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#REDIRECT [[Metoprolol tartrate#Warnings]]
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==Warnings==
 
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===Hypertension and Angina===
 
===Cardiac Failure===
 
[[Sympathetic]] stimulation is a vital component supporting circulatory function in [[congestive heart failure]], and [[beta blockade]] carries the potential hazard of further depressing myocardial [[contractility]] and precipitating more severe failure.
 
====In Patients Without a History of Cardiac Failure====
 
Continued depression of the myocardium with [[beta-blocking agents]] over a period of time can, in some cases, lead to [[cardiac failure]]. At the first sign or symptom of impending [[cardiac failure]], fully digitalize patients and/or give a [[diuretic]]. The response should be observed closely. If [[cardiac failure]] continues, despite adequate [[digitalization]] and [[diuretic]] therapy, withdraw Lopressor.
 
===Bronchospastic Diseases===
 
PATIENTS WITH [[BRONCHOSPASTIC DISEASES]] SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS, including Lopressor.
 
Because of its relative [[beta-1]] selectivity, however, Lopressor may be used with caution in patients with [[bronchospastic disease]] who do not respond to, or cannot tolerate, other [[antihypertensive]] treatment. Since [[beta-1]] selectivity is not absolute, a [[beta2]]-stimulating agent should be administered concomitantly, and the lowest possible dose of Lopressor should be used. In these circumstances it would be prudent initially to administer Lopressor in smaller doses three times daily, instead of larger doses two times daily, to avoid the higher plasma levels associated with the longer dosing interval (see DOSAGE AND ADMINISTRATION).
 
===Major Surgery===
 
Chronically administered [[beta-blocking therapy]] should not be routinely withdrawn prior to major surgery; however, the impaired ability of the heart to respond to reflex [[adrenergic]] stimuli may augment the risks of [[general anesthesia]]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.
 
===Diabetes and Hypoglycemia===
 
[[Beta blockers]] may mask [[tachycardia]] occurring with [[hypoglycemia]], but other manifestations such as [[dizziness]] and [[sweating]] may not be significantly affected.
 
===Pheochromocytoma===
 
If Lopressor 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]].
 
===Thyrotoxicosis===
 
[[Beta-adrenergic blockade]] may mask certain clinical signs (e.g., [[tachycardia]]) of [[hyperthyroidism]]. Avoid abrupt withdrawal of [[beta blockade]], which might precipitate a [[thyroid storm]].
 
===Myocardial Infarction===
 
====Cardiac Failure====
 
 
[[Sympathetic]] stimulation is a vital component supporting circulatory function, and [[beta blockade]] carries the potential hazard of depressing [[myocardial contractility]] and precipitating or exacerbating minimal [[cardiac failure]].
 
During treatment with Lopressor, monitor the hemodynamic status of the patient. If [[heart failure]] occurs or persists despite appropriate treatment, discontinue Lopressor.
 
===Bradycardia===
 
Lopressor produces a decrease in sinus [[heart rate]] in most patients; this decrease is greatest among patients with high initial heart rates and least among patients with low initial heart rates. [[Acute myocardial infarction]] (particularly inferior infarction) may in itself produce significant lowering of the sinus rate. If the sinus rate decreases to <40 beats/min, particularly if associated with evidence of lowered [[cardiac output]], [[atropine]] (0.25-0.5 mg) should be administered intravenously. If treatment with [[atropine]] is not successful, discontinue Lopressor and consider cautious administration of [[isoproterenol]] or installation of a [[cardiac pacemaker]].
 
===AV Block===
 
Lopressor slows AV conduction and may produce significant first- (P-R interval ≥0.26 sec), second-, or third-degree heart block. Acute myocardial infarction also produces heart block.
 
If heart block occurs, discontinue Lopressor and administer atropine (0.25-0.5 mg) intravenously. If treatment with atropine is not successful, consider administration of isoproterenol or installation of a cardiac pacemaker.
 
===Hypotension===
 
If hypotension (systolic blood pressure ≤90 mmHg) occurs, '''discontinue Lopressor''', and assess the hemodynamic status of the patient and the extent of myocardial damage. Invasive monitoring of central venous, pulmonary capillary wedge, and arterial pressures may be required. Institute appropriate therapy with fluids, positive inotropic agents, balloon counterpulsation, or other treatment modalities. If [[hypotension]] is associated with sinus [[bradycardia]] or AV block, direct treatment at reversing these (see above).
 
==Precautions==
 
===General===
 
'''Start at a low dose''' and uptitrate slowly in patients with impaired hepatic function.
 
Information for Patients
 
*Advise patients to take Lopressor regularly and continuously, as directed, with or immediately following meals. If a dose should be missed, the patient should take only the next scheduled dose (without doubling it).
*Patients should not discontinue Lopressor without consulting the physician.
*Advise patients to:
: Avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient’s response to therapy with Lopressor has been determined.
 
: Contact the physician if any difficulty in breathing occurs.
 
: Inform the physician or dentist before any type of surgery that he or she is taking Lopressor.<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = LOPRESSOR (METOPROLOL TARTRATE) TABLET [NOVARTIS PHARMACEUTICALS CORPORATION] | url =http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=bb05420c-fd24-4672-9f62-fdd313819287 | publisher =  | date =  | accessdate = }}</ref>
 
==References==
 
{{Reflist}}
 
{{FDA}}
 
[[Category:Drugs]]
[[Category:Cardiovascular Drugs]]
[[Category:Beta blockers]]

Latest revision as of 03:51, 22 July 2014

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