Back to Beta Blockers
Brand Name:
Toprol XL
Name: Metoprolol tartrate
Pregnancy Category B
Drug classes
Beta-adrenergic blocking agent (alpha 1-selective)
Antihypertensive agent
Mechanism of action
Competitively blocks beta-adrenergic receptors in the heart and juxtoglomerular
apparatus. They lead to decreased heart rate decreasing the work load
by the heart. They do not produce coronary vasodilatation but lead to
a shift and redistribution of coronary circulation to the ischemic areas.
It decreases the release of renin from the kidney, thus lowering blood
pressure. Acts in the CNS to reduce sympathetic outflow and vasoconstrictor
tone.
Indications
Hypertension, alone or with other
drugs, especially diuretics
Prevention of reinfarction in MI patients
who are hemodynamically stable
or within 3-10 d of the acute MI
Treatment of angina pectoris
Contraindications
Contraindicated in the presence of sinus bradycardia (heart block
greater than 1st degree), cardiogenic
shock, CHF.
Adverse effects
CNS: Nystagmus, ataxia, dysarthria,
slurred speech, mental confusion, dizziness, drowsiness, insomnia, transient
nervousness, motor twitchings,fatigue, irritability, depression, numbness,
tremor, headache, photophobia, diplopia, conjunctivitis
GI: Nausea, vomiting,
diarrhea,
constipation,
gingival hyperplasia, toxic hepatitis, liver damage, sometimes fatal;
hypersensitivity reactions with hepatic involvement, including hepatocellular
degeneration and fatal hepatocellular necrosis
Respiratory: Pulmonary fibrosis, acute
pneumonitis
Hematologic: Hematopoietic complications,
sometimes fatal: thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis,
pancytopenia; macrocytosis and megaloblastic anemia that usually respond
to folic acid therapy; eosinophilia, monocytosis, leukocytosis, simple
anemia, hemolytic anemia, aplastic anemia, hyperglycemia
GU: Nephrosis
Dermatologic: Dermatologic reactions,
scarlatiniform, morbilliform, maculopapular, urticarial and nonspecific
rashes; serious and sometimes fatal dermatologic reactions-bullous, exfoliative,
or purpuric dermatitis, lupus erythematosus, and Stevens-Johnson syndrome;
toxic epidermal necrolysis, hirsutism, alopecia, coarsening of the facial
features, enlargement of the lips, Peyronie's disease
Other: Lymph node hyperplasia, sometimes progressing to frank
malignant
lymphoma, monoclonal gammopathy and multiple myeloma (prolonged therapy),
polyarthropathy, osteomalacia, weight gain, chest pain, periarteritis
nodosa
IV use
complications: Hypotension, transient
hyperkinesia, drowsiness, nystagmus, circumoral tingling, vertigo, nausea,
cardiovascular collapse, CNS depression
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