Instructions for use METOCARD

Pharmacodynamics and pharmacokinetics

Taking this drug helps reduce cardiac output and normalizes heart function. Depression of central sympathetic impulses was also noted. In this case, there is no membrane stabilizing effect and internal sympathomimetic activity does not appear.

Inside the body, Metocard tablets undergo rapid and complete absorption from the gastrointestinal tract. The drug binds slightly to proteins and penetrates well through the placenta. metabolic process occurs in the liver and is excreted from the body primarily through the kidneys.

Contraindications

Metokard is not prescribed for:

• high sensitivity to it;
• cardiogenic shock;
• sinoatrial (SA) and atrioventricular (AV) blockade of II – III degree;
• sick sinus syndrome;
• severe bradycardia;
• heart failure;
• Prinzmetal's angina;
• lactation;
• simultaneous use of MAO inhibitors or administration of verapamil;
• arterial hypotension;
• under 18 years of age.

Maximum caution is required for: diabetes mellitus, obliterating diseases of peripheral vessels, bronchial asthma, metabolic acidosis, chronic obstructive pulmonary disease, chronic liver and also renal failure , myasthenia gravis, pheochromacytoma , AV block of the first degree, depression, psoriasis, thyrotoxicosis, pregnancy and in old age.

Side effects

During treatment with Metocard, side effects may develop, which depend on the individual characteristics of the patient. In most cases, they are not very pronounced and disappear when the drug is stopped.

Typically, undesirable actions affect the functioning of the nervous, digestive, cardiovascular, respiratory, endocrine and other systems.

They may manifest themselves as: increased fatigue, weakness, headache , sinus bradycardia, palpitations, low blood pressure , orthostatic hypotension, dizziness , sometimes loss of consciousness, nausea, vomiting, abdominal pain, dry mouth, diarrhea, constipation , nasal congestion, difficulty exhalation, shortness of breath , hyperglycemia, hypothyroidism.

Damage to the skin, manifested by urticaria, itching , rash, exacerbation of psoriasis, skin hyperemia, exanthema, photodermatosis , increased sweating, and reversible alopecia .

Possible decrease in visual acuity, secretion of tear fluid, and development of conjunctivitis . Laboratory parameters may change, which is manifested by thrombocytopenia, agranulocytosis, leukopenia , and so on.

Metokard tablets 50 mg No. 10x3

Name

Metocard tablet 50 mg in blister pack. №10x3

Description

The tablets are white, round, biconvex, with a scoring line.

Main active ingredient

metoprolol tartrate

Release form

Pills

Dosage

50mg

special instructions

Monitoring of patients taking Metocard includes regular monitoring of heart rate and blood pressure, blood glucose levels in patients with diabetes. If necessary, the dose of insulin or oral hypoglycemic drugs for patients with diabetes mellitus should be selected individually. The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min. When taking a dose above 200 mg/day, cardioselectivity decreases. In case of heart failure, treatment with metoprolol begins only after reaching the compensation stage. It is possible that the severity of hypersensitivity reactions may increase (against the background of a burdened allergic history) and the lack of effect from the administration of usual doses of epinephrine (adrenaline). While taking Metocard, symptoms of peripheral arterial circulation disorders may intensify. The drug is discontinued gradually, reducing the dose over 10 days. If treatment is abruptly stopped, withdrawal syndrome may occur (increased angina attacks, increased blood pressure). When discontinuing the drug, special attention should be paid to patients with angina pectoris. For exertional angina, the selected dose of the drug should ensure the heart rate at rest within the range of 55-60 beats/min, and during exercise - no more than 110 beats/min. Patients who use contact lenses should take into account that during treatment with beta-blockers, the production of tear fluid may decrease. Metoprolol may mask some clinical manifestations of hyperthyroidism (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms. In diabetes mellitus, Metocard can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels. If it is necessary to prescribe to patients with bronchial asthma, β2-adrenergic receptor stimulants are used as concomitant therapy; for pheochromocytoma - alpha-blockers. If surgical intervention is necessary, it is necessary to warn the anesthesiologist about the therapy being performed (choosing a general anesthesia agent with minimal negative inotropic effect); discontinuation of the drug is not recommended. Drugs that reduce catecholamine reserves (for example, reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure and bradycardia. In elderly patients, regular monitoring of liver function is recommended. Correction of the dosage regimen is required only if an elderly patient develops increasing bradycardia (less than 50 beats/min), a pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), AV blockade, bronchospasm, ventricular arrhythmias, severe liver dysfunction , sometimes it is necessary to stop treatment. In patients with severe renal failure, monitoring of renal function is recommended. Special monitoring should be carried out for the condition of patients with depressive disorders taking metoprolol; in case of depression caused by taking beta-blockers, it is recommended to discontinue therapy. Use in pediatrics The safety and effectiveness of the drug in children and adolescents under 18 years of age have not been established. Effect on the ability to drive vehicles and operate machinery. At the beginning of treatment with metoprolol, patients may experience dizziness and fatigue. In this case, they should refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions. In the future, this issue should be resolved after assessing the patient’s individual response to the therapy.

