complications due to worsening hyperthyroidism.
Ventricular arrhythmias
Based on the American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) guideline for management of patients with ventricular arrhythmias and prevention of sudden cardiac death, beta-blockers are effective for control of ventricular arrhythmias and ventricular premature beats.
Metoprololsuccinaat retard A description
Metoprololsuccinaat retard A is a cardioselective β1-adrenergic blocking agent used for acute myocardial infarction (MI), heart failure, angina pectoris and mild to moderate hypertension. It may also be used for supraventricular and tachyarrhythmias and prophylaxis for migraine headaches. Metoprololsuccinaat retard A is structurally similar to bisoprolol, acebutolol and atenolol in that it has two substituents in the para position of the benzene ring. The β1-selectivity of these agents is thought to be due in part to the large substituents in the para position. At low doses, Metoprololsuccinaat retard A selectively blocks cardiac β1-adrenergic receptors with little activity against β2-adrenergic receptors of the lungs and vascular smooth muscle. Receptor selectivity decreases with higher doses. Unlike propranolol and pindolol, Metoprololsuccinaat retard A does not exhibit membrane-stabilizing or intrinsic sympathomimetic activity. Membrane-stabilizing effects are only observed at doses much higher than those needed for β-adrenergic blocking activity. Metoprololsuccinaat retard A possesses a single chiral centre and is administered as a racemic mixture.
Metoprololsuccinaat retard A dosage
Metoprololsuccinaat retard A Dosage
Generic name: Metoprololsuccinaat retard A SUCCINATE 25mg
Dosage form: tablet, extended release
The information at Drugs.com is not a substitute for medical advice. Always consult your doctor or pharmacist.
Metoprololsuccinaat retard A is an extended-release tablet intended for once daily administration. For treatment of hypertension and angina, when switching from immediate-release Metoprololsuccinaat retard A to Metoprololsuccinaat retard A, use the same total daily dose of Metoprololsuccinaat retard A. Individualize the dosage of Metoprololsuccinaat retard A. Titration may be needed in some patients.
Metoprololsuccinaat retard A tablets are scored and can be divided; however, do not crush or chew the whole or half tablet.
Hypertension
Adults: The usual initial dosage is 25 to 100 mg daily in a single dose. The dosage may be increased at weekly (or longer) intervals until optimum blood pressure reduction is achieved. In general, the maximum effect of any given dosage level will be apparent after 1 week of therapy. Dosages above 400 mg per day have not been studied.
Pediatric Hypertensive Patients ≥ 6 Years of age: A pediatric clinical hypertension study in patients 6 to 16 years of age did not meet its primary endpoint (dose response for reduction in SBP); however, some other endpoints demonstrated effectiveness. If selected for treatment, the recommended starting dose of Metoprololsuccinaat retard A is 1 mg/kg once daily, but the maximum initial dose should not exceed 50 mg once daily. Dosage should be adjusted according to blood pressure response. Doses above 2 mg/kg (or in excess of 200 mg) once daily have not been studied in pediatric patients.
Metoprololsuccinaat retard A is not recommended in pediatric patients < 6 years of age.
Angina Pectoris
Individualize the dosage of Metoprololsuccinaat retard A. The usual initial dosage is 100 mg daily, given in a single dose. Gradually increase the dosage at weekly intervals until optimum clinical response has been obtained or there is a pronounced slowing of the heart rate. Dosages above 400 mg per day have not been studied. If treatment is to be discontinued, reduce the dosage gradually over a period of 1 - 2 weeks.
Heart Failure
Dosage must be individualized and closely monitored during up-titration. Prior to initiation of Metoprololsuccinaat retard A, stabilize the dose of other heart failure drug therapy. The recommended starting dose of Metoprololsuccinaat retard A is 25 mg once daily for two weeks in patients with NYHA Class II heart failure and 12.5 mg once daily in patients with more severe heart failure. Double the dose every two weeks to the highest dosage level tolerated by the patient or up to 200 mg of Metoprololsuccinaat retard A. Initial difficulty with titration should not preclude later attempts to introduce Metoprololsuccinaat retard A. If patients experience symptomatic bradycardia, reduce the dose of Metoprololsuccinaat retard A. If transient worsening of heart failure occurs, consider treating with increased doses of diuretics, lowering the dose of Metoprololsuccinaat retard A or temporarily discontinuing it. The dose of Metoprololsuccinaat retard A should not be increased until symptoms of worsening heart failure have been stabilized.
More about Metoprololsuccinaat retard A (Metoprololsuccinaat retard A)
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Consumer resources
- Toprol
- Metoprololsuccinaat retard A extended-release tablets
- Metoprololsuccinaat retard A
- Metoprololsuccinaat retard A (Advanced Reading)
- Other brands: Metoprololsuccinaat retard A Tartrate, Metoprololsuccinaat retard A Succinate ER, Lopressor
Professional resources
- Metoprololsuccinaat retard A (FDA)
- Metoprololsuccinaat retard A Succinate (AHFS Monograph)
Related treatment guides
- Heart Failure
- Angina
- Angina Pectoris Prophylaxis
- High Blood Pressure
- Left Ventricular Dysfunction
- More (2) »
Metoprololsuccinaat retard A interactions
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What other drugs will affect Metoprololsuccinaat retard A?
Catecholamine Depleting Drugs
Catecholamine depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) may have an additive effect when given with beta-blocking agents. Observe patients treated with Metoprololsuccinaat retard A plus a catecholamine depletor for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension.
