Indications & Dose:
Hypertension
Adult: Initially 100 mg daily, increased if necessary to 200 mg daily in 1–2 divided doses, high doses are rarely required; maximum 400 mg per day
Adult: 200 mg once daily
Angina
Adult: 50–100 mg 2–3 times a day
Adult: 200–400 mg daily continued
Arrhythmias
Adult: Usual dose 50 mg 2–3 times a day, then increased if necessary up to 300 mg daily in divided doses
Adult: Up to 5 mg, dose to be given at a rate of 1–2 mg/minute, then up to 5 mg after 5 minutes if required, total dose of 10–15 mg
Migraine prophylaxis
Adult: 100–200 mg daily in divided doses
Adult: 200 mg daily
Hyperthyroidism (adjunct)
Adult: 50 mg 4 times a day
In surgery
Adult: Initially 2–4 mg, given at induction or to control arrhythmias developing during anaesthesia, then 2 mg, repeated if necessary; maximum 10 mg per course Early intervention within 12 hours of infarction
Adult: Initially 5 mg every 2 minutes, to a max. of 15 mg, followed by (by mouth) 50 mg every 6 hours for 48 hours, to be taken 15 minutes after intravenous injection; (by mouth) maintenance 200 mg daily in divided doses.
Children: 1-5mg/kg/24 hrs. divided every 12 hrs
Contraindications:
Bronchial asthma, cardiogenic shock overt cardiac failure, 2nd and 3rd degree AV block, severe sinus bradycardia
Side Effects:
CNS: Confusion, depression, dizziness, fatigue, headache, insomnia, memory loss, strange dreams
CV: Bradycardia, CHF, cold extremities, heart block, hypotension
EENT: Tinnitus, visual disturbances
GI: Constipation, diarrhea, dry mouth, heart burn, nausea
GU: Impotence, sexual dysfunction
HEME: Agranulocytosis (rare)
METAB: Hyperlipidemia (increased TG, total cholesterol, LDL; decreased HDL); masked hypoglycemic response to insulin(sweating excepted)
RESP: Bronchospasm (1%), dyspnea
SKIN: Alopecia, pruritus, rash
Cautions:
Precautions:
Anesthesia/surgery (myocardial depression); avoid abrupt withdrawal, bronchospastic airways, congestive heart failure,diabetes mellitus, hyperthyroidism/ thyrotoxicosis,concurrent clonidine (discontinue atenolol several days prior to withdrawal of clonidine), peripheral vascular disease, renal disease,
Pregnancy & breast-feeding: Use with caution.
Old age: May be used.
Interaction:
Drugs
a-adrenergic blockers: Potential enhanced first dose response (marked initial drop in blood pressure) particularly on standing (especially prazocin)Amiodarone: Bradycardia, cardiac arrest, or ventricular dysrhythmia
Antidiabetic: Altered response to hypoglycemia, prolonged recovery of normoglycemia, hypertension, blockade of tachycardia; may increase blood glucose and impair peripheral circulation
Antipyrine: Increased antipyrine concentrations
Barbiturates: Reduced ß-blocker concentrations
Beta agonists: Antagonism of bronchodilating effect Bromazepam, diazepam, oxazepam: increased benzodiazepine effect, (lorazepam and alprazolam unaffected)
Cimetidine, etintidine, propafenone, propoxyphene, quinidine: Increased plasma metoprolol concentration
Clonidine: Abrupt withdrawal of clonidine while ona (ß-blocker may exaggerate the rebound hypertension due to unopposed oc stimulation
Digoxin: Additive prolongation of atrioventricular (AV) conduction time
Dihydropyridines (nicardipine, nifedipine, felodipine, isradipine, nisoldipine): Increased beta blocker effects
Diltiazem: Potentiates ß-adrenergic effects; hypotension, left ventricular failure, and AV conduction disturbances problematic in elderly, patients with left ventricular dysfunction, aortic stenosis, or with large doses of either drug Dipyridamole,
Tacrine: Bradycardia
Fluoxetine: Enhanced effect of ß-blocker Hypoglycemic agents,: Masked hypoglycemia, hyperglycemia
Isoproterenol: Potential reduction in effectiveness of isoproterenol in the treatment of. asthma; less likely with cardioselective agents like metoprolol
Local anesthetics: Use of local anesthetics containing epinephrine may result in hypertensive reactions in patients taking P-blockers
NSAIDs: Reduced hypotensive effects of ß-blockers
Phenylephrine: Enhanced pressor response to phenylephrine, particularly when it is administered
Prazosin: First-dose response to prazosin may be enhanced by blockade
Quinolones: Inhibition of ß-blocker metabolism, increased ß-blocker effects
Rifampin: Reduced plasma metoprolol concentration
Theophylline: Antagonistic pharmacodynamic effects
Verapamil: Potentiates ß-adrenergic effects; hypotension, left ventricular failure, and AV conduction disturbances problemmatic in elderly, patients with left ventricular dysfunction, aortic stenosis, or with large doses of either drug
Warnings:
Adverse Effects:
Lactations:
Special Precautions:
Counselling:
Side Effects Or Adverse Reactions:
Patient And Carer Advice:
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