Lopressor injection: Difference between revisions

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{{{{BASEPAGENAME}} }}
{{Lopressor injection}}
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'''''For information about metoprolol, click [[metoprolol|here]].'''''
'''''For information about metoprolol, click [[Metoprolol|here]].'''''


==[[Drug project disclaimer|Disclaimer]]==
==Disclaimer==


==[[{{BASEPAGENAME}}/black box warning|{{fontcolor|#FF0000|Black Box Warning}}]]==
'''''WikiDoc Drug Project is a constellation of drug information for healthcare providers and patients vigorously vetted on the basis of FDA package insert, MedlinePlus, Practice Guidelines, Scientific Statements, and scholarly medical literature.  The information provided is not a medical advice or treatment.  WikiDoc does not promote any medication or off-label use of drugs. Please read our full disclaimer [[wikidoc:General_disclaimer|{{fontcolor|#FF0000|here}}]].'''''
 
==<span style="color:#FF0000; background:#000000;">Black Box Warning</span>==
 
FDA Package Insert for {{PAGENAME}} contains no information regarding ''Black Box Warning''.


==Overview==
==Overview==


{{BASEPAGENAME}} is a anti-anginal, antiarrhythmic, beta-adrenergic blocker drug that is FDA approved for the treatment of [[acute myocardial infarction]], [[angina]], and [[hypertension]]. There is a Black Box Warning for this drug as shown <span style="background:#000000;">'''[[{{BASEPAGENAME}}/black box warning|{{fontcolor|#FF0000|here}}]]'''</span>. Common adverse reactions include [[bradyarrhythmia]], [[heart block]], [[heart failure]], [[hypotension]], [[pruritus]], [[rash]], [[constipation]], [[diarrhea]], [[indigestion]], [[nausea]], [[dizziness]], [[fatigue]], [[headache]], [[depression]], [[dyspnea]], and [[wheezing]].
[[Lopressor injection]] is a anti-[[angina|anginal]], [[antiarrhythmic]], [[beta-adrenergic blocker]] drug that is FDA approved for the treatment of [[acute myocardial infarction|acute myocardial infarction (AMI)]]. Common adverse reactions include [[bradyarrhythmia]], [[constipation]], [[depression]], [[diarrhea]], [[dizziness]], [[dyspnea]], [[fatigue]], [[headache]], [[heart block]], [[heart failure]], [[hypotension]], [[indigestion]], [[nausea]], [[pruritus]], [[rash]], and [[wheezing]].
 
==Adult Indications and Dosage==
 
===FDA-Labeled Indications and Dosage (Adult)===
 
=====Acute Myocaridal Infarction=====
 
* Dosing Information
 
:* Upon patient presentation: [[Lopressor injection]] 5 mg IV x 3 boluses at 2-min intervals
 
:* 15 minutes after the full IV dose: [[Lopressor tablet]] 50 mg PO q6h for 2 days followed by [[Lopressor tablet]] 100 mg PO q12h (or ''[[Lopressor tablet]]'' 25—50 mg PO q6h for 2 days if intolerable to the full IV dose; discontinue [[Lopressor]] in patients with severe intolerance.)
 
[[Lopressor injection]] is indicated in the treatment of [[hemodynamics|hemodynamically]] stable patients with definite or suspected [[acute myocardial infarction]] to reduce cardiovascular [[mortality]] when used in conjunction with [[Lopressor tablet|oral Lopressor]] maintenance therapy. Treatment with [[Lopressor injection]] can be initiated as soon as the patient’s clinical condition allows.
 
Early Treatment: During the early phase of definite or suspected [[acute myocardial infarction]], initiate treatment with [[Lopressor injection]] as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s [[hemodynamic]] condition has stabilized. Begin treatment in this early phase with the [[intravenous]] administration of three bolus injections of 5 mg of [[Lopressor injection]] each; give the injections at approximately 2-minute intervals. During the [[intravenous]] administration of [[Lopressor]], monitor [[blood pressure]], [[heart rate]], and [[electrocardiogram]].
 
