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AI-Generated response:

What are the contraindications for metoprolol?

Answer generated on June 4, 2024

The AI-generated responses are for illustration purposes only and should not be used for medical purposes.

Metoprolol is contraindicated in patients with severe bradycardia, sick sinus syndrome without a pacemaker, second or third-degree AV block, cardiogenic shock, decompensated heart failure, and known hypersensitivity to metoprolol or its excipients.[1-4]

  • Severe bradycardia and sick sinus syndrome are contraindications unless a functioning pacemaker is present due to the risk of exacerbating these conditions.[1-4]

  • Second or third-degree AV block is a contraindication without a functioning pacemaker, as metoprolol can further impair AV conduction.[1-4]

  • Cardiogenic shock and decompensated heart failure are contraindications due to the negative inotropic effects of metoprolol, which can worsen these conditions.[1-4]

  • Hypersensitivity to metoprolol or any of its excipients is a contraindication, as it can lead to severe allergic reactions.[1][3-4]

  • Patients with a systolic blood pressure less than 100 mmHg should not use metoprolol due to the risk of further lowering blood pressure.[1][3]

Additional info

Metoprolol, a beta-blocker, is primarily used to manage hypertension, angina, and in some cases, heart failure. However, its use must be carefully considered in patients with certain cardiac conditions due to its potential to exacerbate these conditions. The drug works by blocking beta-adrenergic receptors in the heart, leading to decreased heart rate, myocardial contractility, and conduction velocity through the AV node. This mechanism, while beneficial under specific circumstances, poses risks in the presence of conditions like severe bradycardia or AV block, where maintaining adequate heart rate and conduction is crucial. Additionally, in the setting of cardiogenic shock or severe heart failure, the negative inotropic effects (decreased force of contraction) of metoprolol could be detrimental, potentially leading to worsening of heart failure symptoms or even precipitating shock. Therefore, it is crucial to evaluate each patient's cardiac function and overall health status before initiating therapy with metoprolol to avoid these severe contraindications.

References

Reference 1

1.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 4, 2024.

Contraindications And Precautions Metoprolol is contraindicated in patients with severe bradycardia , sick sinus syndrome , second- or third-degree AV block , cardiogenic shock , decompensated heart failure , and sick sinus syndrome unless a functioning pacemaker is present. The negative inotropic effects produced by beta-blockers can exacerbate heart failure; although use should be avoided in decompensated heart failure, metoprolol can be used with caution in stable patients. If symptoms occur, increase diuretics. It may be necessary to dose reduce or temporarily discontinue metoprolol. Patients with first-degree AV block, sinus node dysfunction, conduction disorders (including Wolff-Parkinson-White) or on concomitant medications that cause bradycardia, may be at increased risk of bradycardia, including sinus pause, heart block, and cardiac arrest. Monitor heart rate and rhythm and dose reduce or discontinue if severe bradycardia develops.

Contraindications And Precautions 1. AV block 2. beta-blocker hypersensitivity 3. bradycardia 4. cardiogenic shock 5. hypotension 6. sick sinus syndrome

Contraindications And Precautions Metoprolol is contraindicated in patients with hypersensitivity to metoprolol or any of the product excipients or those with known beta-blocker hypersensitivity. Cross-sensitivity between beta-blockers may occur. Use metoprolol with caution in patients with a history of anaphylactic reactions. These patients may have a more severe reaction if rechallenge to the allergen occurs while receiving a beta-blocker. The patient may also be unresponsive to the usual doses of epinephrine used to treat the reaction.

Contraindications 4 CONTRAINDICATIONS Hypersensitivity to Metoprolol (metoprolol tartrate) injection and related derivatives, or to any of the excipients; hypersensitivity to other beta blockers (cross sensitivity between beta blockers can occur). Metoprolol (metoprolol tartrate) injection is contraindicated in patients with a heart rate <45 beats/min; second- and third-degree heart block (unless a functioning pacemaker is present); significant first-degree heart block (P-R interval ≥0.24 sec); systolic blood pressure <100 mmHg; or decompensated cardiac failure. • Known hypersensitivity to product components. ( 4 ) • Severe bradycardia, greater than first degree heart block, or sick sinus syndrome without a pacemaker. ( 4 ) • Cardiogenic shock or decompensated heart failure. ( 4 )

Reference 2

2.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 1, 2024.

Contraindications And Precautions Because beta-blockers depress conduction through the AV node, metoprolol is contraindicated in patients with severe bradycardia, sick sinus syndrome, or advanced AV block (second or third-degree AV block) unless a functioning pacemaker is present. In general, metoprolol should be avoided in patients with acute pulmonary edema and is contraindicated in patients with cardiogenic shock or decompensated heart failure due to systolic dysfunction. The risk for bradycardia may be increased in patients with first-degree AV block, sinus node dysfunction, or conduction disorders (including Wolff-Parkinson-White syndrome). Although some beta-blockers including metoprolol have been used as adjunctive therapy in patients with compensated congestive heart failure, beta-blockers should be used cautiously in this patient population; worsening cardiac failure may occur during up-titration of beta-blockers. In the setting of congestive heart failure due to left ventricular dysfunction, sympathetic stimulation is a vital component supporting circulatory function. The negative inotropic effects of beta-blockade may result in further depression of myocardial contractility and precipitate decompensated heart failure in these patients; however, stable patients with heart failure benefit from beta-blocker therapy. Several low dose beta-blockers (e.g., bisoprolol, carvedilol, metoprolol) have shown benefit in the treatment of hypertrophic cardiomyopathy, dilated cardiomyopathy, or Class II-IV heart failure. If metoprolol; hydrochlorothiazide is used in a patient with coexisting heart failure, low initial doses should be used and increases in dosage should be made gradually.

Reference 3

3.

Food and Drug Administration (DailyMed).

Publish date: October 4, 2020.

Contraindications 4 CONTRAINDICATIONS Hypersensitivity to metoprolol and related derivatives, or to any of the excipients; hypersensitivity to other beta blockers (cross sensitivity between beta blockers can occur). Metoprolol is contraindicated in patients with a heart rate <45 beats/min; second-and third-degree heart block (unless a functioning pacemaker is present); significant first-degree heart block (P-R interval ≥0.24 sec); systolic blood pressure <100 mmHg; or decompensated cardiac failure. • Known hypersensitivity to product components. ( 4 ) • Severe bradycardia, greater than first degree heart block, or sick sinus syndrome without a pacemaker. ( 4 ) • Cardiogenic shock or decompensated heart failure. ( 4 )

Reference 4

4.

Food and Drug Administration (DailyMed).

Publish date: December 5, 2020.

Contraindications 4 CONTRAINDICATIONS Metoprolol succinate extended-release tablet is contraindicated in severe bradycardia, second or third degree heart block, cardiogenic shock, decompensated cardiac failure, sick sinus syndrome (unless a permanent pacemaker is in place), and in patients who are hypersensitive to any component of this product. • Known hypersensitivity to product components. (4) • Severe bradycardia. (4) • Heart block greater than first degree. (4) • Cardiogenic shock. (4) • Decompensated cardiac failure. (4) • Sick sinus syndrome without a pacemaker. (4)

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