Metoprolol pills 25mg 60pcs

Composition

1 tablet contains:

Active ingredients:  

metoprolol tartrate 25 mg.

Auxiliary substances:  

colloidal anhydrous silicon dioxide,

microcrystalline cellulose,

sodium carboxymethyl starch (type A),

magnesium stearate.

Shell composition:  

hypromellose,

polysorbate 80,

talc,

titanium dioxide (E 171).

Pharmacological action

Cardioselective beta-1-adrenoblocker without internal sympathomimetic activity. It has antihypertensive, antianginal and antiarrhythmic effects. Reduces the automatism of the sinus node, reduces heart rate, slows down AV conduction, reduces contractility and excitability of the myocardium, reduces the minute volume of the heart, reduces the need for oxygen in the myocardium.

Suppresses the stimulating effect of catecholamines on the heart during physical and psychoemotional stress.

Causes a hypotensive effect, which stabilizes by the end of the 2nd week of the course application. For angina pectoris, metoprolol reduces the frequency and severity of seizures. Normalizes the heart rate in supraventricular tachycardia and atrial fibrillation.

In case of myocardial infarction, it helps to limit the area of ischemia of the heart muscle and reduces the risk of fatal arrhythmias, reduces the possibility of relapses of myocardial infarction. When used in medium therapeutic doses, it has a less pronounced effect on the smooth muscles of the bronchi and peripheral arteries than non-selective beta-blockers.

Indications

-Arterial hypertension,

– prevention of angina attacks,

– cardiac arrhythmias (supraventricular tachycardia, extrasystole),

– secondary prevention after myocardial infarction,

– hyperkinetic cardiac syndrome (including hyperthyroidism, NCD).

– prevention of migraine attacks.

Contraindications

Hypersensitivity, cardiogenic shock, grade II and III AV block, sinoatrial block, chronic (decompensated) heart failure, sinus node weakness syndrome, severe sinus bradycardia (heart rate less than 60 beats / min), Prinzmetal angina, acute myocardial infarction (heart rate less than 45 beats / min, PQ interval more than 0.24 sec, systolic blood pressure less than 100 mm Hg).

Pregnancy and lactation. Simultaneous intravenous use of slow calcium channel blockers such as verapamil. Under 18 years of age. Pheochromocytoma. patients receiving long-term or intermittent therapy with inotropic agents acting on beta-adrenergic receptors.

Side effects

From the cardiovascular system:  possible bradycardia, arterial hypotension, impaired AV conduction, the appearance of symptoms of heart failure.

From the digestive system:  at the beginning of therapy, dry mouth, nausea, vomiting, diarrhea, constipation are possible; in some cases, liver function disorders may occur.

From the central nervous system and peripheral nervous system:  at the beginning of therapy, weakness, fatigue, dizziness, headache, muscle cramps, a feeling of cold and paresthesia in the extremities are possible; there may be a decrease in the secretion of tear fluid, conjunctivitis, rhinitis, depression, sleep disorders, nightmares.

From the hematopoietic system:  in some cases – thrombocytopenia.

From the endocrine system:  hypoglycemic conditions in patients with diabetes mellitus.

Respiratory system disorders:  predisposed patients may develop symptoms of bronchial obstruction.

Allergic reactions:  skin rash, itching.

Interaction

When used simultaneously:

• antiarrhythmic drugs (hedonophobia tools and amiodarone) may increase the inotropic and Chrono dromotroponoe effects;
• calcium channel blockers (verapamil, diltiazem, nifedipine) or other antiaritmikami Shutova is reduced and stroke volume of the heart, heart rate, and the on/in the introduction of verapamil there is a threat of cardiac arrest;
• barbiturates accelerates the metabolism of Metoprolol Organic matter, which reduces its efficiency,
• inducers or inhibitors of microsomal enzymes may change in the Organic matter concentration of Metoprolol in plasma decrease when receiving rifampicin – increase when taking cimetidine, ethanol, gidralazina, inhibitors of serotonin reuptake (paroxetine, fluoxetine, and sertraline), oral contraceptives;
• Indometacin and other NSAIDs, COX inhibitors may reduce antigipertenzivnye;
• calcium channel blockers, cardiac glycosides, reserpine, nitrates increases the risk of hypotension, bradycardia, AV-blockade, the negative inotropic effects;
• insulin and oral antidiabetic drugs increase the risk of hypoglycemia;
• narcotic drugs, anesthetics and other drugs that affect the Central nervous system, in particular sleeping pills (bromazepam, lorazepam), tranquilizers (chlordiazepoxide, trimetozine, tofisopam), tri – and tetracyclic antidepressants cardiodepressive mutual potentiation of the effect
• of the allergens used for immunotherapy or allergen extracts for skin tests increases the risk of severe systemic reactions and anaphylaxis;
• iodine-containing radiopaque drugs for I/V use increase the risk of anaphylactic reactions;
• norepinephrine, epinephrine and other sympathomimetics increases the risk of developing hypertension;
• of phenylpropanolamine in high doses – the paradoxical increase in blood pressure (up to a hypertensive crisis);
• clonidine – the risk of a pronounced increase in blood pressure with the sharp reversal of clonidine on the background of concomitant use of Metoprolol Organics therefore, in the event of cancellation of clonidine, a gradual discontinuation of Metoprolol Organics should begin a few days before its cancellation;
• sympathomimetic agents, ganglionic of other β-adrenergic blocker (eg, eye drops), MAO inhibitors type a careful monitoring of the patient;
• diazepam may decrease clearance and increase the AUC of diazepam that can exacerbate its effects and reduce the speed of psychomotor reactions;
• lidocaine may impair the excretion of lidocaine;
• fluoxetine leads to inhibition of Metoprolol metabolism of Organic matter and its accumulation that may enhance cardiodepressive action, and to cause bradycardia, the likelihood of drug interactions is retained even after a few days after the cancellation;
• fluoxetine. A case of lethargy is described;
• ciprofloxacin – a decrease in the clearance of Metoprolol Organic from the body;
• ergotamine may increase peripheral circulatory disorders;
• estrogen decreases the antihypertensive effect of Metoprolol Organic;
• mibefradil in patients with low activity of the CYP2D6 isoenzyme may increase the concentration of Metoprolol Organic in blood plasma and increase the risk of toxic effects.