pharmachologic effect

A cardioselective beta1-blocker that does not have internal sympathomimetic activity and membrane-stabilizing properties. It has antihypertensive, antianginal, antiarrhythmic effects. By blocking β1-adrenergic receptors of the heart in low doses, it reduces the catecholamine-stimulated formation of cAMP from ATP, reduces the intracellular Ca2+ current, has a negative chrono-, dromo-, bathmo- and inotropic effect (reduces heart rate, inhibits conductivity and excitability, reduces myocardial contractility). OPSS at the beginning of the use of beta-blockers (in the first 24 hours after oral administration) increases (as a result of a reciprocal increase in the activity of α-adrenergic receptors and the elimination of stimulation of β2-adrenergic receptors), which after 1-3 days returns to the original level, and with long-term administration - decreases. Acute antihypertensive effect is due to a decrease in cardiac output, a stable antihypertensive effect develops within 2-3 weeks and is due to a decrease in renin synthesis and accumulation of plasma renin, inhibition of the activity of the renin-angiotensin system (of great importance in patients with initial hypersecretion of renin) and the central nervous system, restoration of sensitivity baroreceptors of the aortic arch (there is no increase in their activity in response to a decrease in blood pressure) and, as a result, a decrease in peripheral sympathetic influences. Reduces high blood pressure at rest, during physical exertion and stress. Blood pressure decreases after 15 minutes, maximum after 2 hours and the decrease continues for 6 hours, diastolic blood pressure changes more slowly: a stable decrease is observed after several weeks of regular use. The antianginal effect is determined by a decrease in myocardial oxygen demand as a result of a decrease in heart rate (prolongation of diastole and improvement of myocardial perfusion) and contractility, as well as a decrease in the sensitivity of the myocardium to the effects of sympathetic innervation. Reduces the number and severity of angina attacks and increases exercise tolerance. The antiarrhythmic effect is due to the elimination of arrhythmogenic factors (tachycardia, increased activity of the sympathetic nervous system, increased cAMP content, arterial hypertension), a decrease in the rate of spontaneous excitation of sinus and ectopic pacemakers and a slowdown of atrioventricular conduction (mainly in the antegrade and, to a lesser extent, in the retrograde directions through AV node) and along additional paths. For supraventricular tachycardia, atrial fibrillation, sinus tachycardia in functional heart disease and hyperthyroidism, the drug reduces heart rate or can even lead to the restoration of sinus rhythm. Prevents the development of migraine. When used in average therapeutic doses, in contrast to non-selective beta-blockers, it has a less pronounced effect on organs containing β2-adrenergic receptors (pancreas, skeletal muscles, smooth muscles of peripheral arteries, bronchi and uterus) and on carbohydrate metabolism. When used in large doses (more than 100 mg/day), it has a blocking effect on both subtypes of β-adrenergic receptors.

Pharmacokinetics

Absorption After oral administration, it is quickly and almost completely (95%) absorbed from the gastrointestinal tract. Cmax of metoprolol in blood plasma is achieved 1-2 hours after oral administration. Bioavailability is 50% upon first administration and increases to 70% upon repeated use. Eating increases bioavailability by 20-40%. Distribution Plasma protein binding averages 10%. Penetrates the BBB and placental barrier. Excreted in breast milk in small quantities. Metabolism Biotransformed in the liver. Metabolites do not have pharmacological activity. Elimination T1/2 averages 3.5 hours (from 1 to 9 hours). About 5% of the drug is excreted unchanged by the kidneys. It is not removed by hemodialysis. Pharmacokinetics in special clinical situations The bioavailability of metoprolol increases in liver cirrhosis. Impaired liver function slows down the metabolism of the drug.

Indications for use

arterial hypertension (including hyperkinetic type) in the form of monotherapy or in combination with other antihypertensive drugs; IHD: myocardial infarction (secondary prevention - complex therapy), prevention of angina attacks; heart rhythm disturbances (supraventricular tachycardia, ventricular extrasystole); hyperthyroidism (complex therapy); prevention of migraine attacks.

Directions for use and doses

The drug is taken orally at the same time as a meal or immediately after a meal. The tablets can be divided in half, but not chewed, and washed down with liquid. For arterial hypertension, the initial dose is 50-100 mg/day in 1-2 doses. If necessary, the daily dose is gradually increased to 100-200 mg. In the absence of a satisfactory therapeutic effect, Metocard can be prescribed in combination with other antihypertensive drugs. The maximum daily dose is 200 mg. For angina pectoris, arrhythmia, and prevention of migraine attacks, 100-200 mg/day is prescribed in 2 doses (morning and evening). For secondary prevention of myocardial infarction, a dose of 200 mg/day is prescribed in 2 doses (morning and evening). For functional cardiac disorders accompanied by tachycardia, the drug is prescribed at a dose of 100 mg/day in 2 divided doses (morning and evening). In elderly patients, with impaired renal function, and also if hemodialysis is necessary, no dose adjustment is required. In case of liver dysfunction, the dose of the drug should be reduced depending on the clinical condition.

Use during pregnancy and lactation

During pregnancy, Metocard should be used only when the expected benefit to the mother outweighs the potential risk to the fetus. Metoprolol penetrates the placental barrier. If it is necessary to use the drug during pregnancy due to the possible development of bradycardia, arterial hypotension, and hypoglycemia in the newborn, careful monitoring of fetal development is necessary. After delivery, it is necessary to ensure strict monitoring of the condition of the newborn for 48-72 hours. Metoprolol is excreted in breast milk. The effect of metoprolol on a newborn has not been studied, therefore, if it is necessary to use Metocard during lactation, breastfeeding should be discontinued.