CYP2D6 Inhibitors
Drugs that inhibit CYP2D6 such as quinidine, fluoxetine, paroxetine, and propafenone are likely to increase Metoprololsuccinaat retard A concentration. In healthy subjects with CYP2D6 extensive metabolizer phenotype, coadministration of quinidine 100 mg and immediate-release Metoprololsuccinaat retard A 200 mg tripled the concentration of S-Metoprololsuccinaat retard A and doubled the Metoprololsuccinaat retard A elimination half-life. In four patients with cardiovascular disease, coadministration of propafenone 150 mg t.i.d. with immediate-release Metoprololsuccinaat retard A 50 mg t.i.d. resulted in two- to five-fold increases in the steady-state concentration of Metoprololsuccinaat retard A. These increases in plasma concentration would decrease the cardioselectivity of Metoprololsuccinaat retard A.
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 Metoprololsuccinaat retard A 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 betablocker therapy, delay the introduction of beta-blockers for several days after clonidine administration has stopped.
Metoprololsuccinaat retard A side effects
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What are the possible side effects of Metoprololsuccinaat retard A?
The following adverse reactions are described elsewhere in labeling:
- •
- Worsening angina or myocardial infarction.
- •
- Worsening heart failure.
- •
- Worsening AV block.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The adverse reaction information from clinical trials does, however, provide a basis for identifying the adverse events that appear to be related to drug use and for approximating rates.
Hypertension and Angina: Most adverse reactions have been mild and transient. The most common (>2%) adverse reactions are tiredness, dizziness, depression, diarrhea, shortness of breath, bradycardia, and rash.
Heart Failure: In the MERIT-HF study comparing Metoprololsuccinaat retard A succinate in daily doses up to 200 mg (mean dose 159 mg once-daily; n=1990) to placebo (n=2001), 10.3% of Metoprololsuccinaat retard A succinate patients discontinued for adverse events vs. 12.2% of placebo patients.
The table below lists adverse reactions in the MERIT-HF study that occurred at an incidence of ≥ 1% in the Metoprololsuccinaat retard A succinate group and greater than placebo by more than 0.5%, regardless of the assessment of causality.
Adverse Reactions Occurring in the MERIT-HF Study at an Incidence ≥ 1% in the Metoprololsuccinaat retard A Succinate Group and Greater Than Placebo by More Than 0.5%
| Metoprololsuccinaat retard A Succinate n = 1990 % of patients | Placebo n = 2001 % of patients | |
| 1.8 | 1 |
| 1.5 | 0.4 |
Post-operative Adverse Events: In a randomized, double-blind, placebo-controlled trial of 8351 patients with or at risk for atherosclerotic disease undergoing non-vascular surgery and who were not taking beta–blocker therapy, Metoprololsuccinaat retard A succinate 100 mg was started 2 to 4 hours prior to surgery then continued for 30 days at 200 mg per day. Metoprololsuccinaat retard A succinate use was associated with a higher incidence of bradycardia (6.6% vs. 2.4%; HR, 2.74; 95% CI 2.19, 3.43), hypotension (15% vs. 9.7%; HR 1.55; 95% CI 1.37, 1.74), stroke (1% vs. 0.5%; HR 2.17; 95% CI 1.26, 3.74) and death (3.1% vs. 2.3%; HR 1.33; 95% CI 1.03, 1.74) compared to placebo.
Post-Marketing Experience
The following adverse reactions have been identified during post-approval use of extended-release Metoprololsuccinaat retard A or immediate-release Metoprololsuccinaat retard A. 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.
Cardiovascular: Cold extremities, arterial insufficiency (usually of the Raynaud type), palpitations, peripheral edema, syncope, chest pain and hypotension.
Respiratory: Wheezing (bronchospasm), dyspnea.
Central Nervous System: Confusion, short-term memory loss, headache, somnolence, nightmares, insomnia, anxiety/nervousness, hallucinations, paresthesia.
Gastrointestinal: Nausea, dry mouth, constipation, flatulence, heartburn, hepatitis, vomiting.
Hypersensitive Reactions: Pruritus.
Miscellaneous: Musculoskeletal pain, arthralgia, blurred vision, decreased libido, male impotence, tinnitus, reversible alopecia, agranulocytosis, dry eyes, worsening of psoriasis, Peyronie’s disease, sweating, photosensitivity, taste disturbance.
Potential Adverse Reactions: 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 Metoprololsuccinaat retard A succinate.
Central Nervous System: 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.
Hematologic: Agranulocytosis, nonthrombocytopenic purpura, thrombocytopenic purpura.
Hypersensitive Reactions: Laryngospasm, respiratory distress.
Metoprololsuccinaat retard A contraindications
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What is the most important information I should know about Metoprololsuccinaat retard A?
You should not use this medication if you are allergic to Metoprololsuccinaat retard A, or if you have a serious heart problem such as heart block, sick sinus syndrome, or slow heart rate.
Before taking Metoprololsuccinaat retard A, tell your doctor if you have congestive heart failure, low blood pressure, circulation problems, pheochromocytoma, asthma or other breathing problems, diabetes, depression, liver or kidney disease, a thyroid disorder, or severe allergies.
Metoprololsuccinaat retard A may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.
Drinking alcohol can increase certain side effects of Metoprololsuccinaat retard A.
Do not stop taking Metoprololsuccinaat retard A without first talking to your doctor. Stopping suddenly may make your condition worse.
If you need surgery, tell the surgeon ahead of time that you are using Metoprololsuccinaat retard A.
Metoprololsuccinaat retard A is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.
If you are being treated for high blood pressure, keep using this medication even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.
Active ingredient matches for Metoprololsuccinaat retard A:
Metoprolol in Netherlands.
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).
- PubChem. "metoprolol". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- DrugBank. "metoprolol". http://www.drugbank.ca/drugs/DB00264 (accessed September 17, 2018).
Reviews
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Information checked by Dr. Sachin Kumar, MD Pharmacology
