Tablets: white with a gray shade or white color, with a facet on both parties and dividing risky on one party, have the round flat form, on 100 mg (on 10 or 30 pieces in a blister strip packaging, in a cardboard pack from 1 to 10 packagings; on 10, 20, 30, 40, 50, 60, 70, 80, 90 or 100 pieces in polymeric containers, in a cardboard pack 1 container; on 10 pieces in blisters, in a cardboard pack of 3 or 5 blisters), on 50 mg (in blister strip packagings: on 10 pieces, in a cardboard pack of 1, 2, 3, 5 or 10 packagings, on 15 or 20 pieces, in a cardboard pack 2 packagings, on 30 pieces, in a cardboard pack 1 or 2 packagings; in polymeric containers on 20, 30, 40 or 50 pieces, in a cardboard pack 1 container), on 25 mg (in blister strip packagings: on 10 pieces, in a cardboard pack 1 packaging, on 30 pieces, in a cardboard pack 1 or 2 packagings; in polymeric containers on 20, 40 or 50 pieces, in a cardboard pack 1 container);
Tablets, film coated: a round biconvex form, with dividing risky on one of the parties, can be pinkish or from white till yellow-white color, on 50 mg (on 14 pieces in blisters, in a cardboard pack 2 or 4 blisters), on 100 mg (on 10 pieces in blisters, in a cardboard pack 3 blisters).

Active ingredient – a metoprolola tartrate:

1 tablet – 25 mg, 50 mg or 100 mg;
1 tablet in a film cover – 50 mg (pink color) or 100 mg.

Auxiliary components:

Tablets: cellulose microcrystallic, lactoses monohydrate, potato starch, povidone, carboxymethylstarch of sodium, magnesium stearate;
Tablets, film coated: sodium carboxymethylstarch (type A), cellulose microcrystallic, silicon dioxide colloid anhydrous, magnesium stearate.

In addition as a part of a cover: polysorbate 80, gipromelloz, titanium dioxide (E171), talc; at a pink cover there is a dye crimson (Ponso 4R).

Indications to use

Coronary heart disease: a myocardial infarction (as a part of complex therapy of secondary prevention), prevention of attacks of stenocardia;
Monotherapy or as a part of the combined treatment (with other anti-hypertensive means) arterial hypertension, including hyperkinetic type, tachycardia;
Hyperthyroidism (as a part of complex therapy);
Disturbances of a heart rhythm, including ventricular premature ventricular contraction, supraventricular tachycardia;
Prevention of attacks of migraine.

Contraindications

Cardiogenic shock;
Sinuatrial (SA) blockade;
Atrioventricular (AV) blockade of the II-III degree;
The expressed bradycardia;
Sick sinus syndrome;
Printsmetal's stenocardia;
Heart failure in a decompensation stage;
Arterial hypotension (for secondary prevention of a myocardial infarction – with a systolic arterial pressure (AP) below 100 mm of a mercury column and the heart rate (HR) less than 45 beats per minute);
Simultaneous therapy by monoamine oxidase inhibitors (MAO) or verapamil;
Age up to 18 years;
Breastfeeding period;
Hypersensitivity to components of drug or other beta adrenoblockers.

With care Metoprolol sick with AV blockade of the I degree, a metabolic acidosis, a diabetes mellitus, a chronic obstructive pulmonary disease (chronic obstructive bronchitis, emphysema of lungs), bronchial asthma, obliterating diseases of peripheral vessels (Reynaud's syndrome, the alternating lameness), a myasthenia, a chronic renal and/or liver failure, a pheochromocytoma, a thyrotoxicosis, psoriasis, a depression (including the anamnesis), at advanced age and during pregnancy is recommended to appoint.

Route of administration and dosage

Pill is taken entirely inside, in time or right after food, washing down with enough liquid.

The mode of dosing is appointed by the doctor on the basis of clinical indications.

