BOX WARNING
Ischemic Heart Disease: Following abrupt cessation of therapy with certain beta-blocking agents, exacerbations of angina pectoris and, in some cases, myocardial infarction have occurred. When discontinuing chronically administered Lopressor, particularly in patients with ischemic heart disease, the dosage should be gradually reduced over a period of 1-2 weeks and the patient should be carefully monitored. If angina markedly worsens or acute coronary insufficiency develops, Lopressor administration should be reinstated promptly, at least temporarily, and other measures appropriate for the management of unstable angina should be taken. Patients should be warned against interruption or discontinuation of therapy without the physician’s advice. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue Lopressor therapy abruptly even in patients treated only for hypertension.
Bronchospastic Diseases : PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS. Because of its relative beta 1 selectivity, however, Lopressor may be used with caution in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Since beta 1 selectivity is not absolute, a beta 2 -stimulating agent should be administered concomitantly, and the lowest possible dose of Lopressor should be used. In these circumstances it would be prudent initially to administer Lopressor in smaller doses three times daily, instead of larger doses two times daily, to avoid the higher plasma levels associated with the longer dosing interval ( see DOSAGE AND ADMINISTRATION).
Major Surgery: The necessity or desirability of withdrawing beta-blocking therapy prior to major surgery is controversial; the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures.
Lopressor, like other beta blockers, is a competitive inhibitor of beta-receptor agonists, and its effects can be reversed by administration of such agents, e.g., dobutamine or isoproterenol. However, such patients may be subject to protracted severe hypotension. Difficulty in restarting and maintaining the heart beat has also been reported with beta blockers.
Diabetes and Hypoglycemia: Lopressor should be used with caution in diabetic patients if a beta-blocking agent is required. Beta blockers may mask tachycardia occurring with hypoglycemia, but other manifestations such as dizziness and sweating may not be significantly affected.
Pheochromocytoma: In patients known to have, or suspected of having, a pheochromocytoma, Lopressor is contraindicated (see CONTRAINDIATIONS). If Lopressor is required, it should be given in combination with an alpha blocker, and only after the alpha blocker has been initiated. 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.
Thyrotoxicosis: Beta-adrenergic blockade may mask certain clinical signs (e.g., tachycardia) of hyperthyroidism. Patients suspected of developing thyrotoxicosis should be managed carefully to avoid abrupt withdrawal of beta blockade, which might precipitate a thyroid storm.
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LOPRESSOR SUMMARY
Lopressor, metoprolol tartrate USP, is a selective beta1-adrenoreceptor blocking agent, available as 50- and 100-mg tablets for oral administration and in 5-mL ampuls for intravenous administration. Each ampul contains a sterile solution of metoprolol tartrate USP, 5 mg, and sodium chloride USP, 45 mg, and water for injection USP.
Hypertension
Lopressor tablets are indicated for the treatment of hypertension. They may be used alone or in combination with other antihypertensive agents.
Angina Pectoris
Lopressor is indicated in the long-term treatment of angina pectoris.
Myocardial Infarction
Lopressor ampuls and tablets are indicated in the treatment of hemodynamically stable patients with definite or suspected acute myocardial infarction to reduce cardiovascular mortality. Treatment with intravenous Lopressor can be initiated as soon as the patient’s clinical condition allows (see DOSAGE AND ADMINISTRATION, CONTRA-INDICATIONS, and WARNINGS). Alternatively, treatment can begin within 3 to 10 days of the acute event (see DOSAGE AND ADMINISTRATION).
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LOPRESSOR NEWS HIGHLIGHTS
Published Studies Related to Lopressor (Metoprolol)
Impact of beta-blockers on sleep in patients with mild hypertension: a randomized trial between nebivolol and metoprolol. [2008.09]
INTRODUCTION: Sleep is an innate and essential part of human life. Various aspects of sleep are negatively affected by beta-blockers. We compared the impact of two beta-blockers, metoprolol [generic for Lopressor] succinate (extended release) and nebivolol, on sleep quality in patients with stage 1 hypertension... CONCLUSION: Nebivolol was associated with improved sleep (as assessed by the PSQI), whereas metoprolol was associated with a worsening of sleep characteristics.
A randomized, double-blind study of valsartan versus metoprolol on arterial distensibility and endothelial function in essential hypertension. [2008.07]
BACKGROUND: Antihypertensive drugs may have differential, pressure-independent effects on hypertension-associated alterations of arterial function. We compared the effects of a 12-week therapy with the AT(1)-receptor antagonist valsartan (Val) versus the beta-blocker metoprolol [generic for Lopressor] (Met) on arterial stiffness and endothelial function in mildly hypertensive patients at rest and during generalized sympathetic stimulation... CONCLUSION: Short-term treatment with Val and Met had similar effects on large artery functional vessel wall properties in a population of mildly hypertensive patients.