Interaction with other drugs

Concomitant use with MAO inhibitors is not recommended due to a significant increase in the hypotensive effect. The break between taking MAO inhibitors and metoprolol should be at least 14 days. Simultaneous intravenous administration of verapamil can provoke cardiac arrest. The simultaneous administration of nifedipine leads to a significant decrease in blood pressure. When used simultaneously with Metocard, agents for inhalation general anesthesia (hydrocarbon derivatives) increase the risk of suppression of myocardial function and the development of arterial hypotension. Beta-agonists, theophylline, cocaine, etrogens (sodium retention), indomethacin and other NSAIDs (sodium retention and blocking renal prostaglandin synthesis) weaken the hypotensive effect. There is an increased inhibitory effect on the central nervous system when used simultaneously with the standard; summation of the cardiodepressive effect - with drugs for general anesthesia; increased risk of peripheral circulatory disorders - with ergot alkaloids. When taken together with oral hypoglycemic agents, their effect may be reduced; with insulin - increasing the risk of developing hypoglycemia, increasing its severity and duration, masking some symptoms of hypoglycemia (tachycardia, sweating, increased blood pressure). When combined with antihypertensive drugs, diuretics, nitroglycerin or slow calcium channel blockers, a sharp decrease in blood pressure may develop (special caution is required when combined with prazosin). When Metocard is used with verapamil, diltiazem, antiarrhythmic drugs (amiodarone), reserpine, alpha-methyldopa, clonidine, guanfacine, general anesthesia agents and cardiac glycosides, an increase in the severity of the decrease in heart rate and inhibition of AV conduction is observed. If metoprolol and clonidine are taken simultaneously, then when metoprolol is discontinued, clonidine is discontinued after a few days (due to the risk of withdrawal syndrome). Inducers of microsomal liver enzymes (rifampicin, barbiturates) lead to increased metabolism of metoprolol, a decrease in the concentration of metoprolol in the blood plasma and a decrease in the effect. Inhibitors of microsomal liver enzymes (cimetidine, oral contraceptives, phenothiazines) - increase the concentration of metoprolol in the blood plasma. Allergens used for immunotherapy or allergen extracts for skin testing when used in combination with metoprolol increase the risk of systemic allergic reactions or anaphylaxis; iodine-containing radiopaque agents for intravenous administration increase the risk of developing anaphylactic reactions. Metoprolol, when used simultaneously, reduces the clearance of xanthine (except for diphylline), especially with the initially increased clearance of theophylline under the influence of smoking; reduces the clearance of lidocaine, increases the concentration of lidocaine in the blood plasma. When used simultaneously, Metocard enhances and prolongs the effect of antidepolarizing muscle relaxants and prolongs the anticoagulant effect of coumarins. When Metocard is used together with ethanol, the risk of a pronounced decrease in blood pressure increases. Tri- and tetracyclic antidepressants, antipsychotics (neuroleptics), sedatives and hypnotics, when used together with metoprolol, increase central nervous system depression.

Contraindications

cardiogenic shock; AV block II or III degree; sinoatrial block; SSSU; severe bradycardia; chronic heart failure in the decompensation phase; Prinzmetal's angina; arterial hypotension (if used for secondary prevention of myocardial infarction - systolic blood pressure less than 100 mm Hg, heart rate less than 45 beats/min); lactation period; simultaneous use with MAO inhibitors; simultaneous intravenous administration of verapamil; age under 18 years; hypersensitivity to metoprolol or other components of the drug, other beta-blockers. The drug should be prescribed with caution for diabetes mellitus, metabolic acidosis, bronchial asthma, chronic obstructive pulmonary disease (emphysema, chronic obstructive bronchitis), obliterating diseases of peripheral vessels (intermittent claudication, Raynaud's syndrome), chronic liver and/or renal failure, myasthenia gravis, pheochromocytoma, AV blockade of the first degree, thyrotoxicosis, depression (including a history), psoriasis, pregnancy, as well as in elderly patients.

Compound

metoprolol tartrate 50 mg Excipients: lactose, povidone, talc, magnesium stearate, microcrystalline cellulose, rice starch.

Overdose

Symptoms: severe severe sinus bradycardia, dizziness, nausea, vomiting, cyanosis, marked decrease in blood pressure, arrhythmia, ventricular ecstasystole, bronchospasm, fainting, in case of acute overdose - cardiogenic shock, loss of consciousness, coma, AV block (up to the development of complete transverse block and cardiac arrest), cardialgia. The first signs of overdose appear 20 minutes to 2 hours after taking the drug. Treatment: gastric lavage and administration of adsorbents, symptomatic therapy: with a pronounced decrease in blood pressure, the patient should be in the Trendelenburg position; in case of excessive decrease in blood pressure, bradycardia and heart failure - intravenous administration (with an interval of 2-5 minutes) of beta-agonists until the desired effect is achieved or intravenous administration of 0.5-2 mg of atropine sulfate. If there is no positive effect, administer dopamine, dobutamine or norepinephrine (norepinephrine). As subsequent measures, it is possible to prescribe 1-10 mg of glucagon and install a transvenous intracardial pacemaker. For bronchospasm, β2-adrenergic receptor stimulants should be administered intravenously. Metoprolol is poorly excreted by hemodialysis.

