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| __NOTOC__
| | #REDIRECT [[Metoprolol succinate#Warnings]] |
| {{Metoprolol}}
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| {{CMG}}
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| {| style="border: 3px solid #696969;"
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| | style="background: #000000; border: 0px; padding: 20px 20px; width: 800px;" |
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| <center>
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| <font color="#F8F8FF">'''WARNING: ISCHEMIC HEART DISEASE'''</font>
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| </center>
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| <center>
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| <font color="#F8F8FF" size="1">''See full prescribing information for complete boxed warning.''</font>
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| </center>
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| <b><font color="#F8F8FF">
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| Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered TOPROL-XL, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1 - 2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, TOPROL-XL administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Warn patients against interruption or discontinuation of therapy without the physician’s advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue TOPROL-XL therapy abruptly even in patients treated only for hypertension.
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| </font></b>
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| |}
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| ===Ischemic Heart Disease===
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| Following abrupt cessation of therapy with certain [[beta-blocking agent]]s, exacerbations of [[angina pectoris]] and, in some cases, [[myocardial infarction]] have occurred. When discontinuing chronically administered TOPROL-XL, particularly in patients with [[ischemic heart disease]], gradually reduce the dosage over a period of 1 - 2 weeks and monitor the patient. If [[angina]] markedly worsens or acute [[myocardial ischemia|coronary ischemia]] develops, promptly reinstate TOPROL-XL, and take measures appropriate for the management of [[unstable angina]]. Warn patients not to interrupt therapy without their physician’s advice. Because [[coronary artery disease]] is common and may be unrecognized, avoid abruptly discontinuing TOPROL-XL in patients treated only for [[hypertension]].
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| ====Heart Failure====
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| Worsening [[cardiac failure]] may occur during up-titration of TOPROL-XL. If such symptoms occur, increase [[diuretic]]s and restore clinical stability before advancing the dose of TOPROL-XL ''[see [[Toprol XL dosage and administration|Dosage and Administration]]]''. It may be necessary to lower the dose of TOPROL-XL or temporarily discontinue it. Such episodes do not preclude subsequent successful titration of TOPROL-XL.
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| ====Bronchospastic Disease====
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| PATIENTS WITH [[BRONCHOSPASTIC DISEASE]]S SHOULD, IN GENERAL, NOT RECEIVE [[BETA-BLOCKER]]S. Because of its relative [[beta1]] cardio-selectivity, however, TOPROL-XL may be used in patients with [[bronchospastic disease]] who do not respond to, or cannot tolerate, other [[antihypertensive]] treatment. Because [[beta1]]-selectivity is not absolute, use the lowest possible dose of TOPROL-XL. [[Bronchodilator]]s, including [[beta2]]-[[agonist]]s, should be readily available or administered concomitantly ''[see [[Toprol XL dosage and administration|Dosage and Administration]]]''.
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| ====Pheochromocytoma====
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| If TOPROL-XL is used in the setting of [[pheochromocytoma]], it should be given in combination with an [[alpha blocker]], and only after the [[alpha blocker]] has been initiated. Administration of [[beta-blocker]]s alone in the setting of [[pheochromocytoma]] has been associated with a paradoxical increase in [[blood pressure]] due to the attenuation of beta-mediated [[vasodilatation]] in [[skeletal muscle]].
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| ====Major Surgery====
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| Avoid initiation of a high-dose regimen of extended-release metoprolol in patients undergoing non-cardiac surgery, since such use in patients with [[cardiovascular]] risk factors has been associated with [[bradycardia]], [[hypotension]], [[stroke]] and death.
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| Chronically administered [[beta-blocking therapy]] should not be routinely withdrawn prior to major surgery, however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
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| ====Diabetes and Hypoglycemia====
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| [[Beta-blocker]]s may mask [[tachycardia]] occurring with [[hypoglycemia]], but other manifestations such as [[dizziness]] and [[sweating]] may not be significantly affected.
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| ====Hepatic Impairment====
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| Consider initiating TOPROL-XL therapy at doses lower than those recommended for a given indication; gradually increase dosage to optimize therapy, while monitoring closely for adverse events.
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| ====Thyrotoxicosis====
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| [[Beta-adrenergic blockade]] may mask certain clinical signs of [[hyperthyroidism]], such as [[tachycardia]]. Abrupt [[withdrawal]] of [[beta-blockade]] may precipitate a [[thyroid storm]].
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| ====Anaphylactic Reaction====
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| While taking [[beta-blocker]]s, patients with a history of severe [[anaphylactic reaction]]s to a variety of [[allergen]]s may be more reactive to repeated challenge and may be unresponsive to the usual doses of [[epinephrine]] used to treat an [[allergic reaction]].
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| ====Peripheral Vascular Disease====
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| [[Beta-blocker]]s can precipitate or aggravate symptoms of [[arterial insufficiency]] in patients with [[peripheral vascular disease]].
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| ====Calcium Channel Blockers====
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| Because of significant inotropic and chronotropic effects in patients treated with beta-blockers and calcium channel blockers of the verapamil and diltiazem type, caution should be exercised in patients treated with these agents concomitantly.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = TOPROL XL (METOPROLOL SUCCINATE) TABLET, EXTENDED RELEASE [BRYANT RANCH PREPACK] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=01038198-b4f0-41f3-9a9c-5c84e5a0d3b9 | publisher = | date = | accessdate = }}</ref>
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| ==References==
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| {{Reflist}}
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| {{FDA}}
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| [[Category:Beta blockers]]
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| [[Category:Cardiovascular Drugs]]
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| [[Category:Drugs]]
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