In patients who tolerate the full [[intravenous]] dose (15 mg), initiate [[Lopressor tablet]]s, 50 mg every 6 hours, 15 minutes after the last [[intravenous]] dose and continue for 48 hours. Thereafter, the maintenance dosage is 100 mg orally twice daily. Start patients who appear not to tolerate the full [[intravenous]] dose on [[Lopressor tablet]]s either 25 mg or 50 mg every 6 hours (depending on the degree of intolerance) 15 minutes after the last intravenous dose or as soon as their clinical condition allows. In patients with severe intolerance, discontinue Lopressor (see ''[[Lopressor injection#Warnings|Warnings]]'').<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = LOPRESSOR (METOPROLOL TARTRATE) INJECTION, SOLUTION [NOVARTIS PHARMACEUTICALS CORPORATION] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6640cc61-edee-4808-a26f-cbc2c0b7af86#nlm34067-9 | publisher =  | date =  | accessdate = }}</ref>
 
===Off-Label Use and Dosage (Adult)===
 
====Guideline-Supported Use====
 
=====[[Atrial Fibrillation]], Rate Control=====
 
* Developed by: [[American College of Cardiology|American College of Cardiology (ACC)]] and [[American Heart Association|American Heart Association (AHA)]]
 
* Class of Recommendation: [[ACC AHA guidelines classification scheme#Class I: Benefit >>> Risk|Class I]]
 
* Level of Evidence: [[ACC AHA guidelines classification scheme#Level of Evidence B:|Level B]]
 
* Dosing Information
 
:: Acute Setting: [[Lopressor injection]] 2.5—5 mg IV bolus over 2 min; up to 3 doses<ref name="Fuster-2006">{{Cite journal  | last1 = Fuster | first1 = V. | last2 = Rydén | first2 = LE. | last3 = Cannom | first3 = DS. | last4 = Crijns | first4 = HJ. | last5 = Curtis | first5 = AB. | last6 = Ellenbogen | first6 = KA. | last7 = Halperin | first7 = JL. | last8 = Le Heuzey | first8 = JY. | last9 = Kay | first9 = GN. | title = ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation). | journal = Eur Heart J | volume = 27 | issue = 16 | pages = 1979-2030 | month = Aug | year = 2006 | doi = 10.1093/eurheartj/ehl176 | PMID = 16885201 }}</ref>
 
In the absence of [[preexcitation]], [[intravenous]] administration of [[beta blockers]] ([[esmolol]], [[metoprolol]], or [[propranolol]]) or nondihydropyridine [[calcium channel antagonist]]s ([[verapamil]], [[diltiazem]]) is recommended to slow the ventricular response to [[atrial fibrillation]] in the acute setting, exercising caution in patients with [[hypotension]] or [[heart failure]].<ref name="Wann-2013">{{Cite journal  | last1 = Wann | first1 = LS. | last2 = Curtis | first2 = AB. | last3 = Ellenbogen | first3 = KA. | last4 = Estes | first4 = NA. | last5 = Ezekowitz | first5 = MD. | last6 = Jackman | first6 = WM. | last7 = January | first7 = CT. | last8 = Lowe | first8 = JE. | last9 = Page | first9 = RL. | title = Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. | journal = Circulation | volume = 127 | issue = 18 | pages = 1916-26 | month = May | year = 2013 | doi = 10.1161/CIR.0b013e318290826d | PMID = 23545139 }}</ref>
 
====Non–Guideline-Supported Use====
 
=====[[Atrial flutter]]=====
 
* Dosing Information
 
:: [[Lopressor injection]] dose range: 2—15 mg<ref name="Amsterdam-1991">{{Cite journal  | last1 = Amsterdam | first1 = EA. | last2 = Kulcyski | first2 = J. | last3 = Ridgeway | first3 = MG. | title = Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. | journal = J Clin Pharmacol | volume = 31 | issue = 8 | pages = 714-8 | month = Aug | year = 1991 | doi =  | PMID = 1880230 }}</ref>
 
=====[[Multifocal atrial tachycardia]]=====
 
* Dosing Information
 
:: [[Lopressor injection]] dose range: 2—15 mg<ref name="Amsterdam-1991">{{Cite journal  | last1 = Amsterdam | first1 = EA. | last2 = Kulcyski | first2 = J. | last3 = Ridgeway | first3 = MG. | title = Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. | journal = J Clin Pharmacol | volume = 31 | issue = 8 | pages = 714-8 | month = Aug | year = 1991 | doi =  | PMID = 1880230 }}</ref>
 