Side effect

From the central nervous system and peripheral nervous system: increased fatigue, weakness, headache, slower speed of mental and motor reactions; rarely - paresthesia in the limbs (in patients with intermittent claudication and Raynaud's syndrome), depression, anxiety, decreased attention, drowsiness, insomnia, nightmares, confusion or short-term memory loss, muscle weakness. From the senses: rarely - decreased vision, decreased secretion of tear fluid, dry and sore eyes, conjunctivitis, tinnitus. From the cardiovascular system: sinus bradycardia, palpitations, decreased blood pressure, orthostatic hypotension, dizziness, sometimes loss of consciousness; rarely - decreased myocardial contractility, temporary worsening of symptoms of chronic heart failure (edema, swelling of the feet and/or lower legs, shortness of breath), arrhythmias, manifestation of vasospasm (increased peripheral circulatory disorders, coldness of the lower extremities, Raynaud's syndrome), impaired myocardial conduction. From the digestive system: nausea, vomiting, abdominal pain, dry mouth, diarrhea, constipation, change in taste, impaired liver function, increased activity of liver enzymes; extremely rarely - hyperbilirubinemia. Dermatological reactions: urticaria, skin itching, rash, exacerbation of psoriasis, psoriasis-like skin reactions, skin hyperemia, exanthema, photodermatosis, increased sweating, reversible alopecia. From the respiratory system: nasal congestion, difficulty exhaling (bronchospasm when prescribed in high doses - loss of selectivity and/or in predisposed patients), shortness of breath. From the endocrine system: hyperglycemia in patients with non-insulin-dependent diabetes mellitus, hypothyroidism. From the hematopoietic system: rarely - thrombocytopenia (unusual bleeding and hemorrhage), agranulocytosis, leukopenia. Effect on the fetus: possible intrauterine growth retardation, hypoglycemia, bradycardia. Other: back or joint pain; in isolated cases - a slight increase in body weight, decreased libido and/or potency. Side effects depend on the individual sensitivity of the patient. They are usually minor and disappear after discontinuation of the drug.

Storage conditions

The drug should be stored in a dry place, protected from light, out of the reach of children, at a temperature not exceeding 25°C.

Buy Metokard tablets 50 mg No. 10x3 in the pharmacy

Price for Metokard tablets 50 mg No. 10x3

Instructions for use for Metocard tablets 50 mg No. 10x3

Metocard, instructions for use (Method and dosage)

These tablets are intended for oral administration. It is recommended to do this during or after meals. It is allowed to divide the tablets in half, swallow without chewing, and drink plenty of liquid.

Treatment of arterial hypertension begins with an initial daily dosage of 50-100 mg. Tablets should be taken 1-2 times - in the morning and in the evening. If the therapeutic effect is insufficient, then a gradual increase in the daily dosage to 100-200 mg is possible. Additional prescription of other antihypertensive drugs is also allowed. In this case, the maximum daily dosage should not be more than 200 mg.

When treating angina pectoris, arrhythmia and preventing migraine attacks, tablets are prescribed in a daily dosage of 100-200 mg, which is divided into two doses.

The dosage for secondary prevention of myocardial infarction is 200 mg. The drug is divided into two doses - in the morning and in the evening. During the treatment of functional disorders of cardiac activity, which are accompanied by tachycardia , the drug is prescribed in a daily dosage of 100 mg.

For elderly patients, with problems with kidney function and during hemodialysis , the dosage does not change. Reducing the dosage in case of liver dysfunction can be carried out taking into account the clinical condition of the patient.

