Item nanme:Metoprolol succinate sustained release tablets Item character:This product is white
Indication: hypertension. angina pectoris. Stable chronic heart failure with left ventricular systolic dysfunction
Item specifications:47.5mg*7tab/box
Usage and dosage:Oral, once a day, preferably in the morning, can be taken apart, but can not chew or crush, should be taken with at least half a cup of liquid delivery. At the same time, food intake did not affect its bioavailability.
The dosage should be individualized to avoid bradycardia.
The following are effective medication guidelines:
hypertension
5-95 mg once a day. Patients who do not respond to 95 Mg can use other antihypertensive drugs, preferably diuretics and dihydropyridine calcium antagonists, or increase the dose.
angina pectoris
95-190 mg once a day. Nitrates can be used in combination or increased dose when necessary.
In stable heart failure, combination therapy with angiotensin-converting enzyme inhibitors, diuretics, and perhaps digitalis.
The patient had stable chronic heart failure, had no acute heart failure at least in the last 6 weeks, and had not changed the basic treatment at least in the last 2 weeks.
use β The treatment of heart failure with receptor blockers sometimes causes temporary deterioration of symptoms. In some cases, treatment can be continued or reduced, while in others, treatment may need to be discontinued. For patients with severe heart failure (NYHA IV), it is up to doctors who are especially trained in heart failure treatment to decide whether to start metoprolol succinate sustained-release tablets.
Dosage for patients with stable heart failure of cardiac function class II
In the first two weeks of treatment, the recommended starting dose is 23.75 mg once a day. After two weeks, the dose can be increased to 47.5 mg once a day. After that, the dose can be doubled every two weeks. The target dosage of long-term treatment is 190 mg once a day.
Dosage in patients with stable heart failure of cardiac function class III-IV
The recommended starting dosage is 11.875 Mg (half of 23.75 mg tablets), once a day. The dose should be individualized, and the patients should be closely observed in the process of increasing the dose, because the symptoms of heart failure may worsen in some patients. After 1-2 weeks, the dose can be increased to 23.75 mg once a day. After another 2 weeks, the dose can be increased to 47.5 mg once a day. For those who can tolerate higher doses, the dose can be doubled every two weeks, up to 190 mg once a day.
For patients with hypotension and / or bradycardia, it may be necessary to reduce the dosage of the drug or reduce the dosage of this product. The initial hypotension does not necessarily mean that the patient can not tolerate the dosage of this product in the long-term treatment, but the dosage can only be increased after the condition is stable. Other considerations include the possible need for increased monitoring of renal function.
Renal dysfunction
Renal function had no significant effect on the clearance rate, so patients with renal dysfunction did not need to adjust the dose.
Liver function damage
Generally, the dosage of metoprolol succinate in patients with liver cirrhosis is the same as that in patients with normal liver function. Dose reduction should be considered only when liver function is severely impaired (e.g. in patients undergoing bypass surgery).
Adverse reactions Occasionally, joint pain, hepatitis, muscle spasm, dry mouth, conjunctivitis like symptoms, rhinitis and attention deficit, and gangrene in patients with vascular disease have been reported.
Taboo: Cardiogenic shock. Sick sinus syndrome. 2. Degree III atrioventricular block. Patients with unstable, decompensated heart failure (pulmonary edema, hypoperfusion, or hypotension) are treated continuously or intermittently β Patients with positive inotropic therapy with receptor agonists. Symptomatic bradycardia or hypotension. This product should not be given to patients with suspected acute myocardial infarction whose heart rate < 45 beats > 0.24 seconds or systolic blood pressure < 100 mmHg. In patients with heart failure indications, if their supine systolic blood pressure is lower than 100 mmHg in multiple measurements, the suitability of this product should be re evaluated before treatment. Patients with severe peripheral vascular disease at risk of gangrene. For any ingredient or other β Allergic to receptor blockers.
Matters needing attention: Metoprolol may aggravate the symptoms of peripheral vascular circulatory disorders such as intermittent claudication. It is necessary to be cautious in the treatment of severe renal damage, various emergencies with metabolic acidosis and the combination of digitalis.
Patients with variant angina pectoris (Prinzmetal's) use β Receptor blockers may be due to α The frequency and degree of angina pectoris attack are aggravated by receptor-mediated coronary vasoconstriction. Therefore, it is not selective β- Receptor blockers cannot be used in such patients. selectivity β 1 receptor blockers should also be used with caution.
For patients with bronchial asthma or other chronic obstructive pulmonary disease, adequate bronchodilation should be given at the same time, β The dose of 2 receptor agonist may need to be increased.
The effect of metoprolol treatment on glucose metabolism or cover up the risk of hypoglycemia is lower than that of non selective treatment β Receptor blockers.
In rare cases, the original moderate atrioventricular conduction abnormalities worsen (most likely leading to atrioventricular block).
β The treatment of receptor blockers may hinder the treatment of allergic reactions, and the conventional dose of epinephrine does not always achieve the desired effect. If metoprolol succinate is used in patients with pheochromocytoma, it should be combined with metoprolol succinate α Receptor blockers.
In patients with severe symptomatic stable heart failure (NYHA IV), there are limited clinical controlled studies on the efficacy / safety of this product. Therefore, the treatment of this kind of patients can only be started by experienced and well-trained doctors.
Clinical studies of heart failure usually exclude patients with symptomatic heart failure accompanied by acute myocardial infarction and unstable angina pectoris. Therefore, there is still a lack of data on the efficacy / safety of this drug in the treatment of acute myocardial infarction with heart failure. It is forbidden to use in patients with unstable and decompensated heart failure.
Sudden withdrawal β Receptor blockers are dangerous, especially in high-risk patients, which may worsen chronic heart failure and increase the risk of myocardial infarction and sudden death. Therefore, the drug should be withdrawn gradually as far as possible. The whole withdrawal process should take at least two weeks, and the dosage should be halved until it is finally reduced to half a tablet of 23.75 mg. The last dosage should be given at least four days before withdrawal. If symptoms appear, it is recommended to withdraw the drug more slowly. If the drug is to be stopped before surgery, it must be stopped at least 48 hours, unless there are special circumstances, such as thyrotoxicosis and pheochromocytoma.
Athletes should use it with caution.
Influence on driving car and operating machinery
Dizziness and fatigue may occur during the treatment with this product, so it should be used with caution when attention is needed, such as driving and operating machinery.
Medication for pregnant and lactating women: gestation
β Receptor blockers can cause fetal or neonatal bradycardia. Therefore, in the last 3 months of pregnancy and before and after delivery, the use of β These risks should be taken into account when using receptor blockers.
Lactating women
Metoprolol can enter the milk, but it is unlikely to endanger the baby at the therapeutic dose.
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