How to use metoprolol? Super-full usage summary is coming

*For medical professionals only

Clinical decision-making can be simpler

01 Hypertension

1.1

Adult (domestic usage)

▌ 1.1.1 Review

It is used in the treatment of hypertension [1-3,6].

▌1.1.2 Dosage

Tablets, capsules:

take orally. The dose should be individualized to avoid the development of bradycardia. It should be taken on an empty stomach, and taking the drug at mealtime can increase the bioavailability of metoprolol by 40%.

Take 100 to 200 mg daily in 1-2 divided doses [1,6].

Taken orally, once a day, preferably in the morning, can be broken open, but not chewed or crushed, should be taken with at least half a cup of liquid.

Slow and controlled release tablets:

47.5-95 mg once a day. Patients who do not respond to 95 mg may be given a combination of other antihypertensives, preferably diuretics and calcium antagonists of the dihydropyridine class, or increased doses [2].

Oral: 0.1 g daily, taken in the morning or as directed by a physician [3].

1.2

Adult (FDA Usage)

▌ 1.2.1 Review

Metoprolol tartrate tablets and metoprolol succinate extended-release tablets are suitable for the treatment of hypertension. May be used alone or in combination with other antihypertensive drugs.

Metoprolol succinate extended-release tablets are indicated for the treatment of hypertension to lower the blood pressure of patients. Lowering blood pressure reduces the risk of fatal and non-fatal cardiovascular events, primarily stroke and myocardial infarction.

These benefits have been demonstrated in controlled trials of various pharmacological antihypertensive drugs, including this product [8-9].

▌1.2.2 Dosage

Tablets:

Metoprolol tartrate tablets should be individualized for administration. Metoprolol tartrate tablets should be taken with or immediately after a meal. The initial dose of metoprolol tartrate tablets is usually 100 mg daily, taken in single or divided doses.

Whether used alone or in conjunction with diuretics, the dose can be increased every other week (or longer) until the optimal antihypertensive effect is achieved. In general, the maximum effect of any given dose level will be evident after one week of treatment. The effective dose range of metoprolol tartrate tablets is 100-450 mg per day.

Extended-release tablets:

Metoprolol succinate extended-release tablets are administered once a day. For the treatment of hypertension and angina, when switching from immediate-release metoprolol succinate to metoprolol succinate extended-release tablets, the same total daily dose of metoprolol succinate extended-release tablets can be used. Metoprolol succinate extended-release tablets should be individualized for administration. Some patients may require retiteration.

Metoprolol succinate extended-release tablets can be broken open, however, do not crush or chew full or half tablets.

The usual initial dose is a single dose of 25-100 mg per day. The dose can be increased every other week (or longer) until the optimal antihypertensive effect is achieved. In general, the maximum effect of any given dose level will be evident after one week of treatment. The efficacy and safety of doses exceeding 400 mg per day have not been established [9].

02 Angina

2.1

Adult (domestic usage)

▌ 2.1.1 Review

It is used in the treatment of angina [1-3,6].

▌2.1.2 Dosage

Tablets, capsules:

It is advocated for use in the early stages, i.e., within the first few hours, as immediate use in patients who have failed to thrombolytically reduce the extent of infarction and reduce short-term (15-day) mortality (this effect occurs 24 hours after administration).

In patients who have already thrombolytic, the rate of re-infarction and re-ischemia can be reduced, and mortality can be reduced if it is used within 2 hours.

General use: metoprolol can be injected intravenously once 2.5-5 mg (within 2 minutes) and once every 5 minutes, for a total of 3 doses of 10-15 mg. Thereafter, 25 to 50 mg is given every 6 to 12 hours for 24 to 48 hours, followed by 50 to 100 mg once twice a day [1,6].

Slow and controlled release tablets:

95-190 mg once a day. Nitrates may be combined or increased when required[2].

Oral: 0.1 g daily, taken in the morning or as directed by a physician [3].

2.2

Adult (FDA Usage)

▌ 2.2.1 Review

Metoprolol tartrate tablets may be used for long-term treatment of angina [8].

Metoprolol succinate extended-release tablets provide long-term treatment for angina to reduce the frequency of angina attacks and improve exercise tolerance [9].

▌2.2.2 Dosage

Tablets:

Metoprolol tartrate tablets should be individualized for administration. Metoprolol tartrate tablets should be taken with or immediately after a meal.

The initial dose of metoprolol tartrate tablets is usually 100 mg daily, taken in 2 divided doses. Gradually increase the dose each week until optimal clinical efficacy is achieved or the heart rate is significantly slowed.

The effective dose range of metoprolol tartrate tablets is 100-400 mg per day. The efficacy and safety of using doses of more than 400 mg per day have not been determined. If treatment is to be discontinued, gradually reduce the dose over a period of 1 to 2 weeks [8].

