Metocard, pills 50mg, 30pcs

Composition

1 tablet contains:

metoprolol tartrate 50 mg.

Auxiliary substances:

lactose,

povidone,

talc,

magnesium stearate,

microcrystalline cellulose,

rice starch.

Pharmacological action

Metocardium – antiarrhythmic, hypotensive, antianginal.

Selectively blocks beta_-1-adrenergic receptors, interferes with the action of endogenous catecholamines, and inhibits the activity of the renin-angiotensin system.

Reduces minute volume and heart rate. Inhibits central sympathetic impulses. It does not have a membrane-stabilizing effect and does not have internal sympathomimetic activity.

Pharmacokinetics

It is rapidly and almost completely absorbed from the gastrointestinal tract. cmax and T_max when taking Metocard 100 mg or Metocard retard are 99.4±33 ng/mg and 1.58±0.55 h, or 152.9±72.8 ng/ml and 2.75±0.87 h. Protein binding is 11-12%. It is metabolized in the liver, T_1/2 — 3.5 hours. It is mainly excreted by the kidneys (95%). Passes through the placenta.

Indications

Arterial hypertension, CHD, heart failure

Contraindications

• pulse less than 50 beats per minute
• severe heart failure
• bronchial asthma
• severe liver and/or kidney function disorders
• hypersensitivity to Metocard.

Side effects

From the nervous system and sensory organs: headache, dizziness, nightmares, insomnia, depression, short-term amnesia, disorientation, paresthesia; visual impairment, dry eyes, tinnitus.

From the cardiovascular system and blood (hematopoiesis, hemostasis): bradycardia, palpitation, hypotension, violation of AV conduction, circulatory insufficiency, thrombocytopenia, agranulocytosis.

Respiratory system disorders: bronchospasm, suffocation.

Gastrointestinal disorders: dry mouth, heartburn, flatulence, stomach pain, vomiting, constipation/diarrhea.

Allergic reactions: itching, rash, psoriatic skin changes.

Others: Peyronie’s disease, myalgia, alopecia.

Interaction

Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The interval between taking MAO inhibitors and metoprodol should be at least 14 days.

Simultaneous intravenous use of verapamil may cause cardiac arrest. Simultaneous use of nifedipine leads to a significant decrease in blood pressure.

Concomitant use of Metocard with inhaled general anesthesia agents (hydrocarbon derivatives) increases the risk of myocardial function suppression and hypotension; beta-adrenostimulants, theophylline, cocaine, estrogens (sodium retention), Indometacin, and other NSAIDs (sodium retention and blocking prostaglandin synthesis by the kidneys) weaken the hypotensive effect.

There is an increase in the depressive effect on the central nervous system when used simultaneously with ethanol ; a summation of the cardiodepressive effect – with general anesthesia; an increase in the risk of peripheral circulatory disorders – with ergot alkaloids.

When taken together with oral hypoglycemic agents, their effect may decrease; with insulin, it may increase the risk of hypoglycemia, increase its severity and duration, and mask some symptoms of hypoglycemia (tachycardia, sweating, increased blood pressure).

When combined with antihypertensive agents, diuretics, nitroglycerin or slow calcium channel blockers, a sharp decrease in blood pressure may develop (special caution is necessary when combined with prazosin).

When using Metocardia with verapamil, diltiazem, antiarrhythmic agents (amiodarone), reserpine, alpha-methyldopa, clonidine, guanfacine, general anesthesia and cardiac glycosides, an increase in the severity of heart rate reduction and suppression of AV conduction is observed.

If metoprolol and clonidine are taken simultaneously, then when metoprolol is discontinued, clonidine is discontinued after a few days (due to the risk of withdrawal syndrome).

Inducers of microsomal liver enzymes (rifampicin, barbiturates) lead to an increase in metoprolol metabolism, a decrease in the concentration of metoprolol in blood plasma and a decrease in the effect. Inhibitors of microsomal liver enzymes (cimetidine, oral contraceptives, phenothiazines) – increase the concentration of metoprolol in blood plasma.

Allergens used for immunotherapy or allergen extracts for skin tests when combined with metoprolol increase the risk of systemic allergic reactions or anaphylaxis; iodine-containing radiopaque substances for intravenous use-increase the risk of anaphylactic reactions.

Metoprolol with simultaneous use reduces the clearance of xanthine (except diphylline), especially with an initially increased clearance of theophylline under the influence of smoking; reduces the clearance of lidocaine, increases the concentration of lidocaine in blood plasma.

Metocard, when used simultaneously, enhances and prolongs the effect of antidepolarizing muscle relaxants, and prolongs the anticoagulant effect of coumarins.

When Metocardia is co-administered with ethanol, the risk of a marked decrease in blood pressure increases.

Tri-and tetracyclic antidepressants, antipsychotic drugs (neuroleptics), sedatives and sleeping pills when used together with metoprolol increase CNS depression.

How to take, course of use and dosage

The drug is taken orally at the same time as a meal or immediately after a meal. Tablets can be divided in half, but not chewed, and washed down with liquid.

The dose is determined individually depending on tolerability and therapeutic efficacy. The maximum dose is 400 mg / day.