The comparative effects of metoprolol and perindopril on aortic elasticity in young patients with prehypertension. [2008.06]
CONCLUSION: The current study revealed that early pharmacological intervention had strong beneficial effects on aortic elasticity in patients with prehypertension despite the fact that neither metoprolol [generic for Lopressor] nor perindopril was superior to the other.
Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. [2008.05.31]
BACKGROUND: Trials of beta blockers in patients undergoing non-cardiac surgery have reported conflicting results. This randomised controlled trial, done in 190 hospitals in 23 countries, was designed to investigate the effects of perioperative beta blockers... INTERPRETATION: Our results highlight the risk in assuming a perioperative beta-blocker regimen has benefit without substantial harm, and the importance and need for large randomised trials in the perioperative setting. Patients are unlikely to accept the risks associated with perioperative extended-release metoprolol [generic for Lopressor].
Comparison of the efficacy of metoprolol and carvedilol for preventing atrial fibrillation after coronary bypass surgery. [2008.05.07]
BACKGROUND: Atrial fibrillation (AF) occurs frequently after coronary artery bypass grafting (CABG) and often results in prolonged postsurgical hospital stays and increased mortality and morbidity. Beta blockers are known to prevent postoperative AF. In this prospective study, we investigated the efficacy of carvedilol compared with metoprolol [generic for Lopressor] succinate in preventing postoperative AF... CONCLUSIONS: These results show that carvedilol is superior to metoprolol in decreasing development of early postoperative AF.
Clinical Trials Related to Lopressor (Metoprolol)
Fed Study of Metoprolol Tartrate Tablets 25 mg and Lopressor® 50 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan's metoprolol
tartrate tablets to Novartis' Lopressor® tablets following a single, oral 50 mg (2 x 25 mg
tablets for Mylan's formulation and 1 x 50 mg for Lopressor®) dose administered under fed
conditions.
Factorial Study of Metoprolol Succinate TOPROL-XL (324A) [Completed]
The purpose of this research study is to determine if treatment with the combination of
metoprolol succinate and hydrochlorothiazide is more effective at lowering blood pressure
than treatment with either of the two drugs alone. The study will also determine which
combined doses of metoprolol succinate and hydrochlorothiazide are most effective at lowering
blood pressure (without unacceptable side effects), and whether it is possible to combine
both drugs in a single tablet to simplify blood pressure treatment.
Fed Study of Metoprolol Tartrate Tablets 100 mg and Lopressor® 100 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan's metoprolol
tartrate tablets to Novartis's Lopressor® tablets following a single, oral 100 mg (1 x 100
mg) dose administered under fed conditions.
Food Study of Metoprolol Tartrate/Hydrochlorothiazide Tablets 100/50 mg to Lopressor HCT® Tablets 100/50 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan metoprolol
tartrate/hydrochlorothiazide 100/50 mg tablets to Novartis Lopressor HCT® 100/50 mg tablets
following a single, oral 100/50 mg (1 x 100/50 mg) dose administration under fed conditions.
Fasting Study of Metoprolol Tartrate/Hydrochlorothiazide Tablets 100/50 mg and Lopressor HCT® Tablets 100/50 mg [Completed]
The objective of this study was to investigate the bioequivalence of Mylan metoprolol
tartrate/hydrochlorothiazide 100/50 mg tablets to Novartis Lopressor HCT® 100/50 mg tablets
following a single, oral 100/50 mg (1 x 100/50 mg) dose administration under fasting
conditions.
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LOPRESSOR PATIENT REVIEWS / RATINGS / COMMENTSBased on a total of 1 ratings/reviews, Lopressor has an overall score of 8. The effectiveness score is 10 and the side effect score is 8. The scores are on ten point scale: 10 - best, 1 - worst.
| | Lopressor review by 39 year old female patient | | | Rating |
| Overall rating: | |   |
| Effectiveness: | | Highly Effective |
| Side effects: | | Mild Side Effects | | |
Treatment Info |
| Condition / reason: | | high blood pressure |
| Dosage & duration: | | 50 mg taken once daily for the period of 10 yrs |
| Other conditions: | | acid reflux |
| Other drugs taken: | | prilosec | | |
Reported Results |
| Benefits: | | rapid heart beat stoped, and blood pressure went down. |
| Side effects: | | tired and dizzy at first |
| Comments: | | Take once daily. |
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Page last updated: 2008-11-03
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