=====[[Supraventricular tachycardia]]=====
 
* Dosing Information
 
:: [[Lopressor injection]] dose range: 2—15 mg<ref name="Amsterdam-1991">{{Cite journal  | last1 = Amsterdam | first1 = EA. | last2 = Kulcyski | first2 = J. | last3 = Ridgeway | first3 = MG. | title = Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias. | journal = J Clin Pharmacol | volume = 31 | issue = 8 | pages = 714-8 | month = Aug | year = 1991 | doi =  | PMID = 1880230 }}</ref>
 
=====Injection Site Pain Associated with Propofol Use=====
 
* Dosing Information
 
:: Pretreatment with [[Lopressor injection]] 2 mg.<ref name="Aşik-2003">{{Cite journal  | last1 = Aşik | first1 = I. | last2 = Yörükoğlu | first2 = D. | last3 = Gülay | first3 = I. | last4 = Tulunay | first4 = M. | title = Pain on injection of propofol: comparison of metoprolol with lidocaine. | journal = Eur J Anaesthesiol | volume = 20 | issue = 6 | pages = 487-9 | month = Jun | year = 2003 | doi =  | PMID = 12803269 }}</ref>
 
==Pediatric Indications and Dosage==
 
===FDA-Labeled Indications and Dosage (Pediatric)===
 
=====Condition 1=====
 
* Dosing Information
 
:: (Dosage)
 
=====Condition 2=====
 
* Dosing Information
 
:: (Dosage)
 
===Off-Label Use and Dosage (Pediatric)===
 
====Guideline-Supported Use====
 
=====Condition 1=====
 
* Developed by: (Organisation)
 
* Class of Recommendation: (Class) (Link)
 
* Strength of Evidence: (Category A/B/C) (Link)
 
* Dosing Information
 
:: (Dosage)
 
=====Condition 2=====
 
* Developed by: (Organisation)
 
* Class of Recommendation: (Class) (Link)
 
* Strength of Evidence: (Category A/B/C) (Link)
 
* Dosing Information
 
:: (Dosage)
 
====Non–Guideline-Supported Use====
 
=====Condition 1=====
 
* Dosing Information
 
:: (Dosage)
 
=====Condition 2=====
 
* Dosing Information
 
:: (Dosage)
 
=====Condition 3=====
 
* Dosing Information
 
:: (Dosage)
 
==Contraindications==
 
*[[Ventricular fibrillation]]
*Hypersensitivity to digoxin
 
==Warnings==
 
=====Conidition 1=====
 
(Description)
 
=====Conidition 2=====
 
(Description)
 
=====Conidition 3=====
 
(Description)
 
==Adverse Reactions==
 
===Clinical Trials Experience===
 
=====Condition 1=====
 
======Central Nervous System======
 
: (list/description of adverse reactions)
 
======Cardiovascular======
 
: (list/description of adverse reactions)
 
======Respiratory======
 
: (list/description of adverse reactions)
 
======Gastrointestinal======
 
: (list/description of adverse reactions)
 
======Hypersensitive Reactions======
 
: (list/description of adverse reactions)
 
======Miscellaneous======
 
: (list/description of adverse reactions)
 
=====Condition 1=====
 
======Central Nervous System======
 
: (list/description of adverse reactions)
 
======Cardiovascular======
 
: (list/description of adverse reactions)
 
======Respiratory======
 
: (list/description of adverse reactions)
 
======Gastrointestinal======
 
: (list/description of adverse reactions)
 
======Hypersensitive Reactions======
 
: (list/description of adverse reactions)
 
======Miscellaneous======
 
: (list/description of adverse reactions)
 
===Postmarketing Experience===
 
(Description)
 
==Drug Interactions==
 
* Drug 1
* Drug 2
* Drug 3
* Drug 4
* Drug 5
 
=====Drug 1=====
 
(Description)
 
=====Drug 2=====
 
(Description)
 
=====Drug 3=====
 
(Description)
 
=====Drug 4=====
 
(Description)
 
=====Drug 5=====
 
(Description)
 
==Use in Specific Populations==
 
====Pregnancy====
 
: '''[[Pregnancy category#United States|Pregnancy Category (FDA)]]: X'''
 
