Betaloc 50 mg

Description

Indications:
Betaloc is primarily used for the management of conditions such as hypertension and angina pectoris. It is also effective in treating cardiac arrhythmias, particularly supraventricular tachyarrhythmias. As an adjunct therapy, Betaloc aids in hyperthyroidism management. In cases of acute myocardial infarction, early intervention with Betaloc has been shown to reduce infarct size and the occurrence of ventricular fibrillation. Additionally, it may provide pain relief, potentially reducing the need for opiate analgesics. Betaloc has been proven to decrease mortality in patients experiencing acute myocardial infarction.
Use as directed by a registered healthcare professional.

Pharmacology:
Metoprolol, the active ingredient in Betaloc, is a selective beta-1 adrenergic blocker. It works by reducing the impact of catecholamines—stress-induced hormones—on the heart, leading to a decrease in heart rate, blood pressure, and cardiac output. Unlike non-selective beta-blockers, Metoprolol has minimal interference with insulin release and carbohydrate metabolism. It also poses less risk of interfering with the body’s response to hypoglycemia compared to non-selective beta-blockers.

Dosage & Administration:
Film-coated Tablets:

• Hypertension: Start with 100 mg per day, which may be increased by 100 mg weekly to a maximum of 400 mg per day. If a single daily dose does not provide full control, a twice-daily regimen may be adopted. Combination therapy with a diuretic or other antihypertensive agents may be beneficial.
• Angina: Typically, 50 mg to 100 mg should be administered 2 to 3 times a day.
• Cardiac Arrhythmias: Begin with 50 mg twice or three times daily, with a maximum dose of 300 mg daily in divided doses.
• Hyperthyroidism: 50 mg, taken four times a day. The dosage may be adjusted as the euthyroid state is achieved.
• Myocardial Infarction: Start 15 minutes after the last injection with 50 mg every 6 hours for 48 hours. Maintenance therapy usually involves a 200 mg daily dose.
• Elderly Patients: No special dosage adjustments are required for otherwise healthy elderly patients. However, those with significant hepatic dysfunction may require dosage modifications.

Extended-release Tablets:

• Hypertension: Begin with 25 to 100 mg once daily.
• Angina Pectoris: Typically, 100 mg once daily, with individual dosage adjustments as necessary.
• Heart Failure: Starting at 25 mg daily for patients with NYHA class II heart failure, and 12.5 mg daily for more severe cases. Dosage can be increased weekly until optimal blood pressure control is achieved.

IV Injection:

• Arrhythmias: Administer up to 5 mg via IV injection at a rate of 1-2 mg/min, repeating every 5 minutes if needed, to a total of 10-15 mg.
• Surgery: For controlling arrhythmias during anesthesia, administer 2-4 mg slowly, up to a maximum of 10 mg.
• Myocardial Infarction: For early intervention, administer 5 mg every 2 minutes for a maximum of 15 mg, followed by 50 mg orally every 6 hours for 48 hours. Maintenance dosage is typically 200 mg daily.

Use only as prescribed by a registered healthcare professional.

Interactions:
Metoprolol’s effects can be intensified when combined with catecholamine-depleting drugs (e.g., reserpine, MAO inhibitors). Drugs like quinidine, fluoxetine, paroxetine, and propafenone, which inhibit CYP2D6, may increase Betaloc concentration and diminish its cardioselectivity. Concurrent use with digitalis glycosides may enhance the risk of bradycardia. Additionally, withdrawal from clonidine can exacerbate rebound hypertension when combined with beta-blockers.

Contraindications:
Betaloc is contraindicated in patients with conditions such as AV block, uncontrolled heart failure, severe bradycardia, sick-sinus syndrome, cardiogenic shock, or severe peripheral arterial disease. It should also be avoided in individuals with known hypersensitivity to Metoprolol or other beta-blockers, particularly when myocardial infarction is complicated by significant bradycardia, first-degree heart block, systolic hypotension (<100 mmHg), or severe heart failure.

Side Effects:
Common side effects include fatigue, dizziness, headaches, depression, and gastrointestinal issues such as nausea, constipation, or flatulence. Other possible side effects include slow heart rate, shortness of breath, confusion, blurred vision, muscle pain, tinnitus, and decreased libido. More serious side effects may involve exacerbation of AV block and mental confusion.

Pregnancy & Lactation:
Pregnancy Category C. The safety of Betaloc during pregnancy has not been thoroughly studied, and it should only be used when the benefits clearly outweigh the risks. Betaloc is excreted in breast milk in small quantities, so caution is recommended when administering this medication to breastfeeding women.

Precautions & Warnings:

• Bronchospastic Diseases: Betaloc should be used cautiously in individuals with bronchospastic diseases.
• Major Surgery: Discontinuation of beta-blockers before surgery is controversial, as the heart may not respond optimally to adrenergic stimuli during anesthesia.
• Diabetes: Beta-blockers may mask tachycardia associated with hypoglycemia, although other symptoms like sweating and dizziness may not be significantly affected.
• Peripheral Vascular Disease: Beta-blockers may worsen symptoms of arterial insufficiency in patients with peripheral vascular disease.
• Calcium Channel Blockers: Care should be taken when Betaloc is used with calcium channel blockers due to potential inotropic and chronotropic effects.

Use in Special Populations:

• Hepatic Impairment: Caution is advised when using Betaloc in patients with liver dysfunction.
• Pediatric Use: Betaloc’s safety and efficacy in children under 6 years have not been established, although no significant differences were observed in patients aged 6 to 16 years compared to adults.
• Geriatric Use: No significant differences were noted in efficacy or adverse event rates between elderly and younger patients.

Overdose Effects:
Symptoms of overdose may include severe hypotension, sinus bradycardia, AV block, heart failure, cardiogenic shock, and bronchospasm. Immediate treatment involves close monitoring and the use of supportive measures like sympathomimetic agents, atropine, or inotropic agents. For overdoses, vomiting, gastric lavage, or activated charcoal may help prevent further absorption. In case of severe symptoms, glucagon (1-10 mg IV) can reverse excessive beta-blockade. Betaloc cannot be effectively removed by hemodialysis.

Storage Conditions:
Store in a cool, dry place, away from light. Keep out of the reach of children.