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Overview

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This medicine contains an important and useful components, as it consists of
Gokshura (Tribulus Terrestris), Punarnava (Boerhaavia Diffusa), Pashanabheda (Saxifraga Ligulata) , Saindhava, Suvarchika IH , Mustaka (Cyperus Rotundus) , Satavari (Asparagus Racemosus), Kulattha (Dolichos Biflorus) , Ushire (Vetiveria Zizanioideis available in the market in concentration

Name

Metoprolol Tartrate

Precaution

Before using **Metoprolol Tartrate**, patients must consult with their healthcare provider to evaluate any potential risks or conditions that may require special consideration. Key precautions include: - **Cardiac conditions**: Metoprolol is used for heart conditions, but caution is necessary for patients with **bradycardia** (slow heart rate), **heart block**, or **severe peripheral arterial disease**. The medication may worsen these conditions, so careful monitoring is essential. - **Asthma or COPD**: **Metoprolol Tartrate** is a **beta-blocker** and can exacerbate breathing problems in individuals with **asthma** or **chronic obstructive pulmonary disease (COPD)**. It is contraindicated in patients with severe asthma or bronchospasm, as it can cause bronchoconstriction. - **Diabetes**: Beta-blockers like Metoprolol may mask symptoms of **hypoglycemia** (low blood sugar) in diabetic patients, such as tremors and tachycardia. It should be used cautiously in diabetic individuals or those at risk for hypoglycemia. - **Renal and hepatic impairment**: Caution is required when prescribing Metoprolol in patients with impaired **renal function** or **liver disease**. Adjustments to dosage or close monitoring may be necessary in these cases. - **Pregnancy and breastfeeding**: Metoprolol is classified as **Category C** in pregnancy, meaning it should only be used if the benefits outweigh the potential risks. It is excreted in breast milk, so its use in lactating mothers should be carefully considered.

Indication

**Metoprolol Tartrate** is primarily used to treat a variety of cardiovascular conditions, including: - **Hypertension (High Blood Pressure)**: Metoprolol is commonly prescribed to manage high blood pressure, helping to reduce the risk of strokes, heart attacks, and kidney problems. - **Angina Pectoris**: It is used to treat **angina**, a type of chest pain caused by insufficient blood flow to the heart. - **Heart Failure**: Metoprolol is part of the treatment regimen for **congestive heart failure (CHF)**. It helps in improving heart function, reducing symptoms like fluid retention, and improving the patient’s quality of life. - **Post-Myocardial Infarction**: After a **heart attack**, Metoprolol helps prevent further cardiac events by reducing the workload on the heart. - **Arrhythmias**: Metoprolol is used to treat **abnormal heart rhythms** like **atrial fibrillation** or **ventricular arrhythmias**, helping to control heart rate and improve rhythm stability.

Contra indication

Metoprolol should not be used in the following situations: - **Severe bradycardia**: Metoprolol is contraindicated in patients with a resting heart rate of **less than 45-50 beats per minute**, as it may worsen **bradycardia**. - **Second or third-degree heart block**: Patients with significant **heart block** or **sick sinus syndrome** should not use Metoprolol unless they have a **pacemaker**. - **Hypotension**: Metoprolol should not be given to individuals with **severe hypotension** (low blood pressure), as it may exacerbate this condition. - **Asthma or COPD**: As a **beta-blocker**, Metoprolol may cause bronchospasm and worsen respiratory conditions like **severe asthma** or **chronic obstructive pulmonary disease**. - **Severe liver impairment**: Patients with **severe hepatic impairment** should avoid using Metoprolol, as the drug’s metabolism may be significantly altered.

Side Effect

Metoprolol is generally well-tolerated, but common side effects include: - **Fatigue**: Many patients experience tiredness or **fatigue**, especially when first starting the medication. - **Dizziness or lightheadedness**: Due to its blood pressure-lowering effects, Metoprolol can cause **dizziness**, particularly when standing up quickly (orthostatic hypotension). - **Bradycardia**: One of the more significant side effects is **bradycardia** (slow heart rate), which can be dangerous if it becomes severe. - **Cold extremities**: Patients may experience **cold hands** or **feet** due to the beta-blocking action on peripheral blood vessels. - **Shortness of breath**: This may occur, particularly in individuals with underlying **respiratory conditions** like **asthma** or **COPD**. - **Gastrointestinal disturbances**: **Nausea**, **vomiting**, or **diarrhea** can occur in some patients. - **Depression or mood changes**: Some individuals report **depression**, **mood swings**, or a general feeling of **low energy** while on Metoprolol. - **Erectile dysfunction**: Metoprolol may affect sexual function in both men and women, potentially leading to **erectile dysfunction** or reduced libido.

