Mental confusion and short-term memory loss have been reported. Distribution studies in mice confirm exposure of the fetus when metoprolol is administered to the pregnant animal. Vomiting was a common occurrence.

Because of variable plasma levels attained with a given dose and lack of a consistent relationship of antihypertensive activity to dose, selection of In several studies of patients with acute myocardial infarction, intravenous followed by oral administration of metoprolol caused a reduction in heart rate, systolic blood pressure and cardiac output. Patients should not discontinue metoprolol without consulting the physician.Advise patients (1) to avoid operating automobiles and machinery or engaging in other tasks requiring alertness until the patient’s response to therapy with metoprolol has been determined; (2) to contact the physician if any difficulty in breathing occurs; (3) to inform the physician or dentist before any type of surgery that he or she is taking metoprolol.Catecholamine-depleting drugs (e.g., reserpine) may have an additive effect when given with beta-blocking agents or monoamine oxidase (MAO) inhibitors.

Dosages above 450 mg per day have not been studied. In patients with severe intolerance, discontinue metoprolol tartrate tablets (see Start patients with contraindications to treatment during the early phase of suspected or definite myocardial infarction, patients who appear not to tolerate the full early treatment, and patients in whom the physician wishes to delay therapy for any other reason on metoprolol tartrate tablets, 100 mg twice daily, as soon as their clinical condition allows.

500 mg; 850 mg; 1000 mg; Riomet® solution. The safety and efficacy of metoprolol in pediatric patients have not been established.No dose adjustment of metoprolol tartrate tablets is required in patients with renal impairment.Metoprolol blood levels are likely to increase substantially in patients with hepatic impairment. Nonetheless, because the overall regimen showed a clear beneficial effect on survival without evidence of an early adverse effect on survival, one acceptable dosage regimen is the precise regimen used in the trial. In addition, possibly significant hypertension may theoretically occur up to 14 days following discontinuation of the concomitant administration with an irreversible MAO inhibitor.Both digitalis glycosides and beta-blockers slow atrioventricular conduction and decrease heart rate.

Because the specific benefit of very early treatment remains to be defined however, it is also reasonable to administer the drug orally to patients at a later time as is recommended for certain other beta-blockers.Metoprolol tartrate tablets are indicated for the treatment of hypertension.

In a 21-month study in Swiss albino mice at three oral dosage levels of up to 750 mg/kg per day, benign lung tumors (small adenomas) occurred more frequently in female mice receiving the highest dose than in untreated control animals.

It may be necessary to lower the dose of metoprolol or to discontinue it.Do not abruptly discontinue metoprolol therapy in patients with coronary artery disease.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle.Metoprolol may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Monitor heart rate and PR interval.Concomitant administration of a beta-adrenergic antagonist with a calcium channel blocker may produce an additive reduction in myocardial contractility because of negative chronotropic and inotropic effects.Potent inhibitors of the CYP2D6 enzyme may increase the plasma concentration of metoprolol which would mimic the pharmacokinetics of CYP2D6 poor metabolizer (see Concomitant administration of hydralazine may inhibit presystemic metabolism of metoprolol leading to increased concentrations of metoprolol. Because of its relative beta Beta-blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected.If metoprolol is used in the setting of pheochromocytoma, it should be given in combination with an alpha-blocker, and only after the alpha-blocker has been initiated.

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Equivalent maximal beta-blocking effect is achieved with oral and intravenous doses in the ratio of approximately 2.5:1.There is a linear relationship between the log of plasma levels and reduction of exercise heart rate. Metoprolol has been shown to increase postimplantation loss and decrease neonatal survival in rats at doses up to 11 times the maximum daily human dose of 450 mg, when based on surface area. The increase in exercise capacity and the reduction in left ventricular ischemia are also significantly related to the logarithm of the oral dose.The estimated oral bioavailability of immediate-release metoprolol is about 50% because of pre-systemic metabolism which is saturable leading to non-proportionate increase in the exposure with increased dose.Metoprolol is extensively distributed with a reported volume of distribution of 3.2 L/kg to 5.6 L/kg. In a 2-year study in rats at three oral dosage levels of up to 800 mg/kg per day, there was no increase in the development of spontaneously occurring benign or malignant neoplasms of any type.