Metoprolol

definition

Metoprolol / Metohexal belongs to a group of so-called beta-receptor blockers. Beta blockers are therefore opponents of the beta receptors. Beta-blockers are mainly used in the cardiovascular system, for example to treat high blood pressure (hypertension), in the context of a heart attack or in the event of a heart failure (Heart failure).

Beta receptors are not only found on the heart and blood vessels, they are also found on the lungs, for example. Functional changes in other organs of the body can therefore also occur when taking Metohexal.

Dosage and intake

Metoprolol is available in the pharmacy in the form of Tablets available and is therefore taken orally, i.e. by mouth. The tablets can be bought in different dosages. It is important that there is also a so-called tablet in addition to the "normal" tablet Retard preparation gives. This serves to prolong the delivery of active ingredients to the body, so that you may save yourself a second dose of medication per day.
Depending on the dose, the tablets have a notch to make them easier to divide.

Metoprolol / Metohexal requires a prescription, so it can only be obtained from a pharmacy with the help of a doctor's prescription. The duration of use and the amount of dosage must always be individually adapted by the doctor to the patient concerned.

The tablets should be swallowed whole and with sufficient liquid. One should take it if possible after eating happen. If only a single dose per day is scheduled, this should be done in the morning. If given twice a day, this is done in the morning and evening.

The duration of the intake of Metoprolol / Metohexal is not limited in time as with other tablets. Should the tablets nevertheless be discontinued, special attention should be given to one slowly sneak out to pay attention. Abrupt withdrawal can lead to so-called cardiac ischemia, which means a lack of oxygen in the heart. There can also be a significant increase in blood pressure again. These effects are also called Rebound effects designated.
Even with the first dose, it is advisable to slowly approach the required dose.

The doses of metoprolol differ depending on the disease. In arterial hypertension, the popularly known high blood pressure, a 50 milligram tablet is taken once or twice a day. If this is not enough, the dose can be increased to two times two tablets, which then corresponds to 200 milligrams.

How Metroprolol Works

Metoprolol belongs to a group of beta blockers. So drugs in this group block what are known as beta-adrenergic receptors. The stress hormone acts by blocking these receptors Moderated adrenaline and norepinephrine or prevented. So the main effects drugs like Metohexal have on that Heart rate and the Blood pressure.

With the beta blockers you can different groups distinguish. The subgroups of beta receptors are decisive here, of which there are beta-1 and beta2 receptors. The various drugs / active ingredients therefore differ primarily in terms of their binding to the respective receptors. If a drug binds equally to both subtypes, this drug is called nonselective Beta blockers. Since these unselective active ingredients act on the entire body and therefore lead to a number of side effects, there are now also more selective Drugs that block only one subtype or that block it to a greater extent.

Metoprolol belongs to the group of selective beta1-receptor blockers. Since the beta1 receptors are found almost exclusively in the heart, these are also called beta blockers cardioselective. The active ingredient lowers the heart rate, the contraction force of the heart and the conduction of excitation in the heart.

Metabolism of Metroprolol

Metoprolol / Metohexal is almost completely absorbed in the gastrointestinal tract after oral ingestion absorbed through the intestinal mucosa. The systemic availability is, however, significantly lower, since metoprolol is high First pass effect subject. In this context, the first-pass effect means that the drug is rapidly metabolized when it first passes through the liver.

Metoprolol is absorbed through the intestinal mucosa and reaches the venous blood vessels of the intestine. These flow into the so-called portal vein, a large vessel that transports blood towards the liver. Metoprolol is already partially metabolized there and therefore no longer enters the body's circulation in order to develop its effect.

The liver cells have a number of different enzyme complexes, each of which can break down different drugs. These enzymes belong to the large group of so-called Cytochrome P450 enzymes. A subunit of this is called CYP2D6, which is responsible, among other things, for the breakdown of metoprolol. Since this enzyme also breaks down other drugs, taking them at the same time may lead to interactions that should always be considered.

Metohexal is almost entirely used in the total Metabolized liver and then eliminated. If the liver is damaged, causing so-called cirrhosis of the liver, metabolism can be impaired and therefore lead to increased drug levels in the blood.

Metoprolol contraindications

Metoprolol / Metohexal must not be taken in a number of diseases. These include, for example, a Hypersensitivity against metoprolol or other beta-receptor blockers.

The intake is also not indicated for one shock or one Bradycardia. Bradycardia describes a pulse rate of less than 50 beats per minute. Even with one too low blood pressureMetoprolol, which is medically known as hypotension, should not be taken.