The recommended daily dosing:

Secondary prevention of a myocardial infarction: 200 mg in 2 receptions (in the morning and in the evening);
Arterial hypertension: an initial dose of 50-100 mg in 1 or 2 receptions. For achievement of therapeutic effect gradual increase in a dose up to 100-200 mg and/or co-administration of other anti-hypertensive drugs is shown. The daily dose should not exceed 200 mg;
Tachycardia against the background of functional disturbances of cordial activity: 100 mg in 2 receptions;
Stenocardia, arrhythmias, prevention of attacks of migraine: 100-200 mg in 2 receptions.

Dose adjustment is not required at renal failures, need of carrying out a hemodialysis, treatment of patients of advanced age.

Patients with functional disorders of a liver need to make Metoprolol's appointment according to their clinical state.

Side effects

Cardiovascular system: heartbeat, sinus bradycardia, decrease in the ABP, orthostatic hypotension (dizziness, loss of consciousness); seldom – decrease in contractility of a myocardium, arrhythmia, temporary strengthening of symptoms of chronic heart failure (short wind, hypostases, including stop and/or the lower part of shins), manifestation of a vasomotor spasm (a cold snap of the lower extremities, strengthening of disturbance of peripheric circulation, Reynaud's syndrome), a cardialgia, disturbance of conductivity of a myocardium;
Nervous system: weakness, increased fatigue, delay of speed of psychomotor reactions, headache; seldom – concern, muscular weakness, paresthesias in extremities (against the background of the alternating lameness and Reynaud's syndrome), drowsiness, a depression, sleeplessness, decrease in attention, confusion of consciousness, dreadful dreams, short-term disturbance of memory;
Alimentary system: dryness in a mouth, nausea, vomiting, taste change, an abdominal pain, diarrhea or a lock, functional disorder of a liver;
Sense bodys: seldom – a sonitus, reduction of secretion of the lacrimal liquid, decrease in sight, conjunctivitis, dryness and morbidity of eyes;
Integument: itch, rash, urticaria, sweating strengthening, exacerbation of psoriasis, psoriazopodobny reactions, dieback, hyperemia, photodermatosis, reversible alopecia;
Endocrine system: a hypoglycemia (at an insulin-dependent diabetes mellitus); seldom – a hypothyroidism, a hyperglycemia (at a diabetes mellitus);
Respiratory system: a nose congestion, an asthma, difficulty of an exhalation (a bronchospasm at high doses);
Laboratory indicators: seldom – an agranulocytosis, thrombocytopenia (unusual hemorrhages and bleedings), a leukopenia, increase in activity of hepatic transaminases; very seldom – a hyperbilirubinemia;
Influence on a fruit: pre-natal bradycardia, a growth inhibition, a hypoglycemia is possible;
Others: dorsodynia or joints; in isolated cases – insignificant increase in body weight, decrease in a potentiality and libido.

The probability and extent of manifestation of side effects depend on individual sensitivity of the patient, as a rule, they have insignificant and passing character.

Special instructions

Treatment by beta adrenoblockers needs to be accompanied with regular control of ChSS and the ABP, at patients with a diabetes mellitus – the level of content of glucose in blood (the dose of hypoglycemic means or insulin is selected at the same time individually).

At purpose of drug of the patient it is necessary to train in a technique of independent calculation of ChSS and to instruct about need of the immediate address to the doctor at ChSS lower than 50 beats per minute.

Metoprolol's cardioselectivity in a dose more than 200 mg a day decreases.

Use of a metoprolol at treatment of heart failure should be begun only in compensation stage.

At patients with the burdened allergological anamnesis strengthening of expressiveness and lack of effect of usual doses of Epinephrinum (adrenaline) at hypersensitivity reactions is possible.

Drug can strengthen symptoms of pathology of peripheric arterial circulation.

Drug withdrawal should be carried out by gradual reduction of a dose within 10 days. The sharp termination of treatment can cause a withdrawal (increase in the ABP, strengthening of attacks of stenocardia) in the patient.

The individual dose of drug at an angina of exertion has to provide to sick ChSS at rest 55-60 beats per minute, at loading – not higher than 110.