: '''[[Pregnancy category#Australia|Pregnancy Category (AUS)]]: X'''
 
(Description)
 
====Labor and Delivery====
 
(Description)
 
====Nursing Mothers====
 
(Description)
 
====Pediatric Use====
 
(Description)
 
====Geriatric Use====
 
(Description)
 
====Gender====
 
(Description)
 
====Race====
 
(Description)
 
====Renal Impairment====
 
(Description)
 
====Hepatic Impairment====
 
(Description)
 
====Females of Reproductive Potential and Males====
 
(Description)
 
====Immunocompromised Patients====
 
(Description)
 
==Administration and Monitoring==
 
====Administration====
 
(Oral/Intravenous/etc)
 
====Monitoring====
 
=====Condition 1=====
 
(Description regarding monitoring, from ''Warnings'' section)
 
=====Condition 2=====
 
(Description regarding monitoring, from ''Warnings'' section)
 
=====Condition 3=====
 
(Description regarding monitoring, from ''Warnings'' section)
 
==IV Compatibility==
 
===Solution===
 
====Compatible====
 
* Solution 1
* Solution 2
* Solution 3
 
====Not Tested====
 
* Solution 1
* Solution 2
* Solution 3
 
====Variable====
 
* Solution 1
* Solution 2
* Solution 3
 
====Incompatible====
 
* Solution 1
* Solution 2
* Solution 3
 
===Y-Site===
 
====Compatible====
 
* Solution 1
* Solution 2
* Solution 3
 
====Not Tested====
 
* Solution 1
* Solution 2
* Solution 3
 
====Variable====
 
* Solution 1
* Solution 2
* Solution 3
 
====Incompatible====
 
* Solution 1
* Solution 2
* Solution 3
 
===Admixture===
 
====Compatible====
 
* Solution 1
* Solution 2
* Solution 3
 
====Not Tested====
 
* Solution 1
* Solution 2
* Solution 3
 
====Variable====
 
* Solution 1
* Solution 2
* Solution 3
 
====Incompatible====
 
* Solution 1
* Solution 2
* Solution 3
 
===Syringe===
 
====Compatible====
 
* Solution 1
* Solution 2
* Solution 3
 
====Not Tested====
 
* Solution 1
* Solution 2
* Solution 3
 
====Variable====
 
* Solution 1
* Solution 2
* Solution 3
 
====Incompatible====
 
* Solution 1
* Solution 2
* Solution 3
 
===TPN/TNA===
 
====Compatible====
 
* Solution 1
* Solution 2
* Solution 3
 
====Not Tested====
 
* Solution 1
* Solution 2
* Solution 3
 
====Variable====
 
* Solution 1
* Solution 2
* Solution 3
 
====Incompatible====
 
* Solution 1
* Solution 2
* Solution 3
 
==Overdosage==


==[[{{BASEPAGENAME}}/adult indications and dosage|Adult Indications and Dosage]]==
===Acute Overdose===


: <BIG><BIG>'''[[{{BASEPAGENAME}}/adult indications and dosage#FDA-Labeled Indications and Dosage (Adult)|FDA-Labeled Indications and Dosage (Adult)]]'''</BIG></BIG>
====Signs and Symptoms====


: <BIG><BIG>'''[[{{BASEPAGENAME}}/adult indications and dosage#Off-Label Use and Dosage (Adult)|Off-Label Use and Dosage (Adult)]]'''</BIG></BIG>
(Description)


==[[{{BASEPAGENAME}}/pediatric indications and dosage|Pediatric Indications and Dosag]]e==
====Management====


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pediatric indications and dosage#FDA-Labeled Indications and Dosage (Pediatric)|FDA-Labeled Indications and Dosage (Pediatric)]]'''</BIG></BIG>
(Description)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pediatric indications and dosage#Off-Label Use and Dosage (Pediatric)|Off-Label Use and Dosage (Pediatric)]]'''</BIG></BIG>
===Chronic Overdose===


==[[{{BASEPAGENAME}}/contraindications|Contraindications]]==
====Signs and Symptoms====


==[[{{BASEPAGENAME}}/warnings|Warnings]]==
(Description)