Buy Metokard tablets 50 mg No. 30 in pharmacies

Instructions for use Metokard tab. 50mg No. 30

Dosage forms tablets 50 mg Synonyms Betaloc Betaloc ZOK Vasocardin Corvitol 100 Corvitol 50 Metozok Metocor Adifarm Metoprolol Metoprolol Zentiva Metoprolol Organics Metoprolol-Acri Metoprolol-Ratiopharm Egilok Egilok retard Egilok C Group Beta1-adrenergic blockers (cardioselective) International non-proprietary name Metoprolol Composition Active substance - Metoprolol. Manufacturers Polpharma Pharmaceutical Plant (Poland) Pharmacological action Pharmacological action - hypotensive, antianginal, antiarrhythmic. Reduces cardiac output and systolic blood pressure, slows heart rate, weakens the stimulating effect of catecholamines on the myocardium during physical activity and mental stress, and prevents reflex orthostatic tachycardia. The antihypertensive effect is due to a decrease in cardiac output and renin synthesis, inhibition of the activity of the renin-angiotensin system and the central nervous system, restoration of baroreceptor sensitivity and, ultimately, a decrease in peripheral sympathetic influences. The hypotensive effect develops quickly (systolic blood pressure decreases after 15 minutes, maximum after 2 hours) and lasts for 6 hours. Diastolic blood pressure changes more slowly. The antianginal effect is a consequence of a decrease in the frequency and strength of heart contractions, energy costs and myocardial oxygen demand. Reduces the frequency and severity of attacks of ischemic heart disease. Has a moderate negative inotropic effect. Metoprolol tartrate is rapidly and almost completely absorbed when taken orally and undergoes intensive first-pass metabolism. It is quickly distributed in tissues, penetrates the blood-brain barrier, the placental barrier, and breast milk. Biotransforms in the liver, producing two active metabolites. It is excreted primarily by the kidneys in the form of metabolites. Pharmacokinetic parameters do not depend on the age of patients. Side effects From the nervous system and sensory organs: weakness, dizziness and headache, decreased concentration, drowsiness/insomnia, nightmares, depression, muscle cramps, paresthesia, nervousness, anxiety, decreased libido, blurred vision, xerophthalmia, conjunctivitis, lethargy , increased fatigue, anxiety, confusion, amnesia/short-term memory loss, hallucinations, tinnitus, impaired taste. From the cardiovascular system and blood (hematopoiesis, hemostasis): bradycardia, palpitations, hypotension, cold extremities, heart failure, AV block, edema syndrome, chest pain, decreased myocardial contractility, arrhythmias, gangrene, impaired myocardial conduction, syncope, thrombocytopenia, leukopenia, agranulocytosis. From the gastrointestinal tract: nausea, abdominal pain, diarrhea or constipation, vomiting, dry mouth, liver dysfunction; flatulence, dyspepsia, heartburn, hepatitis. From the respiratory system: shortness of breath, bronchospasm, vasomotor rhinitis, dyspnea. From the skin: rash, degenerative skin changes, reversible alopecia, photosensitivity, exacerbation of psoriasis; itching, erythema, urticaria, hyperhidrosis. Other: weight loss, arthralgia, arthritis, myalgia, muscle weakness, Peyronie's disease. Indications for use Arterial hypertension of moderate and moderate severity (monotherapy or in combination with other antihypertensive drugs), coronary artery disease, hyperkinetic cardiac syndrome, cardiac arrhythmia (sinus tachycardia, ventricular and supraventricular arrhythmia, including paroxysmal tachycardia, supraventricular tachycardia, extrasystole, flutter and atrial fibrillation, atrial tachycardia), hypertrophic cardiomyopathy, mitral valve prolapse, myocardial infarction (prevention and treatment), migraine (prevention), thyrotoxicosis (complex therapy); treatment of akathisia caused by neuroleptics. Contraindications Hypersensitivity, AV block II and III degrees, sinoatrial block, acute or chronic (in the stage of decompensation) heart failure, sick sinus syndrome, severe sinus bradycardia (heart rate less than 60 beats/min), cardiogenic shock, arterial hypotension (systolic blood pressure less than 100 mm Hg), severe peripheral circulatory disorders, pregnancy, breastfeeding. Restricted for use in: diabetes mellitus, hypoglycemia, severe allergic history, metabolic acidosis, bronchial asthma, emphysema, non-allergic bronchitis, hyperthyroidism, psoriasis, pheochromocytoma, impaired liver and/or kidney function, myasthenia gravis, depression, general anesthesia, elderly and children age. Method of administration and dosage Orally (during or after meals, without chewing and with liquid, once in the morning or in the evening and in the evening (with two doses), intravenously. As an antianginal, antihypertensive and antiarthymic agent, for hyperkinetic syndrome, metoprolol tartrate is prescribed orally at a dose of 100-200 mg in 2-3 doses, if necessary, the dose is increased at weekly intervals to 450 mg/day. In the acute period of myocardial infarction, under monitoring of blood pressure, heart rate and ECG, 3 bolus IV injections of 5 mg each with 2-minute intermittently (total dose 15 mg), if well tolerated, 15 minutes after injection, 25-50 mg is prescribed orally every 6 hours for 48 hours, and then 50-100 mg 2 times a day (morning and evening) for 3 months to 3 years . When switching to the use of metoprolol succinate, the dose remains the same. For the prevention of migraine attacks - 50-100 mg orally 2-4 times a day. Metoprolol succinate for ischemic heart disease, hypertension, arrhythmias, functional disorders of cardiac activity, accompanied by palpitations, is prescribed orally in a dose 50-100 mg 1 time per day, for migraine prevention 200 mg 1 time per day. The dose is increased no earlier than after 1 week, i.e. after the development of the maximum effect. Overdose Symptoms: arterial hypotension, acute heart failure, bradycardia, cardiac arrest, AV block, cardiogenic shock, bronchospasm, impaired breathing and consciousness/coma, nausea, vomiting, generalized convulsions, cyanosis (manifest 20 minutes - 2 hours after administration). Treatment: gastric lavage, symptomatic therapy: administration of atropine sulfate (0.5-2 mg intravenously quickly) - for bradycardia and impaired AV conduction; glucagon (1-10 mg IV, then IV drip 2-2.5 mg/h) and dobutamine - in case of decreased myocardial contractility; adrenomimetics (norepinephrine, adrenaline, etc.) - for arterial hypotension; diazepam (iv slowly) - to eliminate seizures; inhalation of beta-adrenergic agonists or intravenous injection of aminophylline to relieve bronchospastic reactions; cardiac stimulation. Interaction Hypotension is potentiated by sympatholytics, nifedipine, nitroglycerin, diuretics, apressin and other antihypertensive drugs. Antiarrhythmic and anesthetic drugs increase the risk of bradycardia, arrhythmia, and hypotension. Digitalis preparations potentiate the slowing of AV conduction. Simultaneous intravenous administration of verapamil and diltiazem can provoke cardiac arrest. Beta-adrenergic agonists, aminophylline, cocaine, estrogens, indomethacin and other NSAIDs weaken the antihypertensive effect. Strengthens and prolongs the effect of antidepolarizing muscle relaxants. Combination with alcohol leads to a mutual strengthening of the inhibitory effect on the central nervous system. Allergens increase the risk of severe systemic allergic reactions or anaphylaxis. Changes the effectiveness of insulin and oral antidiabetic agents and increases the risk of hypoglycemia. Antacids, hydralazines, oral contraceptives, cimetidine, ranitidine, phenothiazines increase the level of metoprolol in the blood, rifampicin decreases it. Reduces the clearance of lidocaine and the effectiveness of beta2-adrenergic agonists (the dose of the latter must be increased). Incompatible with MAO type A inhibitors. Special instructions In patients with chronic heart failure, myocardial contractility may deteriorate, necessitating the use of cardiac glycosides and/or diuretics with careful monitoring of hemodynamic status. Against the background of diabetes mellitus and hyperfunction of the thyroid gland, metoprolol can mask tachycardia caused by hypoglycemia or thyrotoxicosis. In patients with diabetes mellitus, dose adjustment of antidiabetic drugs and careful monitoring of glycemic levels is necessary. When performing surgery during treatment, the anesthetic agent with the least negative ionotropic effect should be the drug of choice. A more pronounced development of a hypersensitivity reaction and the absence of a therapeutic effect of usual doses of adrenaline against the background of a burdened allergic history are possible. In patients with pheochromocytoma, use is possible only in conjunction with alpha-adrenolytics. Stop taking metoprolol 2-3 days before birth (risk of developing bradycardia, hypotension and hypoglycemia in the newborn); in exceptional cases, newborns after birth should be under medical supervision for 48-72 hours. When discontinuing treatment, the dose should be reduced gradually over 10-14 days. Patients with coronary artery disease should be under close medical supervision during this period. Use with caution while working for vehicle drivers and people whose profession involves increased concentration. During treatment, test results may change during laboratory tests. Storage conditions List B. In a place protected from light, at room temperature.

