Betaloc 25 mg

Description

Indications:

Betaloc is indicated for the treatment of various cardiovascular conditions including:

• Hypertension (High Blood Pressure): Helps in reducing elevated blood pressure.
• Angina Pectoris (Chest Pain): Manages and alleviates chest pain associated with angina.
• Cardiac Arrhythmias: Especially effective for managing supraventricular tachyarrhythmias.
• Adjunct in Hyperthyroidism: Betaloc can be used as an adjunct in the treatment of hyperthyroidism.
• Acute Myocardial Infarction (Heart Attack): Early use of Betaloc following a heart attack reduces infarct size and lowers the chances of life-threatening arrhythmias like ventricular fibrillation. It also aids in pain relief, potentially reducing the need for opiate-based painkillers. Additionally, Betaloc has been shown to decrease mortality in patients who have suffered an acute myocardial infarction.

Note: Always take Betaloc as directed by a registered healthcare professional.

Pharmacology:

Metoprolol, the active ingredient in Betaloc, is a selective beta1-blocker that works by reducing the effects of catecholamines—hormones released during physical or emotional stress. This action helps in lowering heart rate, cardiac output, blood pressure, and the heart’s contractility. Unlike non-selective beta-blockers, Metoprolol has less impact on insulin release and carbohydrate metabolism, making it a preferred choice for patients with diabetes. It also interferes less with the body’s cardiovascular response to hypoglycemia.

Dosage and Administration:

• Film-Coated Tablets:

  • Hypertension: The typical daily dose ranges from 100 mg to 400 mg, which can be administered in one or two doses. The starting dose is generally 100 mg per day (2 Metoprolol-50 tablets), with increases of 100 mg per week as needed. If optimal control isn’t achieved with a single daily dose, a twice-daily regimen may be considered.
  • Angina: Usually 50 mg (one tablet) to 100 mg (two tablets), taken 2 to 3 times a day.
  • Cardiac Arrhythmias: Starting dose of 50 mg (one tablet) twice or three times a day. Doses can be increased up to 300 mg/day in divided doses, depending on the condition.
  • Hyperthyroidism: Typically, 50 mg (one tablet), four times a day. The dose can be reduced once the euthyroid state is achieved.
  • Myocardial Infarction: Begin 15 minutes after the last injection with 50 mg every 6 hours for 48 hours. Maintenance dose is usually 200 mg daily in divided doses.

• Extended-Release Tablets:

  • Hypertension: Start with 25 mg to 100 mg daily, with or without a diuretic.
  • Angina Pectoris: Typically 100 mg daily, but this should be adjusted to meet individual patient needs.
  • Heart Failure: Begin with 25 mg daily for 2 weeks (for NYHA class II heart failure), or 12.5 mg daily for more severe heart failure. Dose may be increased gradually based on patient response.

• Intravenous Injection:

  • Arrhythmias: Administer up to 5 mg by intravenous injection, at a rate of 1-2 mg/min, and repeat after 5 minutes if necessary, for a total of 10-15 mg.
  • In Surgery: Administer 2-4 mg intravenously during induction to manage arrhythmias during anesthesia. Doses can be repeated up to a maximum of 10 mg.
  • Myocardial Infarction: Initiate intravenous therapy with 5 mg every 2 minutes for a total dose of 15 mg, followed by 50 mg orally every 6 hours for 48 hours.

Always follow the dosing instructions provided by your doctor.

Drug Interactions:

• Catecholamine-depleting drugs (e.g., Reserpine, MAO inhibitors) may enhance the effects of beta-blockers like Betaloc.
• Drugs inhibiting CYP2D6, such as quinidine, fluoxetine, paroxetine, and propafenone, can increase Betaloc concentration, potentially decreasing its selectivity for the heart.
• Co-administration with digitalis glycosides or other beta-blockers may heighten the risk of bradycardia (slow heart rate).
• Clonidine withdrawal can trigger rebound hypertension when used with beta-blockers.

Contraindications:

• AV block (heart block)
• Uncontrolled heart failure
• Severe bradycardia (slow heart rate)
• Sick-sinus syndrome or cardiogenic shock
• Severe peripheral arterial disease
• Hypersensitivity to Metoprolol or other beta-blockers

Metoprolol is also contraindicated in patients with significant bradycardia, first-degree heart block, systolic hypotension (<100 mmHg), or severe heart failure after a myocardial infarction.

Side Effects:

Some potential side effects include:

• Fatigue, dizziness, headache, and depression.
• Gastrointestinal discomfort like nausea, diarrhea, and gastric pain.
• Cardiovascular effects such as slow heart rate (bradycardia), shortness of breath, and mental confusion.
• Skin reactions including itching or rash.
• Rarely, blurry vision, tinnitus, and reduced libido may occur.

Consult your healthcare provider if any of these side effects are severe or persistent.

Pregnancy and Lactation:

• Pregnancy Category C: There are no well-controlled studies in pregnant women. Betaloc should only be used if the potential benefit outweighs the risks.
• Betaloc is excreted in breast milk in minimal amounts, so caution should be exercised when administering Metoprolol to nursing mothers.

Precautions and Warnings:

• Bronchospastic Diseases: Betaloc should be used with caution in patients with asthma or other respiratory issues, as beta1-selective blockers can still impact the lungs.
• Major Surgery: The necessity of discontinuing beta-blockers before major surgery is debated. However, due to the reduced ability of the heart to respond to stimuli, there may be an increased risk during anesthesia.
• Diabetes and Hypoglycemia: Beta-blockers like Metoprolol can mask signs of low blood sugar, such as tachycardia, while still allowing other symptoms to appear.
• Peripheral Vascular Disease: Betaloc may worsen symptoms of arterial insufficiency in patients with vascular issues.
• Calcium Channel Blockers: Caution is advised when taking Betaloc in combination with calcium channel blockers due to their combined effects on heart function.

Use in Special Populations:

• Hepatic Impairment: Caution is needed in patients with liver disease, as Metoprolol is metabolized in the liver.
• Pediatric Use: Betaloc is not recommended for children under 6 years. For children aged 6 to 16, side effects are similar to those in adults.
• Geriatric Use: Older adults may experience similar efficacy and side effect profiles compared to younger patients.

Overdose Effects:

An overdose of Betaloc may cause severe symptoms such as:

• Hypotension, bradycardia, heart failure, cardiogenic shock, and cardiac arrest.
• Bronchospasm, coma, nausea, and hypoglycemia may also occur.

Treatment involves close monitoring and may include activated charcoal (if recent ingestion), intravenous fluids, and medications like glucagon or sympathomimetic agents.

Storage Conditions:

Store Betaloc in a cool, dry place, away from direct light.