Pregnancy Category ID

3

Mode of Action

Metoprolol is a **selective beta-1 adrenergic antagonist (beta-blocker)**. Its mechanism of action involves: - **Blocking beta-1 receptors**: Metoprolol primarily targets **beta-1 adrenergic receptors** in the heart, inhibiting the effects of **norepinephrine** and **epinephrine** (adrenaline). This leads to a **decrease in heart rate**, **contractility**, and **cardiac output**, which lowers **blood pressure** and reduces the heart's oxygen demand. - **Reduction of renin release**: By blocking beta-1 receptors in the kidneys, Metoprolol reduces the release of **renin**, a hormone that contributes to high blood pressure by increasing **angiotensin II** levels and promoting fluid retention. - **Antiarrhythmic effects**: Metoprolol also helps stabilize the electrical activity of the heart, reducing the occurrence of **arrhythmias** and controlling abnormal heart rhythms.

Interaction

Metoprolol can interact with various medications, affecting either its efficacy or safety: - **Other antihypertensives**: Combining Metoprolol with other **antihypertensive medications** (e.g., **ACE inhibitors**, **diuretics**, **calcium channel blockers**) can lead to **severe hypotension**. Blood pressure should be closely monitored. - **Calcium channel blockers**: When used with **non-dihydropyridine calcium channel blockers** (like **verapamil** or **diltiazem**), there is an increased risk of **heart block**, **bradycardia**, and **hypotension**. These drugs should be used cautiously in combination. - **Diabetes medications**: Metoprolol may mask the symptoms of **hypoglycemia** (low blood sugar) in diabetic patients, so careful blood sugar monitoring is necessary. Additionally, it may reduce the effectiveness of **insulin** and other **oral antidiabetic medications**. - **Clonidine**: The combination of Metoprolol and **clonidine** may cause **severe hypertension** if clonidine is abruptly discontinued. If both drugs are used, clonidine should be tapered slowly. - **Digoxin**: When combined with **digoxin**, Metoprolol can increase the risk of **bradycardia** or **heart block**, requiring careful monitoring of heart rate. - **NSAIDs**: **Non-steroidal anti-inflammatory drugs (NSAIDs)** can reduce the blood pressure-lowering effect of Metoprolol by impairing kidney function and promoting sodium retention.

Pregnancy Category Note

Information not available

Adult Dose

The typical **adult dose** of **Metoprolol Tartrate** varies depending on the condition being treated: - **Hypertension**: The usual starting dose is **50 mg twice daily**, which may be adjusted based on response, typically up to **100 mg twice daily**. - **Angina**: The usual dose for **angina** is **50 mg twice daily**, with an increase if needed based on symptoms. - **Post-myocardial infarction**: **25-50 mg twice daily** may be started and adjusted based on clinical response. - **Heart failure**: The dose for heart failure starts lower, often at **12.5-25 mg once daily**, and is gradually increased.

Child Dose

The use of Metoprolol in children is generally reserved for specific pediatric conditions, such as pediatric hypertension or certain arrhythmias: - **Pediatric dose**: The dose is based on body weight, typically starting at **0.5-1 mg/kg/day**, divided into two doses. The maximum daily dose should not exceed **2 mg/kg**. - **Adjustment**: For children with other underlying health conditions, such as heart failure, adjustments in dosing are made based on clinical response and tolerability.

Renal Dose

Metoprolol dosage may need adjustment for patients with **renal impairment**, especially if they have severe renal dysfunction: - **Mild to moderate renal impairment (CrCl ≥30 mL/min)**: Regular dosing can be used, but careful monitoring is recommended. - **Severe renal impairment (CrCl <30 mL/min)**: Dose reduction or extended dosing intervals may be necessary, as Metoprolol is metabolized by the liver and eliminated by the kidneys.

Administration

Information not available