In patients with arterial hypertension, the initial dose is 50-100 mg / day in 1-2 divided doses. If necessary, the daily dose is gradually increased to 100-200 mg. In the absence of a satisfactory therapeutic effect, Metocard can be administered in combination with other antihypertensive agents. The maximum daily dose is 200 mg.

For angina pectoris, arrhythmias, and the prevention of migraine attacks,100-200 mg/day is prescribed. in 2 sessions (morning and evening).

For secondary prevention of myocardial infarction, a dose of 200 mg/day is prescribed. in 2 sessions (morning and evening).

In case of functional cardiac disorders accompanied by tachycardia, the drug is prescribed at a dose of 100 mg / day. in 2 sessions (morning and evening).

In elderly patients, with impaired renal function, as well as if hemodialysis is necessary, no dose adjustment is required.

In patients with impaired liver function, the dose of the drug should be reduced depending on the clinical condition.

Overdose

Symptoms: severe sinus bradycardia, dizziness, nausea, vomiting, cyanosis, marked decrease in blood pressure, arrhythmia, ventricular ecstasystole, bronchospasm, syncope, acute overdose – cardiogenic shock, loss of consciousness, coma, AV block (up to the development of complete transverse block and cardiac arrest), cardialgia. The first signs of overdose appear in 20 minutes-2 hours after taking the drug. Treatment: gastric lavage and use of adsorbents, symptomatic therapy: with a pronounced decrease in blood pressure, the patient should be in the Trendelenburg position; in case of excessive decrease in blood pressure, bradycardia and heart failure-intravenous use (with an interval of 2-5 minutes) of beta-adrenostimulants – until the desired effect is achieved or intravenous use of 0.5-2 mg of atropine sulfate. In the absence of a positive effect – the introduction of dopamine, dobutamine or norepinephrine (norepinephrine). As a follow-up, it is possible to prescribe 1-10 mg of glucagon, setting up a transvenous intracardial electrostimulator. In case of bronchospasm, intravenous a2-adrenergic stimulants should be administered.

Metoprolol is poorly excreted by hemodialysis.

Special instructions

Monitoring of patients taking Metocard includes regular monitoring of heart rate and blood pressure, blood glucose in patients with diabetes mellitus. If necessary, the dose of insulin or oral hypoglycemic drugs for patients with diabetes should be selected individually.

The patient should be trained in the method of calculating heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min. When taking a dose higher than 200 mg/day, cardioselectivity decreases.

In heart failure, treatment with metoprolol begins only after reaching the compensation stage.

It is possible to increase the severity of hypersensitivity reactions (against the background of a burdened allergic history) and the lack of effect from the introduction of conventional doses of epinephrine (epinephrine).

Against the background of taking Metocardia, symptoms of peripheral arterial circulation disorders may increase.

Discontinuation of the drug is carried out gradually, reducing the dose over 10 days.

If treatment is abruptly discontinued, withdrawal symptoms may occur (increased angina attacks, increased blood pressure). Special attention should be paid to patients with angina pectoris when discontinuing the drug.

With angina pectoris, the selected dose of the drug should provide a resting heart rate in the range of 55-60 beats / min, with a load of no more than 110 beats / min.

Patients who use contact lenses should take into account that against the background of treatment with beta-blockers, tear fluid production may decrease.

Metoprolol may mask some clinical manifestations of hyperthyroidism (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated, as it can increase symptoms.

In diabetes mellitus, Metocardia can mask tachycardia caused by hypoglycemia.Unlike non-selective beta-blockers, it practically does not increase insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentration to normal levels.

If necessary, prescribe stimulants to patients with bronchial asthma as concomitant therapy ? 2-adrenergic receptors; with pheochromocytoma-alpha-blockers.

If surgical intervention is necessary, it is necessary to warn the anesthesiologist about the therapy being performed (choosing a general anesthesia agent with minimal negative inotropic effect), and discontinuing the drug is not recommended.

Drugs that reduce the supply of catecholamines (for example, reserpine) can increase the effect of beta-blockers, so patients taking such combinations of drugs should be constantly monitored by a doctor for excessive lowering of blood pressure and bradycardia.

In elderly patients, regular monitoring of liver function is recommended. Correction of the dosage regimen is required only if an elderly patient develops increasing bradycardia (less than 50 beats / min), a pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), AV block, bronchospasm, ventricular arrhythmias, severe liver function disorders, and sometimes it is necessary to stop treatment.

Monitoring of renal function is recommended for patients with severe renal insufficiency.

Special monitoring should be carried out for patients with depressive disorders taking metoprolol; in case of depression caused by taking beta-blockers, it is recommended to stop therapy.

The drug should be used with caution in patients with severe liver function disorders.

The drug should be used with caution in patients with severe renal impairment.

The safety and efficacy of the drug in children and adolescents under 18 years of age has not been established.

At the beginning of treatment with metoprolol, patients may experience dizziness and fatigue. In this case, they should refrain from driving vehicles and engaging in potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions. In the future, this issue should be resolved after evaluating the individual patient’s response to the therapy.

Form of production

Tablets

Storage conditions

The drug should be stored in a dry place protected from light at a temperature not exceeding 25°C.

Shelf

life is 3 years.

Active ingredient

Metoprolol

Conditions of release from pharmacies

By prescription

Dosage form

Tablets

Purpose

For adults as directed by your doctor

Indications

Migraine, Arrhythmia, Hypertension, Angina