==[[{{BASEPAGENAME}}/adverse reactions|Adverse Reactions]]==
====Management====


: <BIG><BIG>'''[[{{BASEPAGENAME}}/adverse reactions#Clinical Trials Experience|Clinical Trials Experience]]'''</BIG></BIG>
(Description)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/adverse reactions#Postmarketing Experience|Postmarketing Experience]]'''</BIG></BIG>
==Pharmacology==


==[[{{BASEPAGENAME}}/drug interactions|Drug Interactions]]==
{{Drugbox2
| verifiedrevid = 459444186
| IUPAC_name = (''RS'')-1-(Isopropylamino)-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol
| image = 2000px-Metoprolol structure.svg.png
| drug_name = Metoprolol


==[[{{BASEPAGENAME}}/use in specific populations|Use in Specific Populations]]==
<!--Clinical data-->
| tradename = Lopressor, Toprol XL, Toprolxl XL
| MedlinePlus = a682864
| licence_US = Metoprolol
| pregnancy_AU = C
| pregnancy_US = C
| legal_status = Rx-only
| routes_of_administration = Oral, [[Intravenous|IV]]


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Pregnancy|Pregnancy]]'''</BIG></BIG>
<!--Pharmacokinetic data-->
| bioavailability = 12%
| metabolism = [[Liver|Hepatic]] via [[CYP2D6]], [[CYP3A4]]
| elimination_half-life = 3-7 hours
| excretion = [[Kidney|Renal]]


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Labor and Delivery|Labor and Delivery]]'''</BIG></BIG>
<!--Identifiers-->
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 51384-51-1
| ATC_prefix = C07
| ATC_suffix = AB02
| PubChem = 4171
| IUPHAR_ligand = 553
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00264
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 4027
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = GEB06NHM23
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D02358
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 6904
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 13


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Nursing Mothers|Nursing Mothers]]'''</BIG></BIG>
<!--Chemical data-->
| C=15 | H=25 | N=1 | O=3
| molecular_weight = 267.364&nbsp;[[gram|g]]/[[Mole (unit)|mol]]
| smiles = O(c1ccc(cc1)CCOC)CC(O)CNC(C)C
| InChI = 1/C15H25NO3/c1-12(2)16-10-14(17)11-19-15-6-4-13(5-7-15)8-9-18-3/h4-7,12,14,16-17H,8-11H2,1-3H3
| InChIKey = IUBSYMUCCVWXPE-UHFFFAOYAN
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C15H25NO3/c1-12(2)16-10-14(17)11-19-15-6-4-13(5-7-15)8-9-18-3/h4-7,12,14,16-17H,8-11H2,1-3H3
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = IUBSYMUCCVWXPE-UHFFFAOYSA-N
| melting_point = 120
}}


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Pediatric Use|Pediatric Use]]'''</BIG></BIG>
===Mechanism of Action===


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Geriatric Use|Geriatric Use]]'''</BIG></BIG>
(Description)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Gender|Gender]]'''</BIG></BIG>
===Structure===


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Race|Race]]'''</BIG></BIG>
(Description with picture)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Renal Impairment|Renal Impairment]]'''</BIG></BIG>
===Pharmacodynamics===


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Hepatic Impairment|Hepatic Impairment]]'''</BIG></BIG>
(Description)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Females of Reproductive Potential and Males|Females of Reproductive Potential and Males]]'''</BIG></BIG>
===Pharmacokinetics===


: <BIG><BIG>'''[[{{BASEPAGENAME}}/use in specific populations#Immunocompromised Patients|Immunocompromised Patients]]'''</BIG></BIG>
(Description)


==[[{{BASEPAGENAME}}/routes and preparations|Routes and Preparations]]==
===Nonclinical Toxicology===


==[[{{BASEPAGENAME}}/IV compatibility|IV Compatibility]]==
(Description)


==[[{{BASEPAGENAME}}/overdosage|Overdosage]]==
==Clinical Studies==


==[[{{BASEPAGENAME}}/pharmacology|Pharmacology]]==
=====Condition 1=====


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pharmacology#Mechanism of Action|Mechanism of Action]]'''</BIG></BIG>
(Description)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pharmacology#Structure|Structure]]'''</BIG></BIG>
=====Condition 2=====


