Metoprolol


Indications.


Apart from indications for cardiac purposes, Metoprolol 200 LP is indicated in the long-term treatment of migraine.

Contraindications.



  • Asthma and chronic obstructive pulmonary disease, in their severe forms.

  • Heart failure not controlled by treatment.

  • Cardiogenic shock.

  • Unpaired second and third degree atrioventricular blocks.

  • Prinzmetal's angina (in pure forms and as monotherapy).

  • Sinus disease (including sinoatrial block).

  • Bradycardia (<45 to 50 beats per minute).

  • Raynaud's phenomenon and peripheral arterial disorders, in their severe forms.

  • Untreated pheochromocytoma.

  • Hypotension.

  • Hypersensitivity to metoprolol.

  • History of anaphylactic reaction.


This medication is generally not recommended during breast-feeding.

Side effects.



  • Very common: Asthenia.

  • Common:

    • Dizziness,

    • headache,

    • nausea, abdominal pain, diarrhea, constipation,

    • bradycardia, severe if applicable, postural hypotension, palpitations,

    • cold extremity,

    • dyspnea on exertion.



  • Uncommon:

    • Vomiting,

    • heart failure, drop in blood pressure, precordial pain, cardiogenic shock in patients with myocardial infarction,

    • edema,

    • depression, concentration disturbance, drowsiness, insomnia, nightmare,

    • bronchospasm,

    • hypoglycemia,

    • increased weight.



  • Rare:

    • Paresthesia,

    • dry mouth,

    • slowed atrioventricular conduction or worsening of existing atrioventricular block, arrhythmia,

    • Raynaud's syndrome,

    • worsening of existing intermittent claudication,

    • nervousness, anxiety,

    • impotence,

    • alopecia,

    • rhinitis,

    • visual defects, dryness or eye irritation, conjunctivitis,

    • antinuclear antibodies exceptionally accompanied by clinical manifestations like lupus syndrome and leading to discontinuation of treatment.



  • Very rare:

    • Arthralgia,

    • dysgeusia,

    • retroperitoneal fibrosis,

    • hepatitis,

    • gangrene in patients with severe peripheral circulatory disorders,

    • stroke, amnesia, memory impairment, confusion, hallucination,

    • Peyronie's disease,

    • Exacerbation of psoriasis,

    • reaction photosensitivity,

    • thrombocytopenia.




Overdose.


Like all beta blockers, extreme bradycardia, hypotension, bronchospasm with respiratory failure, heart failure can occur justifying the use of dobutamine, glucagon or even an external pace maker, bronchodilator.