Check with your doctor or pharmacist if you are not sure. Initially mg metoprolol tartrate daily. The dose may be increased to mg daily in single or divided doses. Irregular heart beats arrhythmia: The dose may be increased to mg daily in divided doses. The usual maintenance dose is mg daily in divided doses.
The medicine should be taken for at least 3 months. Overactive thyroid gland thyrotoxicosis: Patients with impaired kidney or liver function: In such cases the dose should be adjusted. Swallow the tablet whole. The score line is only there to help you break the tablet if you have difficulty swallowing it whole.
If you take more Metoprolol Tartrate tablets than you should If you have accidentally taken more than the prescribed dose, contact your nearest casualty department or tell your doctor or pharmacist at once.
Symptoms of overdose are low blood pressure fatigue and dizziness , slow pulse, heart conduction problems, heart failure, shock caused by heart problems, cardiac arrest, shortness of breath, unconsciousness, coma, feeling and being sick, blue colouring of the skin, low blood sugar levels and high levels of potassium in the blood.
If you forget to take Metoprolol Tartrate tablets If you forget to take a dose, take it as soon as you remember, unless it is nearly time for your next dose.
Then go on as before. Do not take a double dose to make up for a forgotten dose. If you stop taking Metoprolol Tartrate tablets Do not suddenly stop taking Metoprolol Tartrate tablets as this may cause worsening of heart failure and increase the risk of heart attack. Only change the dose or stop the treatment in consultation with your doctor.
The concomitant use of clonidine with a non-selective beta blocker, and possibly also with a selective beta blocker, increases the risk of rebound hypertension. If clonidine is administered concomitantly, the administration of the clonidine medication needs to be continued for some time after therapy is discontinued. Anti-arrhythmic drugs Caution is advisable in the case of the concomitant use of some anti-arrhythmic drugs, such as those of the quinidine or amiodarone types, and propafenone since beta blockers can intensify the negative inotropic and negative dromotropic effects thereof.
Paroxetine may increase plasma levels of metoprolol resulting in increased beta-blocking effects Ergotamine As beta-blockers may affect the peripheral circulation, care should be exercised when drugs with similar activity, e.
The administration of adrenaline epinephrine to patients undergoing beta-blockade can result in an increase in blood pressure and bradycardia although this is less likely to occur with beta1-selective drugs.
Inhalational anaesthetics An increase in the cardio-depressive effect due to the concomitant administration of inhalational anaesthetics is possible; however, since beta blockade can prevent excessive fluctuations in blood pressure whilst the patient is intubated and is rapidly antagonised with beta sympathomimetics, concomitant use is not contraindicated see section 4. Prostaglandin synthetase inhibitors The concomitant use of beta blockers with indometacin or other prostaglandin synthetase inhibitors can reduce the hypotensive effect of the medicinal product.
Insulin and oral antidiabetic agents The blood sugar-reducing effect of insulin and oral blood sugar-reducing drugs can be intensified by beta blockers, in particular non-selective beta blockers. In this case, the dosage of the oral blood sugar-reducing drug must be adjusted.
Alpha blockers such as prazosine, tamsulosin, terazosine, doxazosine Increased risk of hypotension, especially severe orthostatic hypotension. Non-steroidal anti-inflammatory drugs Concurrent treatment with non-steroidal anti-inflammatory drugs such as indomethacin may decrease the antihypertensive effect of metoprolol. Whereas baclofen increased risk of orthostatic hypotension in particular. Monitoring of blood pressure and dosage adjustment of the antihypertensive if necessary.
Lidocaine Metoprolol can reduce the clearance of lidocaine. Mefloquine Increased risk of bradycardia Antacid showed an increase in the plasma concentrations of metoprolol when the drug was coadministered with an antacid. The effects of metoprolol and other antihypertensive drugs on blood pressure are usually additive. Care should be taken when combining with other antihypertensive drugs or drugs that might reduce blood pressure, such as tricyclic antidepressants, barbiturates and phenothiazines.
However, combinations of antihypertensive drugs may often be used with benefits to improve control of hypertension. Beta blockers reduce placental perfusion, which may result in intrauterine fetal death, immature and premature deliveries but to date prospective studies have not reported an increased risk of congenital defects in humans. Metoprolol crosses the placenta and is present in cord blood, but no evidence of fetal abnormalities has been reported.
As a precautionary measure, it is preferable to avoid the use of metoprolol during pregnancy. Nevertheless, metoprolol has been used in pregnancy-associated hypertension under close supervision, after 20 weeks gestation. However, in neonates of treated mothers, beta-blocker pharmacologic effects may persist several days after birth and may induce bradycardia, hypoglycaemia, and respiratory distress. Therefore, if metoprolol is used later in pregnancy, the possible undesirable effects on the fetus and neonate in particular hypoglycaemia, hypotension, and bradycardia must be carefully monitored during the first days after birth.
Lactation Cases of neonatal hypoglycaemia and bradycardia have been described with beta-blockers with low plasma protein binding. Metoprolol is excreted in human milk. Even though the metoprolol concentration in milk is very low, breast-feeding should be discontinued during treatment with metoprolol.
Metoprolol may be a little better than other beta-blockers in this regard, but monitor breathing carefully. People with a history of depression should inform their doctors to ensure both their depression and beta-blocker therapy is well managed. Metoprolol is more likely to affect the nervous system than others in its class and may contribute to depression. People with a thyroid disorder should also be carefully monitored as metoprolol may mask signs of an overly active thyroid.
Lastly, people with liver impairments may also need to be very carefully monitored. Be certain to inform your doctor of any other conditions you may have. This information may affect your dose, whether you should even take this medication, or require you to take special tests during treatment. Taking the Medicine Metoprolol is best absorbed when taken with or right after meals. Food may reduce the risk of digestive tract upset and taking the drug at roughly the same time each day allows your body to maintain a constant level of the medication in your blood stream.
Do not take calcium supplements or antacids within two hours of metoprolol because they may reduce absorption. If surgery is scheduled, ask your surgeon and anesthesiologist to see if your beta blocker dose will need to be adjusted.
Never stop taking metoprolol suddenly.
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