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pharmacology#Pharmacodynamics|Pharmacodynamics]]'''</BIG></BIG>
(Description)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pharmacology#Pharmacokinetics|Pharmacokinetics]]'''</BIG></BIG>
=====Condition 3=====


: <BIG><BIG>'''[[{{BASEPAGENAME}}/pharmacology#Nonclinical Toxicology|Nonclinical Toxicology]]'''</BIG></BIG>
(Description)


==[[{{BASEPAGENAME}}/clinical studies|Clinical Studies]]==
==How Supplied==


==[[{{BASEPAGENAME}}/how supplied|How Supplied]]==
(Description)


==[[{{BASEPAGENAME}}/images|Images]]==
* National Drug Code (NDC):
* Storage:
* Manufactured by: 
* Distributed by:


: <BIG><BIG>'''[[{{BASEPAGENAME}}/images#Drug Images|Drug Images]]'''</BIG></BIG>
==Images==


: <BIG><BIG>'''[[{{BASEPAGENAME}}/images#Package and Label Display Panel|Package and Label Display Panel]]'''</BIG></BIG>
===Drug Images===


==[[{{BASEPAGENAME}}/patient information|Patient Information]]==
(PillBox Images)


: <BIG><BIG>'''[[{{BASEPAGENAME}}/patient information#Patient Information from FDA|Patient Information from FDA]]'''</BIG></BIG>
===Package and Label Display Panel===


: <BIG><BIG>'''[[{{BASEPAGENAME}}/patient information#Patient Information from NLM|Patient Information from NLM]]'''</BIG></BIG>
(Package Images)


==Taking with Alcohol==
(Display Panel Images)


Alcohol-{{BASEPAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
==Patient Information==
 
===Patient Information from FDA===
 
(Patient Counseling Information)
 
===Patient Information from NLM===
 
(Link to patient information page)
 
==Precautions with Alcohol==
 
Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.


==Look-Alike Drug Names==
==Look-Alike Drug Names==


* (Paired Confused Name 1a) — (Paired Confused Name 1b)
* (Paired Confused Name 2a) — (Paired Confused Name 2b)
* (Paired Confused Name 3a) — (Paired Confused Name 3b)
==[http://www.fda.gov/drugs/drugsafety/drugshortages/ucm050792.htm Drug Shortage Status]==
==[http://www.goodrx.com/{{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}/price Price]==


==References==


==[http://www.fda.gov/drugs/drugsafety/drugshortages/ucm050792.htm Drug Shortage Status]==
{{reflist}}


==[http://www.goodrx.com/{{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{BASEPAGENAME}}}}}}/price Price]==
</div>

Latest revision as of 15:16, 26 March 2014

Lopressor injection®
Black Box Warning
Adult Indications and Dosage
Pediatric Indications and Dosage
Contraindications
Warnings
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration and Monitoring
IV Compatibility
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient information
Precautions with Alcohol
Look-Alike Drug Names
Drug Shortage Status
Price

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

For information about metoprolol, click here.

Disclaimer

WikiDoc Drug Project is a constellation of drug information for healthcare providers and patients vigorously vetted on the basis of FDA package insert, MedlinePlus, Practice Guidelines, Scientific Statements, and scholarly medical literature. The information provided is not a medical advice or treatment. WikiDoc does not promote any medication or off-label use of drugs. Please read our full disclaimer here.

Black Box Warning

FDA Package Insert for Lopressor injection contains no information regarding Black Box Warning.

Overview

Lopressor injection is a anti-anginal, antiarrhythmic, beta-adrenergic blocker drug that is FDA approved for the treatment of acute myocardial infarction (AMI). Common adverse reactions include bradyarrhythmia, constipation, depression, diarrhea, dizziness, dyspnea, fatigue, headache, heart block, heart failure, hypotension, indigestion, nausea, pruritus, rash, and wheezing.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Acute Myocaridal Infarction
  • Dosing Information

Lopressor injection is indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality when used in conjunction with oral Lopressor maintenance therapy. Treatment with Lopressor injection can be initiated as soon as the patient’s clinical condition allows.

Early Treatment: During the early phase of definite or suspected acute myocardial infarction, initiate treatment with Lopressor injection as soon as possible after the patient’s arrival in the hospital. Such treatment should be initiated in a coronary care or similar unit immediately after the patient’s hemodynamic condition has stabilized. Begin treatment in this early phase with the intravenous administration of three bolus injections of 5 mg of Lopressor injection each; give the injections at approximately 2-minute intervals. During the intravenous administration of Lopressor, monitor blood pressure, heart rate, and electrocardiogram.