When using contact lenses it is necessary to consider decrease in production of the lacrimal liquid against the background of reception of beta adrenoblockers.

Drug can mask tachycardia and other symptoms of a hyperthyroidism.

At patients with a diabetes mellitus Metoprolol's reception can hide the tachycardia caused by a hypoglycemia. At the glycemia caused by insulin drug practically does not influence process of recovery of concentration of glucose in blood to normal level.

At bronchial asthma use of drug is shown with co-administration _{of beta2-adrenostimulyator}, at a pheochromocytoma – afa-adrenoblockers.

Before carrying out surgery it is necessary to report to the anesthesiologist about Metoprolol's reception that the general anesthesia was carried out with the minimum negative inotropic effect without drug withdrawal.

It is necessary to consider that at the simultaneous use of Reserpinum and other drugs reducing stocks of the catecholamines and strengthening effect of beta adrenoblockers, perhaps excessive lowering of arterial pressure and development of bradycardia.

At patients of advanced age it is necessary to control function of a liver, and at strong decrease in the ABP, AV blockade, emergence of a bronchospasm, ventricular arrhythmias, the accruing bradycardia, heavy abnormal liver functions dose adjustment or drug withdrawal is required.

At a heavy renal failure regular control of function of kidneys is required.

It is necessary to control a condition of patients with depressive frustration, at emergence of signs of development of a depression treatment should be stopped.

Metoprolol's use for children is not recommended.

At the beginning of drug use by the patient it is necessary to be careful or refuse control of vehicles and mechanisms as during this period they can test fatigue and dizziness. During treatment safety of a dose is defined individually.

Medicinal interaction

It is impossible to appoint Metoprolol along with MAO inhibitors because of strengthening of hypotensive effect, it is necessary to observe a break between administration of drugs not less than 14 days.

Intravenous (in/in) administration of verapamil against the background of reception of a metoprolol can cause a cardiac standstill.

At simultaneous use with Metoprolol:

Nifedipine, ethanol – considerably reduce the ABP;
Derivatives of hydrocarbons for an inhalation anesthesia – increase probability of development of arterial hypotension against the background of oppression of function of a myocardium;
Theophylline, beta адреностимуляторы, cocaine, estrogen, indometacin and other non-steroidal anti-inflammatory drugs – weaken hypotensive action;
Neuroleptics, tetra-and tricyclic antidepressants, hypnotic drugs and sedatives and ethanol – strengthen oppression of a nervous system;
Ergot alkaloids – increase risk of frustration of peripheric circulation;
Antihypertensives, diuretics, blockers of slow calcium channels or nitroglycerine – exponentiate sharp decrease in the ABP (especially Prazozinum);
Diltiazem, verapamil, antiarrhytmic means (Amiodaronum), Methyldopum, Reserpinum, a clonidine, means for the general anesthesia, гуанфацин, cardiac glycosides – lead to strong decrease in ChSS and oppression of AV conductivity;
Rifampicin, barbiturates (inductors of microsomal enzymes of a liver) – accelerate metabolism of a metoprolol, reducing its concentration in a blood plasma and reducing clinical effect;
Hypoglycemic means for intake and insulin – reduce the efficiency, the risk of development of a hypoglycemia increases;
Oral contraceptives, Cimetidinum, fenotiazin (inhibitors) – promote increase in level of concentration of a metoprolol in a blood plasma.

Metoprolol reduces clearance of xanthine (except Diphyllinum), in particular at patients with the increased clearance of theophylline against the background of smoking, increases the level of concentration of lidocaine in a blood plasma, extends anticoagulating effect of coumarins, prolongs and strengthens effect of the anti-depolarizing muscle relaxants.

The combination to the extracts of allergens applied to skin tests and allergens for an immunotherapy increases probability of development of system allergic reactions (including an anaphylaxis). At a concomitant use with X-ray contrast iodinated means for in/in introductions the risk of anaphylactic reactions increases.

At simultaneous use of a metoprolol and clonidine, in need of the treatment termination the clonidine should be cancelled only in several days after a metoprolol.