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Author: Admin | 2025-04-28
Procedures Metoprolol loses beta-receptor selectivity at high doses and in poor metabolizers If the drug is administered for tachycardia secondary to pheochromocytoma, it should be given in combination with an alpha-blocker (which should be started before metoprolol is started) While taking beta-blockers, patients with a history of severe anaphylactic reaction to a variety of allergens may be more reactive to repeated challenge Extended-release tablet should not be withdrawn routinely before major surgery Hydrochlorothiazide can cause an idiosyncratic reaction, resulting in acute transient myopia and acute angle-closure glaucoma, which can lead to permanent vision loss if not treated; discontinue hydrochlorothiazide as rapidly as possible if symptoms occur; prompt medical or surgical treatments may need to be considered if the intraocular pressure remains uncontrolled; risk factors for developing acute angle-closure glaucoma may include the history of sulfonamide or penicillin allergy Caution in patients with a history of psychiatric illness; may cause or exacerbate CNS depression Beta-blockers can precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular diseaseDrug interactions overview Catecholamine depleting drugs (eg, reserpine, monoamine oxidase (MAO) inhibitors) may have an additive effect when given with beta-blocking agents; monitor when coadministration with catecholamine depleting drugs for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension While taking beta-blockers, patients with a history of severe anaphylactic reactions to a variety of allergens may be more reactive to repeated challenges and may be unresponsive to the usual doses of epinephrine used to treat an allergic reaction Drugs that are strong inhibitors of CYP2D6, such as quinidine, fluoxetine, paroxetine, and propafenone, were shown to double metoprolol concentrations; no information about moderate or weak inhibitors, but are likely to increase metoprolol concentration; closely monitor patients when the combination cannot be avoided Digitalis glycosides, clonidine, diltiazem, and verapamil slow atrioventricular conduction and decrease heart rate Concomitant administration of hydralazine may inhibit presystemic metabolism of metoprolol leading to increased concentrations of metoprolol Concomitant use with beta-blockers can increase the risk of bradycardia; if clonidine and a beta-blocker, such as metoprolol are coadministered, withdraw the beta-blocker several days before the gradual withdrawal of clonidine because beta-blockers may exacerbate the rebound hypertension that can follow the withdrawal of clonidine If replacing clonidine with beta-blocker therapy, delay introduction of beta-blockers for several days after clonidine administration has stopped Metoprolol succinate is released faster from Kapspargo Sprinkle in the presence of alcohol; may increase
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