How to take, course of use and dosage

When taken orally, the average dose is 100 mg / day in 1-2 doses. If necessary, the daily dose is gradually increased to 200 mg. With intravenous use, a single dose is 2-5 mg; in the absence of an effect, repeated use is possible after 5 minutes.

Maximum doses:  when taken orally, the daily dose is 400 mg, with intravenous use, a single dose is 15-20 mg.

Overdose

Symptoms:  severe sinus bradycardia, dizziness, AV block (up to the development of complete transverse block and cardiac arrest), marked decrease in blood pressure, syncope, arrhythmia/ventricular extrasystole, acute heart failure; cardiogenic shock, cardiac arrest, bronchospasm, loss of consciousness, coma, nausea, vomiting, cyanosis, hypoglycemia, convulsions. The first signs of overdose appear 20 minutes -2 hours after taking the drug.

Treatment:  gastric lavage and use of adsorbent drugs, 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 — dopamine, dobutamine or norepinephrine. As a follow – up, a transvenous intracardial electrostimulator may be installed. In case of bronchospasm, intravenous beta-adrenomimetics should be administered. For convulsions-slow intravenous use of diazepam. Hemodialysis is ineffective.

Special instructions

With caution: diabetes mellitus, metabolic acidosis, bronchial asthma, chronic obstructive pulmonary disease, enphysema, chronic obstructive bronchitis, liver and kidney disorders (creatinine clearance less than 40 ml/min), myasthenia gravis, pheochromocytoma (with simultaneous use of alpha-blockers), thyrotoxicosis, depression (including history), psoriasis, peripheral circulatory disorders (intermittent claudication, Raynaud’s syndrome), pregnancy, childhood (efficacy and safety not determined), elderly age, burdened allergic history, grade I AV block.

Monitoring of patients taking beta-blockers includes monitoring of heart rate and blood pressure (at the beginning of use – daily, then – 1 time in 3-4 months), blood glucose concentration in patients with diabetes mellitus (1 time in 4-5 months). 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/min.

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

In elderly patients, it is recommended to monitor renal function (1 time in 4-5 months).

It may increase the symptoms of peripheral arterial circulation disorders.

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.

In smokers, the effectiveness of beta-blockers is lower.

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

In diabetes mellitus, it 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 values.

If necessary, in patients with concomitant bronchial asthma, beta-2 – adrenomimetics should be additionally used; in pheochromocytoma, alpha-blockers should be used.

If surgical intervention is necessary, it is necessary to warn the anesthesiologist about taking Metoprolol Organica (the choice of a drug for general anesthesia with minimal negative inotropic effect), and discontinuation of the drug is not recommended.

In case of increasing bradycardia (less than 50/min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV block, bronchospasm, ventricular arrhythmias, severe liver and kidney function disorders, the dose should be reduced or treatment should be discontinued.

It is recommended to stop therapy if skin rashes appear and depression develops due to taking beta-blockers.

Discontinuation of the drug is carried out gradually, reducing the dose over 10 days. If treatment is abruptly discontinued, a “withdrawal” syndrome may occur (increased angina attacks, increased blood pressure). Special attention should be paid to patients with angina pectoris when discontinuing the drug.

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

Influence on the ability to drive motor vehicles and manage mechanisms

During treatment, care should be taken when driving vehicles and engaging in other potentially dangerous activities that require increased concentration of attention and speed of psychomotor reactions.

Storage conditions

In a dark place, at a temperature not exceeding 25°C.

See expiration date. on the packaging.

Active ingredient

Metoprolol

Conditions of release from pharmacies

By prescription

Dosage form

Tablets