Metoprolol Succinate
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Trade Name
Toprol-XL (primary brand name); generic metoprolol succinate (extended-release)
Classification
Beta-adrenergic blocker (selective β1-blocker); antihypertensive, antianginal, antiarrhythmic
Dosage/Route
- * Dosage: Extended-release tablets: 25 mg, 50 mg, 100 mg, 200 mg
- * Route: Oral (PO)
Usual Dosage
- * Hypertension: 25-100 mg PO once daily; may increase to 400 mg/day
- * Heart Failure: Start 12.5-25 mg PO daily; titrate to 200 mg/day as tolerated
- * Angina: 100 mg PO daily; adjust to 400 mg/day max
- * Dose titrated based on BP, heart rate, and tolerance
Mechanism of Action
Selectively blocks β1-adrenergic receptors in the heart, reducing heart rate, myocardial contractility, and cardiac output. Lowers blood pressure and oxygen demand; prolongs AV node conduction, aiding arrhythmias
Side Effects & Adverse Effects
- * Side Effects: Fatigue, dizziness, bradycardia, hypotension, depression
- * Adverse Effects:
- – Severe bradycardia or heart block (esp. with overdose or in AV conduction issues)
- – Bronchospasm (less common; β1-selective but caution in asthma/COPD)
- – Heart failure exacerbation (if stopped abruptly)
- – Masked hypoglycemia signs in diabetics
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor HR and BP before each dose (hold if HR <50-60 bpm or SBP <90 mmHg, per protocol)
- – Assess for heart failure signs (edema, dyspnea) during titration
- – Check apical pulse in elderly or cardiac patients
- * Teachings:
- – Take at same time daily, with/without food
- – Do not crush/chew extended-release tablets
- – Rise slowly to avoid dizziness (orthostasis)
- – Report slow pulse, fatigue, or breathing issues
- – Don’t stop suddenly—risks rebound hypertension/tachycardia
Indication for This Patient
- * Hypertension (chronic management)
- * Heart failure (NYHA Class II-IV; improves survival)
- * Angina pectoris (reduces chest pain frequency)
- * Post-myocardial infarction (reduces mortality)
Time
- * Timing: Once daily (extended-release formulation)
- * Onset: 1-2 hours
- * Peak: 6-12 hours (due to extended-release)
- * Duration: 24 hours