Overdose

In cases of overdose, symptoms may occur in the form of severe severe sinus bradycardia, dizziness , nausea, vomiting, cyanosis , marked decrease in pressure, arrhythmia , ventricular ecstasystole, bronchospasm, fainting . Cases of acute overdose are accompanied by cardiogenic shock, loss of consciousness, coma, atrioventricular block, and cardialgia.

In this case, the manifestation of the first signs of an overdose is possible within 30 minutes to 2 hours from the moment of taking the drug. Treatment includes gastric lavage, taking adsorbent drugs and carrying out suitable symptomatic therapy.

Interaction

Concomitant use with MAO inhibitors may enhance the hypotensive effect. Therefore, it is necessary to maintain a break between the use of MAO inhibitors and Metocard for at least 2 weeks. When Verapamil , cardiac arrest may occur .

Combination with Nifedipine can significantly lower blood pressure . Drugs for inhalation general anesthesia can cause depression of myocardial function and arterial hypotension.

A weakening of the hypotensive effect is observed with the simultaneous use of beta-agonists, Theophylline, cocaine, etrogens, Indomethacin and other non-steroidal anti-inflammatory drugs.

Taking Metocard and hypoglycemic drugs can reduce their effectiveness, and with insulin it increases the risk of developing hypoglycemia, increases its severity, masking the symptoms of hypoglycemia, for example, tachycardia, sweating and high blood pressure.

A significant decrease in blood pressure can develop when taken together with antihypertensive drugs, slow calcium channel blockers, some diuretics and Nitroglycerin.

A decrease in heart rate and problems with atrioventricular conduction can develop when taking metoprolol and Verapamil, Diltiazem , antiarrhythmic drugs, Reserpine, Alpha-methyldopa , Clonidine, Guanfacine , general anesthesia drugs and cardiac glycosides .

Combined use with inducers of microsomal liver enzymes Rifampicin and barbiturates, can increase the metabolism of metoprolol, reduce its concentration in the blood plasma , significantly reducing its effectiveness. cimetidine, phenothiazines and oral contraceptives, can increase the concentration of the drug in the blood plasma

Allergens that are used for immunotherapy, as well as allergen extracts intended for skin testing, can increase the risk of systemic allergic reactions , as well as anaphylaxis, as do some iodinated radiocontrast drugs .

It is possible to enhance and prolong the effect of antidepolarizing muscle relaxants and prolong the anticoagulant effect of coumarins . Complex therapy with tri- and tetracyclic antidepressants, antipsychotic drugs, sedatives and hypnotics can increase depression of the nervous system.

Instructions for use METOCARD

If bradycardia, peripheral circulatory disorders, or anaphylactic shock develops during the use of Metocard, the dose should be reduced or the drug discontinued. Cancellation of therapy should be carried out gradually over 2 weeks.

In patients with coronary artery disease, sudden withdrawal of Metocard can increase the symptoms of ischemia and even cause the development of myocardial infarction and ventricular arrhythmia. The dose reduction should be carried out gradually over 2 weeks.

Metocard should be prescribed to patients with bronchial asthma and obstructive bronchitis with caution and only if other antihypertensive drugs are ineffective. In this case, it is recommended to use the lowest effective dose, divided into 3 doses. The possibility of simultaneous use of beta2-agonists should be discussed.