In patients who tolerate the full intravenous dose (15 mg), initiate Lopressor tablets, 50 mg every 6 hours, 15 minutes after the last intravenous dose and continue for 48 hours. Thereafter, the maintenance dosage is 100 mg orally twice daily. Start patients who appear not to tolerate the full intravenous dose on Lopressor tablets either 25 mg or 50 mg every 6 hours (depending on the degree of intolerance) 15 minutes after the last intravenous dose or as soon as their clinical condition allows. In patients with severe intolerance, discontinue Lopressor (see Warnings).[1]

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Atrial Fibrillation, Rate Control
  • Dosing Information
Acute Setting: Lopressor injection 2.5—5 mg IV bolus over 2 min; up to 3 doses[2]

In the absence of preexcitation, intravenous administration of beta blockers (esmolol, metoprolol, or propranolol) or nondihydropyridine calcium channel antagonists (verapamil, diltiazem) is recommended to slow the ventricular response to atrial fibrillation in the acute setting, exercising caution in patients with hypotension or heart failure.[3]

Non–Guideline-Supported Use

Atrial flutter
  • Dosing Information
Lopressor injection dose range: 2—15 mg[4]
Multifocal atrial tachycardia
  • Dosing Information
Lopressor injection dose range: 2—15 mg[4]
Supraventricular tachycardia
  • Dosing Information
Lopressor injection dose range: 2—15 mg[4]
Injection Site Pain Associated with Propofol Use
  • Dosing Information
Pretreatment with Lopressor injection 2 mg.[5]

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Condition 1
  • Dosing Information
(Dosage)
Condition 2
  • Dosing Information
(Dosage)

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Condition 1
  • Developed by: (Organisation)
  • Class of Recommendation: (Class) (Link)
  • Strength of Evidence: (Category A/B/C) (Link)
  • Dosing Information
(Dosage)
Condition 2
  • Developed by: (Organisation)
  • Class of Recommendation: (Class) (Link)
  • Strength of Evidence: (Category A/B/C) (Link)
  • Dosing Information
(Dosage)

Non–Guideline-Supported Use

Condition 1
  • Dosing Information
(Dosage)
Condition 2
  • Dosing Information
(Dosage)
Condition 3
  • Dosing Information
(Dosage)

Contraindications

Warnings

Conidition 1

(Description)

Conidition 2

(Description)

Conidition 3

(Description)

Adverse Reactions

Clinical Trials Experience

Condition 1
Central Nervous System
(list/description of adverse reactions)
Cardiovascular
(list/description of adverse reactions)
Respiratory
(list/description of adverse reactions)
Gastrointestinal
(list/description of adverse reactions)
Hypersensitive Reactions
(list/description of adverse reactions)
Miscellaneous
(list/description of adverse reactions)
Condition 1
Central Nervous System
(list/description of adverse reactions)
Cardiovascular
(list/description of adverse reactions)
Respiratory
(list/description of adverse reactions)
Gastrointestinal
(list/description of adverse reactions)
Hypersensitive Reactions
(list/description of adverse reactions)
Miscellaneous
(list/description of adverse reactions)

Postmarketing Experience

(Description)

Drug Interactions

  • Drug 1
  • Drug 2
  • Drug 3
  • Drug 4
  • Drug 5
Drug 1

(Description)

Drug 2

(Description)

Drug 3

(Description)

Drug 4

(Description)

Drug 5

(Description)

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): X
Pregnancy Category (AUS): X

(Description)

Labor and Delivery

(Description)

Nursing Mothers

(Description)

Pediatric Use

(Description)

Geriatric Use

(Description)

Gender

(Description)

Race

(Description)

Renal Impairment

(Description)

Hepatic Impairment

(Description)

Females of Reproductive Potential and Males

(Description)

Immunocompromised Patients

(Description)

Administration and Monitoring

Administration

(Oral/Intravenous/etc)

Monitoring

Condition 1

(Description regarding monitoring, from Warnings section)

Condition 2

(Description regarding monitoring, from Warnings section)

