CV: BRADYCARDIA, heart block, HF, hypotension, peripheral vasoconstriction.
Derm: rash.
EENT: blurred vision, stuffy nose.
Endo: hyperglycemia, hypoglycemia.
GI: ↑liver enzymes, constipation, diarrhea, drug-induced hepatitis, dry mouth, flatulence, gastric pain, heartburn, nausea, vomiting.
GU: erectile dysfunction, ↓ libido, urinary frequency.
MS: arthralgia, back pain, joint pain.
Neuro: fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia, memory loss, mental status changes, nervousness, nightmares.
Resp: bronchospasm, PULMONARY EDEMA, wheezing.
Misc: drug-induced lupus syndrome.
When switching from immediate-release to extended-release product, the same total daily dose can be used
- PO (Adults): Hypertension/angina: 25–100 mg/day as a single dose initially or 2 divided doses; may be ↑ every 7 days as needed up to 450 mg/day (immediate-release) or 400 mg/day (extended-release) (for angina, give in divided doses). Extended-release products are given once daily. MI: 25–50 mg (starting 15 min after last IV dose) every 6 hr for 48 hr, then 100 mg twice daily. Heart failure: 12.5–25 mg once daily (of extended-release), can be doubled every 2 wk up to 200 mg/day. Migraine prevention: 50–100 mg 2–4 times daily (unlabeled).
- IV (Adults): MI: 5 mg every 2 min for 3 doses, followed by oral dosing.
- PO (Children
6 yr): Hypertension: 1 mg/kg once daily (extended-release capsules); may be titrated, as needed (not to exceed 50 mg/day).
Kapspargo Sprinkle, Lopressor, Toprol XL
Therapeutic Classification: antianginals, antihypertensives
Pharmacologic Classification: beta blockers
Absorption: Well absorbed after oral administration.
Distribution: Crosses the blood-brain barrier, crosses the placenta; small amounts enter breast milk.
Metabolism/Excretion: Mostly metabolized by the liver via the CYP2D6 isoenzyme; the CYP2D6 isoenzyme exhibits genetic polymorphism; 7% of population may be poor metabolizers and may have significantly ↑ metoprolol concentrations and an ↑ risk of adverse effects.
Half-life: 3–7 hr.
(cardiovascular effects)
†Maximal effects on BP (chronic therapy) may not occur for 1 wk. Hypotensive effects may persist for up to 4 wk after discontinuation.