Exists in a patient bronchial asthma or hypersensitivity of the lungs, metoprolol may also not be possible.

At the heart there are different structures that are responsible for running the Cardiac excitation are responsible. If these are diseased or their function is changed, a number of clinical pictures can arise for which the use of metoprolol is not indicated. This includes, for example, the so-called AV block second and third degree. This is a structure that is supposed to transfer the excitation from the atria to the ventricles. If this structure is diseased, the time required for the transition can be increased. Depending on the extent of the extension, the disease is called grade one, two or three.

The administration of Metohexal is also contraindicated in late and severe stages of the peripheral arterial disease. This can lead to an even worse blood flow in the already poorly supplied tissue.

Particularly careful consideration and monitoring has to be carried out with patients with Diabetes mellitus. if the Liver function If the patient is limited, close monitoring is also important here, as overdoses may occur.

During the pregnancy It is best not to take metoprolol as there is insufficient evidence on this. The active ingredient reaches the baby via the placenta and can also lead to a reduction in heart rate, low blood pressure or a blood glucose level that is too low. Beta-blockers can reduce the placental blood flow and thus possibly lead to premature birth. It is also important that metoprolol can pass into breast milk. Therefore, in the Lactation also to refrain from taking it.

Metroprolol interactions

Metoprolol is metabolized via an enzyme complex called CYP2D6. This enzyme complex in the liver is responsible for the metabolism of a number of drugs. Since metoprolol is now metabolized by the complex CYP2D6 when it is excreted, it is important not to inhibit or increase its function by administering other drugs at the same time. This would change the levels of Metohexal in the blood.
An increase in the metoprolol level by inhibiting CYP2D6, for example, makes antiarrhythmics (Medication for arrhythmias of the heart), Antihistamines (also called antiallergic drugs) or some Antidepressants.

When taking metoprolol at the same time oral diabetes medication or insulin their effect can also be prolonged or intensified. Since, among other things, the heart rate normally rises in the case of hypoglycaemia, the administration of beta-receptor blockers, which prevent precisely this rise, should be treated with caution.

With a parallel administration of dehydrating agents (Diuretics), vasodilator drugs, or other antihypertensive drugs, there may be an increased drop in blood pressure.

Side effects of metoprolol

Since the beta receptors are not only located on the heart and blood vessels, but also on the eyes, in the lungs or on the fat cells, side effects can of course also occur in these structures when taking beta-receptor blockers. Occasionally, it can become too, especially at the beginning of the medication fatigue, sleep disorders, increased sweat or a headache come. Temporarily it can too Nausea and vomiting or also to diarrhea come.

You may be able to take metoprolol as well allergic skin reactions occur that deal with Redness and itching, but may also express with sensitivity to light.

The beta receptors in the lungs, when activated, usually cause the bronchi to widen, allowing more air to enter the lungs. Blocking these receptors means that the bronchi will no longer expand, but may narrow with a Increase in breathing resistance. Especially in patients prone to asthmatic problems, the use of metoprolol should therefore be observed with particular caution.

In patients with a peripheral circulatory disorder the symptoms may possibly worsen through the administration of Metohexal. In rare cases, treatment with metoprolol or other beta-blockers can lead to a increased drop in blood pressure, decreased heart rate, Conduction disorders in the heart or lead to unconsciousness. Dry mouth or decreased tearing are rather rare side effects of taking beta blockers.

At Diabetics may possibly lead to ingestion Hypoglycaemia lead that cannot be perceived by the patient to the normal extent. By taking medication, the warning signs of hypoglycaemia such as increased heart rate or tremors may be missing.

Men one has to consider the possible occurrence of Libido and erectile dysfunction enlighten.
The administration of metoprolol can also lead to changes in lipid metabolism with a change in the ratios of the various blood-fat forms.

Overdose with Metroprolol

The overall picture of a metoprolol overdose is mainly due Cardiovascular symptoms and symptoms of Nervous system marked. Significant reductions in heart rate and blood pressure up to cardiac arrest can therefore be signs of an overdose. It can also be massive Difficulty breathing, Vomit or Impaired consciousness come.

As a first therapeutic measure in the event of an overdose, treatment with metoprolol should be interrupted immediately. Medicines can be used in the event of an overdose Atropine and Glucagon give to counteract the effect of the beta blocker. The patient should be monitored in intensive care with regular monitoring of vital parameters such as blood pressure, heart rate and oxygen saturation.