Metoprolol may mask tachycardia in patients with hyperthyroidism. In these patients, the drug should be used with caution, since discontinuation of the drug may cause a hyperthyroid crisis.

Metoprolol can mask the symptoms of hypoglycemia (except dizziness and sweating), and also increase hypoglycemia after the use of insulin. Therefore, the drug should be used with caution in patients with diabetes mellitus, especially unstable ones.

Before performing surgery using general anesthesia, the anesthesiologist should be warned that the patient is taking Metocard.

Caution should be exercised when prescribing the drug to patients with metabolic acidosis.

Patients with pheochromocytoma should take a drug from the group of alpha-blockers simultaneously with Metocard.

While taking Metocard, the level of transaminases, alkaline phosphatase and LDH may increase.

Caution should be exercised when treating elderly patients with Metocard, because in them, an excessive decrease in blood pressure and a slowdown in heart rate can negatively affect the function of vital organs.

Use in pediatrics

The safety and effectiveness of Metokard in children has not been determined.

Impact on the ability to drive vehicles and operate machinery

While taking the drug, the patient's ability to concentrate may be impaired, so the question of the ability to perform work that requires speed of psychomotor reactions and increased attention should be decided only after assessing the patient's individual response to the drug.

special instructions

The withdrawal of this drug is carried out gradually, with a preliminary reduction in dosage for 10 days. If treatment is stopped abruptly, a “withdrawal” syndrome may develop, accompanied by increased attacks of angina pectoris and increased blood pressure. This is especially true for patients suffering from angina pectoris.

When using contact lenses, it is important to remember that during treatment with beta-blockers, a decrease in tear fluid often occurs.

The drug is also able to mask the clinical symptoms of hyperthyroidism, such as tachycardia. In case of thyrotoxicosis, it is dangerous to abruptly discontinue the drug, as this may increase undesirable symptoms.

Diabetes mellitus often masks the tachycardia caused by hypoglycemia. At the same time, there was no increase in hypoglycemia caused by insulin; normal restoration of glucose concentration in the blood occurs .

When treating elderly patients, regular monitoring of liver function is necessary. Dosage adjustments are carried out only in cases of increasing bradycardia, a significant decrease in pressure, atrioventricular block, ventricular arrhythmias, bronchospasms, and so on - the appearance of all of these symptoms requires cessation of treatment.

Additional monitoring of renal function is also required when treating patients with severe renal failure . No less attention is needed during the treatment of patients suffering from depressive disorders, and if they are caused by taking beta-blockers, then discontinuation of therapy is recommended.

During the initial stage of treatment, dizziness and fatigue may develop. Therefore, it is necessary to refrain from driving vehicles and performing potentially dangerous activities that require attention and quick reactions.

Metocard

Monitoring of patients taking beta-blockers includes regular monitoring of heart rate (HR) and blood pressure, blood glucose levels in patients with diabetes. If necessary, for patients with diabetes mellitus, the dose of insulin or hypoglycemic agents prescribed orally should be selected individually.

The patient should be taught how to calculate heart rate and instructed about the need for medical consultation if the heart rate is less than 50 beats/min.

When taking a dose above 200 mg per day, cardioselectivity decreases.

In case of heart failure, treatment with metoprolol begins only after reaching the compensation stage.

It is possible that the severity of hypersensitivity reactions may increase (against the background of a burdened allergic history) and the lack of effect from the administration of usual doses of epinephrine (adrenaline).

May increase symptoms of peripheral arterial circulation disorders.

The drug is discontinued gradually, reducing the dose over 10 days.

If treatment is abruptly stopped, withdrawal syndrome may occur (increased angina attacks, increased blood pressure).

When discontinuing the drug, special attention should be paid to patients with angina pectoris.

For exertional angina, the selected dose of the drug should ensure the heart rate at rest is within 55-60 beats/min, and during exercise - no more than 110 beats/min.

Patients who use contact lenses should take into account that during treatment with beta-blockers, the production of tear fluid may decrease.

Metoprolol may mask some clinical manifestations of hyperthyroidism (eg, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms.

In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels.

If it is necessary to prescribe to patients with bronchial asthma, beta2-adrenergic stimulants are used as concomitant therapy; for pheochromacytoma - alpha-blockers.

If surgical intervention is necessary, it is necessary to warn the anesthesiologist about the therapy being performed (choosing a general anesthesia agent with minimal negative inotropic effect); discontinuation of the drug is not recommended.

Drugs that reduce the supply of catecholamines (for example, reserpine) may enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure and bradycardia.

In elderly patients, it is recommended to regularly monitor liver function. Correction of the dosage regimen is required only if an elderly patient develops increasing bradycardia (less than 50 beats/min), a pronounced decrease in blood pressure (systolic blood pressure below 100 mm Hg), atrioventricular block, bronchospasm, ventricular arrhythmias, severe liver dysfunction , sometimes it is necessary to stop treatment.

In patients with severe renal failure, monitoring of renal function is recommended.

Special monitoring should be carried out for the condition of patients with depressive disorders taking metoprolol; in case of depression caused by taking beta-blockers, it is recommended to discontinue therapy.

Due to the lack of sufficient clinical data, the drug is not recommended for use in children.