Extended-release tablets:

Metoprolol succinate extended-release tablets should be individualized for administration. The usual initial dose is 100 mg daily as a single dose. Gradually increase the dose each week until optimal clinical efficacy is achieved or the heart rate is significantly slowed.

The efficacy and safety of using doses of more than 400 mg per day have not been determined. If treatment is to be discontinued, gradually reduce the dose over a period of 1 to 2 weeks [9].

03 Myocardial infarction

3.1

Adult (domestic usage)

▌ 3.1.1 Review

It is used in the treatment of myocardial infarction [1,6].

▌3.1.2 Dosage

It is advocated for use in the early stages, i.e., within the first few hours, as immediate use in patients who have failed to thrombolytically reduce the extent of infarction and reduce short-term (15-day) mortality (this effect occurs 24 hours after administration).

In patients who have already thrombolytic, the rate of re-infarction and re-ischemia can be reduced, and mortality can be reduced if it is used within 2 hours.

General use: metoprolol can be injected intravenously once 2.5-5 mg (within 2 minutes) and once every 5 minutes, for a total of 3 doses of 10-15 mg. After that 15 minutes, 25-50 mg is taken orally every 6-12 hours for a total of 24-48 hours, followed by 50-100 mg orally once twice a day.

If there is no contraindication to the occurrence of atrial fibrillation in acute myocardial infarction, metoprolol can be used intravenously, as above.

It should be used long-term after myocardial infarction if there is no contraindication, as it has been shown to reduce cardiogenic mortality, including sudden death. Generally 50 to 100 mg twice daily [1,6].

3.2

Adult (FDA Usage)

▌ 3.2.1 Review

Metoprolol tartrate injection is used in combination with oral metoprolol for the treatment of hemodynamically stable patients with confirmed or suspected acute myocardial infarction to reduce cardiovascular mortality. Intravenous metoprolol therapy may be initiated as long as the patient's clinical condition allows [7].

Metoprolol tartrate tablets are used to treat hemodynamically stable patients with confirmed or suspected acute myocardial infarction, and reduce cardiovascular mortality when used alone or in combination with intravenous metoprolol.

Oral metoprolol tartrate tablet therapy may be initiated after intravenous metoprolol therapy or within 3 to 10 days of acute events [8].

▌3.2.2 Dosage

Injection:

Early treatment:

In the early stages of confirmed or suspected acute myocardial infarction, patients should be treated with metoprolol as soon as possible after admission. Such treatment should be started immediately after the patient's hemodynamic condition is stable under coronary care or similar conditions.

At this early stage the treatment is started with intravenous injections of 5 mg of metoprolol each time, at intervals of about 2 minutes. During intravenous administration of metoprolol, blood pressure, heart rate, and electrocardiogram should be monitored.

For patients who can tolerate a whole intravenous dose (15 mg), metoprolol tablets are started, administered every 6 hours, 50 mg 15 minutes after the last intravenous dose and continued for 48 hours. Thereafter, the maintenance dose is 100 mg orally 2 times a day.

For patients who cannot tolerate a complete intravenous dose of metoprolol, 25 mg or 50 mg is administered every 6 hours after the last intravenous dose of 15 minutes or when clinical conditions permit (depending on the degree of intolerance). For patients with severe intolerance, metoprolol should be discontinued [7].

04 Hypertrophic cardiomyopathy

4.1

Adult (domestic usage)

▌ 4.1.1 Review

It is used in the treatment of hypertrophic cardiomyopathy [1,6].

▌4.1.2 Dosage

Generally, 25 to 50 mg twice daily, or 100 mg twice daily [1,6].

05 Aortic dissection

5.1

Adult (domestic usage)

▌ 5.1.1 Review

It is used in the treatment of aortic dissection [1,6].

06 Arrhythmias

6.1

Adult (domestic usage)

▌ 6.1.1 Review

It is used to treat arrhythmias [1,6].

Treatment of supraventricular tachyarrhythmias. Prevention and treatment of myocardial ischemia, suspected or confirmed acute myocardial infarction with tachyarrhythmias and chest pain [4].

Tachyarrhythmias (rapid supraventricular tachycardia and ventricular premature beats); sinus tachycardia that occurs during induction of anesthesia or anesthesia [5].

▌6.1.2 Dosage

Tablets, capsules:

Generally, 25 to 50 mg twice daily, or 100 mg twice daily [1,6].

Supraventricular tachyarrhythmias:

The drug is administered intravenously at a rate of 1-2 mg /min at a rate of up to 5 mg (= 5 mL) at the beginning. This dose can be repeated after 5 minutes until a satisfactory effect is achieved. A total dose of 10-15 mg (=10-15 mL) is usually sufficient; the recommended maximum dose for intravenous administration is 20 mg (=20 mL).