Condition 3

(Description regarding monitoring, from Warnings section)

IV Compatibility

Solution

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Y-Site

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Admixture

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Syringe

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

TPN/TNA

Compatible

  • Solution 1
  • Solution 2
  • Solution 3

Not Tested

  • Solution 1
  • Solution 2
  • Solution 3

Variable

  • Solution 1
  • Solution 2
  • Solution 3

Incompatible

  • Solution 1
  • Solution 2
  • Solution 3

Overdosage

Acute Overdose

Signs and Symptoms

(Description)

Management

(Description)

Chronic Overdose

Signs and Symptoms

(Description)

Management

(Description)

Pharmacology

Template:Px
Metoprolol
Systematic (IUPAC) name
(RS)-1-(Isopropylamino)-3-[4-(2-methoxyethyl)phenoxy]propan-2-ol
Identifiers
CAS number 51384-51-1
ATC code C07AB02
PubChem 4171
DrugBank DB00264
Chemical data
Formula Template:OrganicBox atomTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBox atomTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBoxTemplate:OrganicBox 
Mol. mass 267.364 g/mol
SMILES eMolecules & PubChem
Physical data
Melt. point 120 °C (248 °F)
Pharmacokinetic data
Bioavailability 12%
Metabolism Hepatic via CYP2D6, CYP3A4
Half life 3-7 hours
Excretion Renal
Therapeutic considerations
Licence data

US

Pregnancy cat.

C(AU) C(US)

Legal status

Template:Unicode Prescription only

Routes Oral, IV

Mechanism of Action

(Description)

Structure

(Description with picture)

Pharmacodynamics

(Description)

Pharmacokinetics

(Description)

Nonclinical Toxicology

(Description)

Clinical Studies

Condition 1

(Description)

Condition 2

(Description)

Condition 3

(Description)

How Supplied

(Description)

  • National Drug Code (NDC):
  • Storage:
  • Manufactured by:
  • Distributed by:

Images

Drug Images

(PillBox Images)

Package and Label Display Panel

(Package Images)

(Display Panel Images)

Patient Information

Patient Information from FDA

(Patient Counseling Information)

Patient Information from NLM

(Link to patient information page)

Precautions with Alcohol

Alcohol-Lopressor injection interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Look-Alike Drug Names

  • (Paired Confused Name 1a) — (Paired Confused Name 1b)
  • (Paired Confused Name 2a) — (Paired Confused Name 2b)
  • (Paired Confused Name 3a) — (Paired Confused Name 3b)

Drug Shortage Status

Price

References

  1. ↑ "LOPRESSOR (METOPROLOL TARTRATE) INJECTION, SOLUTION [NOVARTIS PHARMACEUTICALS CORPORATION]".
  2. ↑ Fuster, V.; Rydén, LE.; Cannom, DS.; Crijns, HJ.; Curtis, AB.; Ellenbogen, KA.; Halperin, JL.; Le Heuzey, JY.; Kay, GN. (2006). "ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation)". Eur Heart J. 27 (16): 1979–2030. doi:10.1093/eurheartj/ehl176. PMID 16885201. Unknown parameter |month= ignored (help)
  3. ↑ Wann, LS.; Curtis, AB.; Ellenbogen, KA.; Estes, NA.; Ezekowitz, MD.; Jackman, WM.; January, CT.; Lowe, JE.; Page, RL. (2013). "Management of patients with atrial fibrillation (compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS recommendations): a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines". Circulation. 127 (18): 1916–26. doi:10.1161/CIR.0b013e318290826d. PMID 23545139. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 4.2 Amsterdam, EA.; Kulcyski, J.; Ridgeway, MG. (1991). "Efficacy of cardioselective beta-adrenergic blockade with intravenously administered metoprolol in the treatment of supraventricular tachyarrhythmias". J Clin Pharmacol. 31 (8): 714–8. PMID 1880230. Unknown parameter |month= ignored (help)
  5. ↑ Aşik, I.; Yörükoğlu, D.; Gülay, I.; Tulunay, M. (2003). "Pain on injection of propofol: comparison of metoprolol with lidocaine". Eur J Anaesthesiol. 20 (6): 487–9. PMID 12803269. Unknown parameter |month= ignored (help)
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