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Drugs Dictionary: Metoprolol Succinate

Metoprolol Succinate

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

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