Prevention and treatment of myocardial ischemia, suspected or confirmed acute myocardial infarction with tachyarrhythmias and chest pain:

Immediately administered intravenously 5 mg (= 5 mL). This dose can be repeated after 2 minutes apart until the maximum dose is 15 mg (= 15 mL). Patients with the following conditions cannot be given immediately intravenously: heart rate <70 beats per minute, systolic blood pressure < 110 mmHg or I. AV block.

For further treatment options (oral administration) see the relevant instructions for metoprolol tartrate tablets.

Emergency treatment of tachyarrhythmias:

Metoprolol tartrate adult dose 5 mg, diluted with glucose, slowly injected intravenously at a rate of 1-2 mg per minute, if the condition requires 5 minutes after the injection, depending on the condition, the total dose of 10 mg (4-6 hours after intravenous injection, arrhythmia has been controlled, maintained with oral capsules or tablets, 2-3 times a day, each dose does not exceed 50 mg).

Induction of anesthesia or treatment of arrhythmias during anesthesia:

It is given intravenously at a slow rate of 1 to 2 mg per minute, 2 mg in adults, and 2 mg can be repeated as needed and tolerated, with a maximum total of 10 mg if necessary [5].

07 Hyperthyroidism

7.1

Adult (domestic usage)

▌ 7.1.1 Review

It is used to treat hyperthyroidism [1,6].

▌ 7.1.2 Dosage

Generally, 25 to 50 mg twice daily, or 100 mg twice daily [1,6].

08 Cardiac neurosis

8.1

Adult (domestic usage)

▌ 8.1.1 Review

It is used in the treatment of cardiac neurosis [1,6].

09 Heart failure

9.1

Adult (domestic usage)

▌ 9.1.1 Review

It has been used in recent years for the treatment of heart failure, at which point it should be used under the guidance of an experienced physician [1,6].

Symptom-stabilized chronic heart failure with left ventricular systolic dysfunction [2].

▌9.1.2 Dosage

This drug should be used on the basis of treatment with anti-heart failure such as digitalis and /or diuretics. Initially 6.25 mg once, 2-3 times a day, and then increase 6.25-12.5 mg every few days to a week, 2-3 times a day, the maximum dose can be used to 50-100 mg once, 2 times a day.

The maximum dose should not exceed 300 mg to 400 mg per day [1,6].

In symptomatic stable heart failure, combined therapy with angiotensin-converting enzyme inhibitors, diuretics, and perhaps digitalis.

Patients with stable chronic heart failure, no acute heart failure has occurred in the last 6 weeks, and basic treatment has not changed at least in the last 2 weeks.

Treatment of heart failure with β receptor blockers can sometimes cause temporary worsening of symptoms. In some cases, treatment may be continued or the dose may be reduced, while in other cases treatment may need to be discontinued.

For patients with severe heart failure (NYHA IV), it is only up to those doctors who are particularly trained in the treatment of heart failure to decide whether to start treatment with metoprolol succinate extended-release tablets.

9.2

Adult (FDA Usage)

▌ 9.2.1 Review

Metoprolol succinate extended-release tablets are indicated for the treatment of stable, symptomatic (NYHA grade II or III) heart failure caused by ischemia, hypertension, or cardiomyopathy.

In patients who have received angiotensin-converting enzyme (ACE) inhibitors, diuretics, and, most commonly, digitalis, metoprolol succinate extended-release tablets reduce mortality and hospitalization rates, primarily by reducing cardiovascular mortality and hospitalization rates for heart failure [9].

▌9.2.2 Dosage

During the upward titration process, the dose must be individualized and closely monitored. Before starting the use of metoprolol succinate extended-release tablets, the dose of other drugs used for the treatment of heart failure should be stabilized.

For patients with NYHA grade II heart failure, the recommended starting dose of metoprolol succinate extended-release tablets is 25 mg per day for two weeks, and for patients with more severe heart failure, the recommended starting dose is 12.5 mg per day. The dose is doubled every two weeks to the highest dose the patient can tolerate, or up to 200 mg of metoprolol succinate extended-release tablets are administered. Difficulties with initial titration should not prevent later titration of metoprolol succinate extended-release tablets.

If symptomatic bradycardia occurs, the dose of metoprolol succinate extended-release tablets may be reduced. If a transient exacerbation of heart failure occurs, an increase in the dose of diuretics, a decrease in the dose of metoprolol succinate extended-release tablets, or a temporary discontinuation of this product may be considered. The dose of metoprolol succinate extended-release tablets should not be increased until symptoms of heart failure worsen stabilize [9].

More Corey's Top Drugs, Where to Learn?

You have just entered the department, where do you want to master the common drugs used in Corey? What conditions do I need to adjust the dose? Should I double it for the first time? Whether the solvent is mixed with salt or sugar...

As a veteran of Corey, what is the difference between injections and tablets? What can be learned from foreign usage? How to deal with drug overdose? In the face of new students, how to gracefully throw a link to let Xiao Bai learn the knowledge of medication?

Dry medicine you want

There is a "evidence-based medicine" column on the doctor's station