Analogues of Metocard

Level 4 ATC code matches:
Biol

Metozok

Nebilet

Nebilong

Betaxolol

Bisogamma

Aritel

Cordinorm

Vasocardin

Corvitol

Bidop

Bisoprolol

Nebivolol

Biprol

Bisoprol

Concor Cor

Lokren

Concor

Niperten

Betaloc ZOK

The main analogues: Egilok, Betalok, Corvitol, Vazocardin, Serdol, Metoprolol, Metocor and Metozok.

Reviews about Metocard

This drug is widely used to treat people suffering from hypertension and various heart pathologies. That’s why reviews about Metocard are quite common. As you know, this medicine can be used for a long time, which means that choosing the required dosage requires a special approach. The ideal result of treatment is stabilization of blood pressure and heart rate.

However, this drug does not always help. Patients are often prescribed additional therapy. It is important to consider compatibility with other medications, especially at the initial stage of treatment. Unfortunately, some patients independently supplement treatment with all kinds of tinctures and folk methods. The simultaneous use of Metocard with alcohol-containing drugs, which can depress the activity of the nervous system, causing undesirable effects, can be dangerous.

During treatment, the development of side effects affecting the activity of the nervous and cardiovascular systems is possible. However, it is not always possible to accurately determine whether this is a development of side effects or a manifestation of symptoms of the underlying disease.

One way or another, when prescribed the appropriate dosage, the drug can significantly improve the health of many patients. According to user reports, they noticed an improvement quite quickly. An important point is to prescribe the dosage at the initial stage of therapy and further adjustment. If health improvement does not occur within a month, then the doctor is informed about this so that another more suitable treatment can be promptly selected.

Metocard

Monitoring of patients taking the drug includes monitoring heart rate and blood pressure (at the beginning of use - daily, then once every 3-4 months), blood glucose concentration in patients with diabetes (once every 4-5 months). The patient should be trained in the method of calculating heart rate and instructed about the need for medical consultation if the heart rate is less than 50/min.

It is possible that the severity of allergic reactions may increase (against the background of a burdened allergic history) and there will be no effect from the administration of usual doses of epinephrine.

In elderly patients, it is recommended to monitor kidney function (once every 4-5 months). Treatment with the drug may increase symptoms of peripheral arterial circulation disorders. Patients with cardiac arrhythmias whose systolic blood pressure is below 100 mm Hg should be given IV only if special precautions are taken (there is a risk of a further decrease in blood pressure). The drug is discontinued gradually, reducing the dose over 10 days.

In case of arterial hypertension, the effect of taking the drug occurs after 2-5 days, a stable effect is observed after 1-2 months.

For exertional angina, the selected dose of the drug should ensure the heart rate at rest within the range of 55-60 beats/min, and during exercise - no more than 110 beats/min. In smokers, the effectiveness of beta-blockers is lower.

In combination therapy with clonidine, the latter should be discontinued several days after discontinuation of the drug, in order to avoid a hypertensive crisis. At a dose above 200 mg/day, cardioselectivity decreases.

May mask some clinical manifestations of thyrotoxicosis (for example, tachycardia). Abrupt withdrawal in patients with thyrotoxicosis is contraindicated because it can increase symptoms.

In diabetes mellitus, it can mask tachycardia caused by hypoglycemia. Unlike non-selective beta-blockers, it practically does not enhance insulin-induced hypoglycemia and does not delay the restoration of blood glucose concentrations to normal levels.

If necessary, beta2-agonists are used as concomitant therapy for patients with bronchial asthma; for pheochromocytoma - alpha-blockers.

If surgical intervention is necessary, it is necessary to warn the anesthesiologist about the drug therapy being carried out (choosing a drug for general anesthesia with minimal negative inotropic effect); discontinuation of the drug is not recommended.

Reciprocal activation of the n.vagus can be eliminated by intravenous administration of atropine (1-2 mg).

Drugs that reduce catecholamine reserves (for example, reserpine) can enhance the effect of beta-blockers, so patients taking such combinations of drugs should be under constant medical supervision to detect an excessive decrease in blood pressure or bradycardia.

If elderly patients develop increasing bradycardia (less than 50/min), arterial hypotension (systolic blood pressure below 100 mm Hg), AV block, bronchospasm, ventricular arrhythmias, severe liver and kidney dysfunction, it is necessary to reduce the dose or stop treatment . It is recommended to discontinue therapy if skin rashes appear and depression develops caused by taking beta-blockers.

The drug is discontinued gradually, reducing the dose over 10 days. If treatment is abruptly stopped, withdrawal syndrome may occur (increased angina attacks, increased blood pressure). When discontinuing the drug, special attention should be paid to patients with angina pectoris.

Patients who use contact lenses should take into account that during treatment with beta-blockers, the production of tear fluid may decrease.

During pregnancy, treatment with the drug is prescribed only according to strict indications (due to the possible development of bradycardia, hypotension, hypoglycemia and respiratory paralysis in the newborn). Treatment must be interrupted 48-72 hours before delivery. In cases where this is not possible, it is necessary to ensure strict monitoring of newborns for 48-72 hours after delivery.

At the beginning of treatment, patients may experience dizziness and fatigue. In this case, they should refrain from driving vehicles and engaging in potentially hazardous activities that require increased concentration and speed of psychomotor reactions. In the future, dose safety is determined individually.